The 2005 federal waiver gave Texas and 15 other states the ability to add on, if needed, disaster-specific enhanced benefits. They included things such as more mental-health therapy sessions and more generous long-term services and supports.

Also with federal approval, Texas officials quickly set up an uncompensated care pool to assist hospitals, clinics and doctors.

Several months later, Congress voted to pick up the entire tab for the pool and the special coverage. The cost of Medicaid usually is shared between the federal government and the states.

Sept. 18 request

This year, though, the storm struck right as top managers in Medicaid were leaving and being replaced in Austin. Some advocates of low- and moderate-income Texans wondered aloud whether the commission had lost institutional memory, which was hurting its response to the storm.

Williams disputed that, saying “we’re making informed decisions with the expert staff we have, many of whom have been here for years.”

News of those decisions dribbles out slowly, though.

Only last week, the commission confirmed publicly for the first time that it had asked the federal Centers for Medicare and Medicaid Services for permission to create a special uncompensated care pool for Harvey-driven medical costs. It submitted the “waiver request” on Sept. 18. But the federal centers have not said yes, advising Texas that full federal funding would require an act of Congress, commission officials have told advocates.

The state also asked for enhanced federal match “for Medicaid-related expenditures in the 39 counties” included in disaster designations, Williams said in an email Tuesday. She did not elaborate.

Advocates said that was the first they’d learned of the request.

‘A totally different storm’

The week after Harvey made landfall north of Corpus Christi on Aug. 25, commission officials had numerous phone conversations with their federal counterparts, Williams wrote. The federal centers steered Texas toward making a “comprehensive” waiver request rather than submitting a lot of individual waiver requests, she said.

“While Harvey was a totally different storm, we absolutely looked at the details of our past storm responses, including Katrina, and made very deliberate and informed decisions about what to do for Texas,” she said.

Katrina was different from other storms because “Texas took in hundreds of thousands of evacuees from Louisiana,” she said.

State officials want to help victims “while being mindful of taxpayer dollars going out the door,” Williams said.

On Tuesday, Charles Smith, the commission’s executive commissioner, testified to the Senate Finance Committee that the state worked with the feds “to receive flexibility to allow displaced individuals to access out-of-network services” and speed approvals of out-of-state Medicaid providers who treated displaced Texans, such as those forced to flee to Louisiana.

He did not respond to advocates’ concerns about the commission’s actions after the storm, including how they compare with his predecessors’ actions in similar situations.

Dunkelberg, of the liberal Austin think tank, said she hopes more answers are forthcoming.

“We hope we will soon get clear information on whether and how an affected, uninsured Texan from one of the disaster counties can get help with medical bills, or how a doctor, dentist or clinic could go about getting repayment for free care they gave,” she said.

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Why did Texas Medicaid officials request more aid for Katrina victims than for Harvey?