Public Health Provider – Charity Care Program
Overview
The Texas Health and Human Services Commission (HHSC) Public Health Provider – Charity Care Program (PHP-CCP) allows qualified providers to receive reimbursement for the cost of delivering healthcare services, including behavioral health services, immunizations, and other preventative services when those costs are not reimbursed by another source. The program is authorized under the 1115 waiver. Year 1 of the program consisted of uncompensated care and Medicaid shortfall. Effective as of Year 2, the program has transitioned to reimbursing charity care only.
In accordance with the Special Terms and Conditions of the 1115 waiver, providers must be funded by a unit of government able to certify public expenditures to participate in the program. Publicly owned and operated providers eligible to participate include those established under the Texas Health and Safety Code Chapters 533 and 534 and are primarily providing behavioral health services:
- Community Mental Health Clinics (CMHCs)
- Community Centers
- Local Behavioral Health Authorities (LBHAs)
- Local Mental Health Authorities (LMHAs)
- Local Health Departments (LHDs) and Public Health Districts (PHDs) established under the Texas Health and Safety Code Chapter 121
Beginning October 1, 2021, the PHP-CCP began to allow certain providers to receive supplemental payments for certain medical services. Payments from the pool defray the uncompensated costs of providing medical services to Medicaid-eligible or uninsured individuals. Total pool size for FY22 was limited to no more than $500 million dollars based on allowable uncompentsated care costs. The program was resized based on actual charity care costs for FY2023 and approved by the Centers for Medicare and Medicaid Services (CMS). As a result, total funding will not exceed 499.1 million (total computable ) dollars for FY2023 and after. This pool is subject to resizing in future years based on actual charity care costs incurred by eligible providers.
Announcements
PHP-CCP does not provide financial assistance to individual patients to assist with medical costs. If an individual patient needs assistance please call 2-1-1 or visit the website .
Federal Approval
On December 22, 2021, HHSC received federal approval for PHP-CCP Protocol from the Center for Medicaid and Medicare Services (CMS).
Methodology/Rules
HHSC has adopted §1 Texas Administrative Code (TAC) Section 355.8215 concerning the PHP-CCP under the 1115 waiver to reimburse certain costs for qualifying providers associated with providing care. These costs, include behavioral health, immunizations, chronic disease prevention, and other preventative services for the uninsured. (updated 03/24/2025)
HHSC adopted §1 TAC Section 355.8217, concerning the availability of PHP-CCP payments for eligible providers to help defray the uncompensated costs of charity care beginning October 1, 2022. (updated 03/24/2025)
Year 1 (DY11) Uncompensated Care Trained Preparers
The initial cost report training was conducted in August 2021. Please note that an entity is eligible to submit the PHP-CCP cost reporting tool if at least one individual from their organization is a Trained Preparer.
View the Year 1 (DY11) PHP-CCP Training Slides. (.pdf)
View the PHP-CCP Cost Reporting Tool Supporting Documentation Companion Guide and FTP User Guide (.pdf).
Year 2 (DY12) Charity Care Transition
Year 2 (DY12) of the PHP-CCP transitioned from all uncompensated care to charity care only. Starting with Year 2 providers have been required to create a charity care policy for their organization and submit to HHSC in addition to the PHP-CCP Cost Reporting tool.
HHSC conducted cost report training webinars in preparation for Year 2 of the PHP-CCP program on August 15, 2023, August 22, 2023, and September 15, 2023.
Per 1 TAC Section 355.8217 providers are required to have at least one financial contact attend training annually. At least one financial contact must attend cost reprt training every year to participate in the program. (updated 03/24/2025)
Year 2 of the PHP-CCP Cost report began utilizing the State of Texas Automated Information Reporting System (STAIRS) for the collection of all cost reports beginning Oct. 1, 2023. This online system replaced the Excel spreadsheet cost report providers utilized in Year 1.
HHSC recommends that providers review and become familiar withe STAIRS online cost reporting tool.
View the Addendum to Attachment T (.pdf)
View the Charity Care Transition PowerPoint slides (.pdf)
View the Charity Care Sample Policy 1 (.pdf)
View the Charity Care Sample Policy 2 (.pdf)
View the Healthcare Financial Management Associated (HFMA) Statement 15 (.pdf) – Valuation and Financial Statement Presentation of Charity Care, Implicit Price Concessions and Bad Debts by Institutional Healthcare Providers.
View the Year 2 (DY12) PHP-CCP Training Slides (.pdf).
Email the PHP-CCP team for additional information or questions.
Year 3 (DY13) Cost Report
The PHP-CCP Cost Report for Year 3 (FFY 2024) utilizes the State of Texas Automated Information Reporting System (STAIRS) for the collection of all cost reports.
Beginning with the FFY 2024 Cost Report, providers may use the Provider Name PHP-CCP Cost Report Documentation Template and Instructions (.xlsx) template to submit supporting documentation with their report.
If you are using this template, replace “Provider Name” with the name of your entity and upload to your STAIRS Cost Report.
HHSC has completed the initial review of the Federal Fiscal Year (FFY) 2024/Demonstration Year (DY) 13 Public Health Provider – Charity Care Program (PHP-CCP) Cost Report. Log in to the State of Texas Automated Information Reporting System (STAIRS) to review your Cost Report after adjustments, and either accept your settlement amount or request an informal review.
Payment batches will be initiated once HHSC is notified of the status of all PHP-CCP Cost Reports. Note that the CMS-approved limit is $499,193,023. Therefore, a proportionate reduction to all Cost Report settlements will be applied due to this federal limitations on program size. The current PHP-CCP FFY 2024 Proportionate Reduction estimates are available here (updated 03/28/2025) for review. These proportionate reductions cannot be found on the cost reports in STAIRS for this year but there is a note to indicate that the total allowable costs will be reduced based on the CMS approved limit.
Year 4 (DY14) Program Training
HHSC conducted training webinars in preparation for Year 4 of the PHP-CCP on August 13, 2024, August 20, 2024, and September 13, 2024. Per 1 TAC §Section 355.8217, providers are required to ensure that at least one employee serves as the financial contact and attends the annual training. (updated 03/24/2025)
In addition to the program training for Year 4 (FFY 2025), the training session included an overview of the Cost Report submission for Year 3 (FFY 2024). Cost Report training is required annually by at least one financial contact to obtain training credit to report information in STAIRS.
The FFY 2025 (DY14) Texas PHP-CCP Training Presentation (.pdf) is available for review. (update 03/24/2025)
Please email the PHP-CCP team for additional information or questions or call 737-867-7999 to speak with a PFD staff member regarding the PHP-CCP.