*Clarification appended

Hospitals that serve large uninsured populations in Texas stand to lose critical funding if the state can’t convince the federal government to continue helping with the cost, doctors and health advocates told the state health department Thursday.

With the expiration date of a five-year, $29 billion program approaching, the Health and Human Services Commission will attempt to negotiate a renewal of federal funds to help reimburse hospitals caring for the uninsured.

Rural Texas hospitals serve large uninsured populations and rely on the money to keep from closing, Grace Chimene, a pediatric nurse practitioner, told a panel of HHSC administrators taking public testimony on the need for an extension.

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“When a rural hospital closes, lives are lost due to the lack of emergency services,” the Austin resident said. “If you have an emergency like a heart attack in rural Texas, you better hope that local community has enough insured population to support a community hospital.”

The money was originally intended to help Texas transition over five years to an expanded Medicaid program under the Affordable Care Act. But Texas officials decided not to expand Medicaid, the state-federal insurance program for the poor and disabled, leaving uninsured nearly 1 million residents who would have been eligible for coverage under the expanded program.

That was a rebuke of the Obama administration, which is now considering whether — or to what extent — it will renew the matching funds. Federal officials told HHSC in April they would consider Texas’ refusal to expand Medicaid when determining whether to renew the federal matching funds that supplement local dollars.

Some at the meeting said they worried the federal government would reduce Texas’ uncompensated care funding because the state had refused to expand Medicaid. In addition to reimbursing hospitals for caring for the uninsured, some of the $29 billion also helps fund innovative projects to help care for low-income populations. 

Tom Watkins, a spokesman for March of Dimes, an organization that supports infant health care, said the money helps fund critical services for women without coverage. Many of the adults in the coverage gap are women who will only qualify for Medicaid if they become pregnant, he said.

“This funding is critical to the health of women and children in our state,” Watkins said. “The greatest opportunity to improve the health of a woman, and to improve the health of her child during pregnancy, occurs before they get pregnant.”

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The month-long public comment period for HHSC’s proposal to the federal government to have the funding extended another five years will end Aug. 5. 

Texas should expand Medicaid coverage in addition to securing a waiver extension, said Laura Guerra-Cardus, associate director of the Children’s Defense Fund in Texas.

“Coverage expansion must be part of the solution,” the Austin doctor said. “Without coverage, individuals do not have adequate access to preventative, chronic and ongoing care that makes the concept of health care meaningful.”

However, many who testified said Medicaid coverage expansion itself is more important than extending the five-year program, and urged the HHSC to pressure the government to expand coverage.

HHSC must submit its request for extending the waiver by the end of September. If it fails, the money would run out in September 2016.

Clarification: This story has been changed to clarify comments by Laura Guerra-Cardus.

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