The Texas Catholic Conference of Bishops has asked President Joe Biden and Health and Human Services Secretary Xavier Becerra to end a stalemate between state officials and the federal agency overseeing Medicaid payments that is threatening health care for low-income Texans.

Addressing what they described as "an urgent issue," the prelates Dec. 3 sent the letters explaining that without an agreement covering reimbursements, "children, elderly, disabled residents and those living in poverty throughout our state risk losing access to critical care."

The reimbursements ended Sept. 1 when an agreement between Texas and the Centers for Medicare and Medicaid Services, or CMS, expired.

The impasse "also jeopardizes $10 billion that historically has supported our state's Medicaid system," the bishops wrote.

"Losing these funds in our poorest communities will fracture and devastate our safety net, incredibly, in the midst of a global pandemic that has already adversely affected the poor," the letter said.

The leaders of all 15 Texas archdioceses and dioceses and the Houston-based Personal Ordinariate of the Chair of St. Peter signed the letter in a sign of unified support for reinstating the health care support plan.

Jennifer Carr Allmon, executive director of the Texas bishops' conference, told Catholic News Service, the cutoff of funding, now in its fourth month, threatens the ability of nongovernmental hospitals, including Catholic facilities, to provide the same amount of health care to people without traditional health insurance.

The lack of an agreement revolves around the question of how Texas pays for its share of care under Medicaid.

The question is rooted in a provision in the Affordable Care Act that allows states to expand Medicaid to people whose incomes are too high to be considered living in poverty, but still low enough that they cannot afford traditional health insurance.

Medicaid is a program jointly funded by federal and state governments. Under the program, the federal government pays states for a specific percentage of Medicaid expenditures. States must ensure that they can fund the remaining amount of such expenditures to receive federal support.

Texas declined to implement a formal Medicaid expansion under the ACA. By 2013, however, state legislators approved a plan whereby nongovernment hospitals were required to begin payments to Local Provider Participation Funds that provide the state's share of health care costs for low-income people.

Multiple LPPFs are in place throughout the state. They provide funding for several supplemental and directed payment programs, such as uncompensated care.

All states but Alaska have implemented similar funding programs to provide the match to receive Medicaid funding to cover health care for low-income uninsured patients.

Allmon said CMS officials in the Obama and Trump administrations had approved the arrangement since it was implemented. However, this year CMS has objected to the state's way of providing its share of funding through the LPPFs, leading to the current dilemma for hospitals.

Ascension Texas is one of the affected health care systems.

Geronimo Rodriguez, chief advocacy officer for the Austin-based health care provider, told Catholic News Service Dec. 7 that the amount of charitable health care the system delivers across its 100 facilities is unsustainable without a reimbursement agreement in place.

"We have to make sure we have the proper financing to maintain care of the poor and vulnerable," Rodriguez explained.

Ascension Texas provides $540 million in charity care annually in addition to that which is reimbursed under Medicaid, Rodriguez said, explaining that without an agreement in place, "we're not going to be sustainable over a long period of time."

"There is some concern about the lack of an agreement because at the end of the day the only people that are going to suffer are those that need the care, poor and vulnerable people," he added.

Negotiations between state officials and CMS are continuing.

A CMS spokesperson acknowledged a CNS inquiry, but did not respond right away with a comment for this report.

Allmon said all members of the Texas congressional delegation also were contacted by the bishops' conference and that support for resolving the issue has been bipartisan.

She also said the Catholic conference would prefer to see a Medicaid expansion program in place rather than current system.

"We would love to see that (Medicaid expansion)," Allmon told CNS. "But in the absence of that, this works and the poor are receiving care."

She expressed particular concern for independent hospitals in outlying areas of the state that have limited financial reserves to cover uncompensated care for its poor patients.

"It's really frustrating that the administration would be holding up that access," Allmon said. "This is a classic example of the perfect being the enemy of the good. It may not be the most elegant system, but it is providing health care and health care access."