On April 7, HHSC submitted a request to the Centers for Medicare and Medicaid Services (CMS) for an initial 15-month extension of the 1115 Medicaid Demonstration Waiver, as specified in the attached letter. The purpose of this initial extension is to allow time for state and federal governments to work through a longer term agreement. The Texas 1115 Medicaid Transformation Waiver is a five year waiver expiring on September 30, 2016. The waiver allows the state to expand Medicaid managed care while preserving hospital funding, provides incentive payments for health care improvements and directs more funding to hospitals that serve large numbers of uninsured patients.