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:
- IGT Commitment form (.pdf)
- IGT Commitment form (.xlsx)
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)
Additional Information
HHSC will separately notify providers who have a payment recoupment regarding the recoupment process for amounts owed.
The following resources are available:
- UC SDA Allocation Form (.xlsx)
- UC Payment Protocol Attachment H (.pdf) (Updated 11/13/2024)
- View the Final 2012 UC IGTs (.pdf)
- Waiver Payment Forms for UC/DSRIP Providers
- Guidelines for Participating in Transformation Waiver Payments (.pdf)
- UC Application Fee Voucher (.pdf)