But the federal government does want to encourage states to experiment and find better ways to provide care for the needy, so it grants limited waivers. One is for the Women's Health Program, which provides preventive health care and contraception to women who would not normally qualify for Medicaid. The program saved money by expanding health care coverage to non-pregnant poor women to prevent unplanned pregnancies that Medicaid would have to pay for if not prevented.
The Legislature passed an omnibus bill last year that prompted officials to apply for what is called a transformation waiver. The new state law allows doctors, clinics and hospitals to work together more closely and for state officials to pay hospitals more for providing better, more efficient care. Federal officials granted a waiver allowing the experiment.
The state is currently supervising the creation of Regional Healthcare Partnerships across the state that will allow for coordinated care as well as improving access and quality. These partnerships will also provide greater compensation to hospitals that develop innovative ways that lower costs and improve treatment.
The biggest changes are coming to the Rio Grande Valley, where the state is implementing managed care for Medicaid. That means people in the program must now sign up with private companies who will manage their benefits rather than state officials.
A key part of implementing managed care was overhauling how the state reimburses hospitals for the indigent. The new waiver makes sure that hospitals continue to receive funding for treating indigent, single adults who do not qualify for Medicaid in Texas.
Perry's refusal to expand Medicaid presents an obstacle to achieving the Affordable Care Act's goal of 98 percent of Texans enrolled in some kind of health care program, but the transformation waiver will help provide the indigent with the care they need.
And while Perry has refused a state-run health care exchange for Texans, that decision will not keep millions of Texans of signing up for insurance. Janek said his commission is still waiting for Washington to publish all the new rules under the Affordable Care Act, but one thing he says is certain.
"It is the law of the land and we have to deal with it," Janek said.