On December 21, 2017, The Centers for Medicare and Medicaid Services (CMS) issued a letter to Texas Health and Human Services Commissioner Charles Smith announcing their approval of a Texas 1115 Medicaid Waiver effective January 1, 2018, through September 30, 2022. The waiver is also known as The Texas Healthcare Transformation and Quality Improvement Program. Medicaid 1115 waivers are one type of demonstration waiver, named after section 1115 of the Social Security Act, designed to do any of the following: expand Medicaid or CHIP eligibility or services or utilize innovation in service delivery that yields improved care, efficiency, and reduced costs. Waiver projects must be budget neutral to the federal government. Forty percent of waiver funds come from local funds – mostly property tax dollars – and 60 percent is funded by the federal government. The Texas Health and Human Services Commission (HHSC) administers 1115 Medicaid waivers.