(a) The executive commissioner may seek a waiver under Section 1115 of the Social Security Act (42 U.S.C. § 1315) to the state Medicaid plan to allow the commission to more efficiently and effectively use federal money paid to this state under various programs to defray costs associated with providing uncompensated health care in this state by using that federal money, appropriated state money to the extent necessary, and any other money described by this section for purposes consistent with this subchapter.
(b) The executive commissioner may include the following federal money in the waiver:
(1) money provided under:
(A) the disproportionate share hospitals program;
(B) the upper payment limit supplemental payment program; or
(C) both;
(2) money provided by the federal government in lieu of some or all of the payments provided under one or both of the programs described by Subdivision (1);
(3) any combination of funds authorized to be pooled by Subdivisions (1) and (2); and
(4) any other money available for that purpose, including:
(A) federal money and money identified under Subsection (c);
(B) gifts, grants, or donations for that purpose;
(C) local funds received by this state through intergovernmental transfers; and
(D) if approved in the waiver, federal money obtained through the use of certified public expenditures.

(c) The commission shall seek to optimize federal funding by:
(1) identifying health care-related state and local funds and program expenditures that, before September 1, 2011, are not being matched with federal money; and
(2) exploring the feasibility of:
(A) certifying or otherwise using those funds and expenditures as state expenditures for which this state may receive federal matching money; and
(B) depositing federal matching money received as provided by Paragraph (A) with other federal money deposited as provided by § 526.0154, or substituting that federal matching money for federal money that otherwise would be received under the disproportionate share hospitals and upper payment limit supplemental payment programs as a match for local funds received by this state through intergovernmental transfers.
(d) The terms of a waiver approved under this section must:
(1) include safeguards to ensure that the total amount of federal money provided under the disproportionate share hospitals or upper payment limit supplemental payment program that is deposited as provided by § 526.0154 is, for a particular state fiscal year, at least equal to the greater of the annualized amount provided to this state under those supplemental payment programs during:
(A) state fiscal year 2011, excluding retroactive payment amounts provided during that state fiscal year; or
(B) the state fiscal years during which the waiver is in effect; and
(2) allow this state to develop a methodology for allocating money in the fund to:
(A) supplement Medicaid hospital reimbursements under a waiver that includes terms consistent with, or that produce revenues consistent with, disproportionate share hospital and upper payment limit principles;
(B) reduce the number of individuals in this state who do not have health benefits coverage; and
(C) maintain and enhance the community public health infrastructure provided by hospitals.
(e) In seeking a waiver under this section, the executive commissioner shall attempt to:
(1) obtain maximum flexibility in the use of the money in the fund for purposes consistent with this subchapter;
(2) include an annual adjustment to the aggregate caps under the upper payment limit supplemental payment program to account for inflation, population growth, and other appropriate demographic factors that affect the ability of residents of this state to obtain health benefits coverage;
(3) ensure, for the term of the waiver, that the aggregate caps under the upper payment limit supplemental payment program for each of the three classes of hospitals are not less than the aggregate caps applied during state fiscal year 2007; and
(4) to the extent allowed by federal law, including federal regulations, and federal waiver authority, preserve the federal supplemental payment program payments made to hospitals, the state match with respect to which is funded by intergovernmental transfers or certified public expenditures that are used to optimize Medicaid payments to safety net providers for uncompensated care, and preserve allocation methods for those payments, unless the need for the payments is revised through measures that reduce the Medicaid shortfall or uncompensated care costs.
(f) The executive commissioner shall seek broad-based stakeholder input in the development of the waiver under this section and shall provide information to stakeholders regarding the terms of the waiver for which the executive commissioner seeks federal approval.

Text of section effective on April 01, 2025