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families (through the employer’s plan), it may only appeal to individuals who are eager to keeptheir families in the same plan. 136 (Note: a similar waiver done as an 1115 research anddemonstration project would have to among other things maintain cost-sharing at SCHIPlevels.)There are three 1115 waivers for city-level demonstration projects authorized by House Bill3122 of the 78th Legislature that have not been formally submitted to CMS yet, though there areplans to do so. The HB 3122 Task Force was created through this bill to explore the feasibilityof the development of local expansion waivers that would seek to use local funds for the stateMedicaid match to draw additional federal Medicaid matching funds to their areas. 137 Generaloutlines of these waivers were submitted for preliminary review, and CMS responded that morediscussion would be needed on the proposals, especially on the subject of limited enrollmentoptions. 138 Currently the El Paso County Hospital District, Austin/Travis County, and BexarCounty Hospital District local waivers are under review by this task force. These waiverspropose to use the additional federal dollars that the local match would obtain to fund localprograms to cover uninsured low-income parents not currently eligible for other programs.The proposed Austin/Travis County waiver intends to expand designated Medicaid services tooptional adults — TANF (non-disabled, 18-64) adults with dependent children. This waiverwould include coverage of permanent, legal U.S. residents living in Travis County with incomesbetween 17 and 100 percent FPL. Budget neutrality is to be achieved through savings fromimplementing a reduced benefit package, and by providing a medical home, pharmaceuticalmanagement, and reduced ER visits. Savings are expected to be approximately $565,000 inyear one to over $1,400,000 in year five. 139The Bexar County Hospital District waiver would involve a Medicaid expansion for adult healthcare services to needy parents (aged 21 to 64) of children on Medicaid to promoteindependence from welfare by providing a health care safety net for working poor between 14.4and 100 percent FPL (optional population). The waiver proposes the use of an existingMedicaid HMO. Reenrollment would be required at 12 months. The waiver would seek towaive statewideness, freedom of choice, and cost-sharing. Budget neutrality is expected to bemet through savings achieved by providing services through a medical home and usingcontinuous eligibility versus the existing Medicaid program. Savings are expected to be$272,000 in year one and projected to be $4,418,000 over the five-year waiver period. Plannersproject enrollment of 2,500 participants in year one with annual increases to an enrollment of5,000 in year five. 140The El Paso County Hospital District Waiver would expand Medicaid coverage to TANF andSCHIP adults (21 to 64 years) in the El Paso service delivery area between 14.4 and 200percent FPL. The waiver would also restore the medically needy program for this area, andmay try to expand coverage to a “select number of childless adults” (ages 21-64). 141 Thiswaiver program would utilize an existing managed care model in the service delivery area forthe TANF/SCHIP adults and would use a fee-for-service model for the medically needyprogram. The waiver would use health risk assessments, preventive services, simplified andcontinuous enrollment, and promotores to help achieve budget neutrality. Matching funds wouldcome from funds currently earmarked for the hospital district’s public hospital. 142Other waiver initiatives in the state over the past few years included an HIV waiver and adisability waiver. Both of these waivers would have extended Medicaid coverage to personswithin these targeted populations. However, waiver focus at the federal level has shifted awayfrom disease-specific waivers and instead has concentrated efforts on HIFA-type waivers.Neither the disability or HIV waiver proposals are currently “alive.”B-30