Uncompensated Care Payments

Overview

Historically, every private hospital that participates in the waiver must execute an affiliation agreement with the governmental entity that provides the Intergovernmental Transfer (IGT) for any type of payment (transition, Uncompensated Care [UC], or Delivery System Reform Incentive Payment [DSRIP]). Hospitals receiving transition payments already have the necessary affiliation agreements on file. For details, read this overview (.pdf). Beginning in Demonstration Year (DY) 12, this agreement is no longer a requirement.

Methodology/Rules

The Waiver Payments to Hospitals and Waiver Payments for Physician Services rules are located in Title 1 of the Texas Administrative Code (TAC), Part 15, Chapter 355, Subchapter J, Division 11.

The 1115 Waiver rules are located in 1 TAC, Part 15, Chapter 354, Subchapter D.

Condition of Participation

Beginning in Federal Fiscal Year (FFY) 2024, all hospitals (except for state-owned and rural hospitals) are required to enroll, participate in, and comply with requirements for voluntary supplemental Medicaid or directed Medicaid programs for which the hospital is eligible within the State of Texas to participate in UC. 1 TAC Section, 355.8212 (c)(1)(F) provides further details about this requirement. Please review the list of the required programs (.pdf) to satisfy this condition of participation.

Allocation Form

1115 Transformation Waiver IGT Allocation Confirmation Sheet

The waiver payment team has developed a new allocation confirmation spreadsheet for governmental entities to complete as a step in the payment process. Read more about the allocation form (.pdf)

UC Withheld Payments

The DY3-DY6 UC withheld payment amounts (.pdf) are available. Please note that these amounts are subject to change when ineligible providers are removed and when HHSC caps providers at the final Uncompensated Care Costs (UCC) calculated in the UC reconciliation for the applicable program year.

UC IGT Commitments

DY 13

View the DY 13 UC IGT Commitments File for Hospitals and Physician Groups (.xlsx) (Updated 7/25/2024)

The IGT Commitment form is available in both PDF and Excel:

DY12

View the DY12 UC IGT Commitments File for Hospitals and Physician Groups (.xlsx) (Updated 8/1/2023)

DY11

View the DY11 UC IGT Commitments File for Hospitals and Physician Groups (.xlsx) (Updated 8/30/2022)

UC Final Calculation Files

DY13

View the DY13 UC Final Calculation File for Hospitals and Physician Groups (.xlsx) (Updated 8/22/2024)

DY12

View the DY12 UC Final Calculation File for Hospitals and Physician Groups (.xlsx) (Updated 8/16/2023)

DY11

View the DY11 UC Final Calculation File for Hospitals and Physician Groups (.xlsx)

View the DY11 UC TXPUC withheld and additional hospital payment (.xlsx)

UC Advance Calculation Files

View the DY14 UC Advance Calculation File for Hospitals and Physician Group (.xlsx) (1/13/2025)

View the DY13 UC Advance Calculation File for Hospitals and Physician Groups (.xlsx) (Updated 1/17/2024)

View the DY12 UC Advance Calculation File for Hospitals and Physician Groups (.xlsx)

UC Redistribution Files

View the UC DY 7 Final Reconciliation Redistribution File (.xlsx) (Updated 2/28/2025)

View the UC DY 8 Final Reconciliation Redistribution File (.xlsx) (Updated 2/28/2025)

View the UC DY 9 Final Reconciliation Redistribution File (.xlsx) (Updated 11/25/2024)

Payment Information

View the 2024 DY13 Uncompensated Care Expenditures (.pdf)

View the 2023 DY12 Uncompensated Care Expenditures (.pdf)

View the 2022 DY11 Uncompensated Care Expenditures (.pdf)

View the 2021 DY10 Uncompensated Care Expenditures (.pdf)

View the 2020 DY9 Uncompensated Care Expenditures (.pdf) (Updated 9/15/2020)

View the 2019 DY8 Uncompensated Care Expenditures (.pdf)

View the 2018 DY7 Uncompensated Care Expenditures (.pdf)

View the 2017 DY6 Uncompensated Care Expenditures (.pdf)

View the 2016 DY5 Uncompensated Care Expenditures (.pdf)

View the 2015 DY4 Uncompensated Care Expenditures (.pdf)

View the 2014 DY3 Uncompensated Care Expenditures (.pdf)

View the 2013 DY2 Uncompensated Care Expenditures (.pdf)

View the 2012 DY1 Uncompensated Care Expenditures (.pdf)

Additional Information

HHSC will separately notify providers who have a payment recoupment regarding the recoupment process for amounts owed.

The following resources are available: