In 2011, the Texas Health & Human Services Commission (HHSC) received legislative approval to apply for and accept a five-year project as allowed under Section 1115 of the Social Security Act. The "Transformation & Quality Improvement Program" (aka 1115 Waiver) allowed Texas to expand existing Medicaid managed care programs and to establish two funding pools to assist providers with uncompensated care costs and promote health system transformation. The 1115 Waiver redirects the supplemental payments that historically existed under the Upper Payment Limit (UPL) program in order to improve care delivery systems and capacity, while emphasizing accountability and transparency and requiring demonstrated improvements. These two pools of funding are Uncompensated Care (UC) and Delivery System Reform Incentive Payment Program (DSRIP). In 2016, the 1115 Waiver was extended for a sixth year at level funding. In 2017, the 1115 Waiver was extended for 5 additional years.
The 1115 Waiver's benefits include the following: