Eduardo Olivarez, chief administrative officer for Hidalgo County’s health and human services department, says losing the Medicaid 1115 Waiver program would be “almost catastrophic” for the Rio Grande Valley.

Almost, but not quite.

“If we lost the 1115 Waiver it would be one or two syllables short of using the word catastrophic. I say that because you know what makes our community so wonderful? We are resilient. You know what, if such a catastrophic thing were to occur I feel so confident in our community, I feel so confident in our leadership, and most importantly, I feel so confident in the people of South Texas and their values and their traditions, we would figure something out,” Olivarez said.

“It wouldn’t be beautiful. It wouldn’t be perfect. It wouldn’t be fancy but we would continue because that is what we do. We rely on ourselves to deal with these difficult situations. Now, if we get outside help and outside support, we would welcome that with open arms. But, it would be nearly catastrophic. But it would not be the end of the world because I feel confident in our community. I do not want people to misunderstand what I am saying it is just that I have so much pride in our local residents. They have powerful emotion and passion.”

Olivarez said that thanks the 1115 Waiver program, 78 different healthcare projects are up and running in the Valley. “Over $602 million has gone to a multitude of programs. Our 12 primary healthcare providers, our eight hospitals, our two behavioral health centers, and two university health centers have all benefited. And soon, of course, UT-Rio Grande Valley, which is replacing our two university health centers, will benefit.”

Olivarez was speaking at the end of a public hearing held by Texas Health & Human Services Commission to gather input on the renewal of the state’s current 1115 Waiver. The Commission is holding such hearings across the state.

Peter Clark, communications director for Texans Care for Children, says Texas currently relies on $2 billion per year in federal funding through the Medicaid 1115 Waiver to partially cover the hospital bills of uninsured Texans.

“State leaders have put that hospital funding in jeopardy by thus far refusing to accept federal funding to connect uninsured low-wage workers with health insurance. Florida’s recent loss of federal funding suggests that Texas hospitals could lose half of the current $2 billion in federal funding if state leaders do not take action to reduce the uninsured rate,” Clark said, in a news advisory urging Valley media outlets to attend the HHSC hearing.

Clark pointed out that the expiring 1115 Waiver provides two federal funding streams to Texas, neither of which provides health insurance. “The DSRIP funding supports innovative local health projects and appears likely to be renewed. The Uncompensated Care (UC) funding partially covers the unpayable hospital bills that result from the high number of uninsured Texans. The temporary Waiver was designed to build the health care system’s capacity to serve a higher number of insured Texans under the Affordable Care Act. Texas communities need the Waiver’s DSRIP and UC funding to continue, ideally integrated with a plan to use Medicaid expansion funds to reduce the uninsured rate,” Clark said.

DSRIP stands for Delivery System Reform Incentive Payment.

Clark added that state leaders have jeopardized the $2 billion in annual UC funding for hospitals by thus far refusing to accept federal funding to connect low-wage uninsured workers with health insurance.

Sofia Hernandez, vice president for government affairs at Doctors Hospital at Renaissance, participated in the public hearing on Wednesday. Hernandez said the 1115 Waiver has been of great benefit to the Valley.

“We live in a community with a high number of uninsured. Hidalgo County has about 40 percent of its population uninsured, as compared to the state average of 24 percent. I think, given the need in the community and the critical need for services, I think that is a huge reason to be involved in what is happening as the state tries to renew this waiver. We need to ensure there is a continuation of some of these programs that have benefitted the community,” Hernandez said.

“We know that a lot of the DISRIP programs, for example, have been huge in increasing access to care and really bringing services to the community that were not here before. Certainly, that has been the goal of our hospital as we have brought in a maternal fetal medicine clinic. We have expanded services at the Hope Clinic. It was also a huge reason why we were able to fund the four GME residency programs that recently got accredited. Now, we have 26 residents at our hospital. So, I think a lot of why we were able to participate in graduate medical education and help support the (UTRGV) medical school is that we have programs and projects that are funded through the Waiver. The Waiver has helped us do that and by doing that you are improving access to care in the community.”

Hernandez said she is “optimistic” the state can negotiate an extension of the 1115 Waiver.

“If that were not to happen then I think the Legislature would step in. I think they have put safeguards in place for different legislation to ensure they continue. For example, the uncompensated care program which is critical, especially to communities such as the Valley that have large numbers of uninsured, but, also for the rest of the state that has such a high uninsured population. It is critical that individuals are able to participate and get the care that they need if they don’t have insurance. Eighty five percent of the state is under managed care so that is also critical for the state as it seeks to reduce the cost of care but also increase access.”

Hernandez added: “We certainly encourage the Commission to extend the waiver and to continue to support projects in the community that improve access and that are innovative. Once the state looks at outcomes and best practices we hope that they see our community, not just in terms of the high uninsured but one that drives innovation and is poised, because of the medical school, to invest in clinical research and best practices, things that advance the level of care in the community.”

Olivarez said the 1115 Waiver is a “huge part” of the development of the UTRGV medical school because it is helping to fund residency programs. “We have heard testimony from a multitude of people regarding how these programs have changed the lives of families. Access to healthcare, access to medical services through the residency programs, some of the partnering programs, psychiatric support. We had some very passionate testimony from family members whose relatives receive some psychiatric help. In the past those patients would be arrested and thrown in jail. Now they are being treated with respect and dignity and are being provided primary healthcare and support through psychiatry programs. That is the 1115 Waiver at work.”

Olivarez said extending the 1115 Waiver is vital in four core areas.

“I really feel the extension would enhance not only community health but it would also expand our health education and to a large degree our health literacy. It is empowering our community to take charge of their own healthcare. These programs are allowing that to be done. It would also promote economic development through healthcare. If you have a healthier community you have healthier children who get better test scores who pass high school, who decrease dropout rates, who get better jobs, who attract big industry, who create better paying programs, it all starts with solid healthcare in the community. So, from the economic level it is important,” Olivarez said.

“But, we are also creating a whole new level of health policy. We are the cauldron and an experiment for a bi-national, international region through the development of a new medical school that is not the standard medical school. It is a community-up based medical school, as Dr. Fernandez says. We are going to develop it from the colonia up to the president’s office. Not what the university tells us down. This new concept of health policy development and the vision that UTRGV has, this has never been done anywhere else. Much of this is because of the 1115 Waiver, because of partners, because of community leaders, because of the thousands of people in the Valley who are trying to better our community.”

Editor’s Note: The main image accompanying this story features Eduardo Olivarez, chief administrative officer for Hidalgo County’s health and human services department.