Health and Human Services System Budget Presentation

1. Health and Human Services SystemBudget Presentation HHS Councils Work Session January 28, 2011

2. Department of Aging and Disability Services (DADS) Budget Presentation Health and Human Services Councils Work Session January 28, 2011

3. Comparison of Current Biennium to S.B. 1

4. Summary of Key Issues in SB 1 Medicaid $980.7 million GR and $2.3 billion All Funds reduction due to loss of enhanced federal match that is expiring. 10 percent reduction in rates for Medicaid programs (excluding Medicare Co-pay Skilled Nursing, PACE, and state supported living centers. Community Care waiver caseloads are maintained at August 2011 projected levels (Roll-out of waiver slots was halted in December 2010). Expansion of managed care at HHSC includes the transfer of $524.5 million GR and $1.3 billion All Funds, to HHSC for clients currently being served at DADS. $13.7 million GR, $28.3 million All Funds, and 372.4 FTEs reduced for administrative savings associated with the managed care expansion. Funds 3,713 state supported living center clients in FY12 and 3,402 in FY13.

5. Summary of Key Issues in SB 1 Non-Medicaid $121 million GR and $126.8 million All Funds reduction for non-Medicaid community services and support. An estimated 11,987 individuals could be affected by the reduction in funding for fiscal years 2012 and 2013 when compared to fiscal year 2011 projected client levels. Intake, Access, Eligibility and Guardianship $3.9 million GR and $9.4 million All Funds reduction for client services and grants.  Admin/Capital $6.1 million GR and $11.2 million All Funds reduction for central administration and information technology. This is a reduction of 46.2 FTEs compared to fiscal year 2011. Capital repairs and renovations at state supported living centers are funded with general obligation bonds. $14.8 million in bonds are included in fiscal year 2013. These are the unissued portion of the bonds appropriated in 2010-11 and carried forward to 2013. Funding and Capital Budget authority for DADS PC leases were eliminated Regulatory $7.6 million GR (all GR; no federal match was taken) reduction for Facility and Community-based regulation. This is a reduction of 80 FTEs compared to fiscal year 2011.

6. Department of Assistive and Rehabilitative Services (DARS) Budget Presentation Health and Human Services Councils Work Session January 28, 2011

7. Comparison of Current Biennium with S.B. 1

8. Summary of Key Issues in S.B. 1 SB1 funding will allow DARS to continue serving consumers in all its programs at some level Early Childhood Intervention is funded at $151.5 million all funds per year, which will allow DARS to serve 26,052 children (vs. est. 32,392 for FY2011). Assumes ARRA funding for ECI of $56.2 million will not be available in FY2012-13. Comprehensive Rehabilitation Services is funded at $10.6 million dedicated general revenue per year, which will allow DARS to serve 369 consumers per year (vs. 606 in FY2010) Blind Children’s Program is funded at $3.2 million general revenue per year, which will allow us to serve approximately 2,500 consumers (vs. est. 3,600 for FY2011). Also includes a reduction of 20.1 FTEs in each fiscal year. Autism program is funded at $1.65 million general revenue per year, which will allow us to serve 90 consumers (vs. est. 180 for FY2011) Vocational Rehabilitation – Blind is funded at $41.1 million all funds and assumes ARRA funding of $11.7 million will not be available in FY2012-13. This funding will allow DARS to serve 8,479 consumes per year (vs. est. 9940 for FY2011). Vocational Rehabilitation—General is funded at $204.8 million per year and assumes ARRA funding of $32.5 million will not be available for FY2012-13. This funding will allow DARS to serve 82,636 consumers per year (vs. est. 88,024 for FY2011) Independent Living Centers is funded at $1.9 million all funds per year, which will allow DARS to serve 4782 consumers per year (vs. est. 6632 in FY2011) Disability Determination Services receives a $22.3 million increase in Federal Funds based on 3% growth, and 73.4 FTEs for the biennium. Administration is reduced 10% and includes reduction of 10 FTEs for the biennium. HB1 Differences H.B. 1 eliminated funding for the Autism program. S B. 1 funded Autism at $3.3M which reduces funding for the program by 50%.

9. Department of Family and Protective Services (DFPS) Budget Presentation Health and Human Services Councils Work Session January 28, 2011

10. Comparison of Current Biennium with S.B. 1

11. Summary of Key Issues in SB 1 Caseload growth for foster care and adoption subsidies was not funded, but performance measure targets in the bill reflect growth. Foster care rates were rolled back to the FY 09 rates with another 1% reduction applied, resulting in a 5% reduction to the average daily rate. Adoption subsidies and permanency care assistance payments were also reduced by 1%. • The current FTE cap was reduced by 823.6 in both years. 91% of the reduction, or 749.5 FTEs, are from CPS. Funds for emergency client services in APS were reduced by 10%. • The Relative Caregiver program (monetary assistance, day care services, and home assessments) was not funded. The reimbursement ceiling for adoption legal expenses for families adopting foster children was lowered.

12. Summary of Key Issues in SB 1 • GR match was eliminated for purchased adoptions, post-adoption services, and Preparation for Adult Living services, and was replaced by assumed local match. The health care benefit for non-special needs adoptions was not funded. Funds for day care services were reduced by 23% for children in CPS cases living at home or with a relative, and by 10% for children in foster homes where both foster parents work full time. • Prevention programs were reduced by 40%. HB 1 reduced these programs by 45%. • Funds for operational changes to the agency's casework management automated systems were eliminated.

13. Department of State Health Services (DSHS) Budget Presentation Health and Human Services Councils Work Session January 28, 2011

14. Comparison of Current Biennium with S.B. 1 as Introduced

15. Summary of Key Issues in SB 1 • SB 1 provides $1.4 billion in General Revenue and $3.4 billion All Funds to provide community health services, including serving 48,705 adults and 11,455 children with mental illness. • The following areas are affected by reduced GR: • $59.1 million in Community Mental Health strategies. • $19.2 million in primary care and nutrition services programs. • $12 million in indigent health care programs. • $30 million in funding for trauma care reimbursements. • $18.6 million in the tobacco funding, which represents 82% reduction of the program’s funding in FY10-11. • $6.9 million for FQHC infrastructure grants. Eliminates funding. • Federal funds changes include: • Possible elimination of the Community MH Block Grant - $62 million over the biennium. • $30.4 million reduction in Women, Infants and Children WIC grants. • $62.3 million reduction in federal substance abuse grants, Title V, TANF, Social Services Block grant and one time stimulus funding.

16. Summary of Key Issues in SB 1 • Preparedness and Prevention totals $416 million in GR and over $1 billion All Funds to coordinate essential public health services across the state, implement public health emergency preparedness programs and provide other critical public health services. • The following areas are affected by reduced funding: • $152.1 million decreases in Federal Funds due to one-time H1N1 funds and FEMA reimbursements. • $27.2 million reduction in federal HIV Formula Grant. • $34 million decrease in GR related funds in various programs including Children with Special Health care Needs. • Note: In HB1 the abstinence education program funding is reduced to zero. This is the only difference between SB1 and HB1.

17. Summary of Key Issues in SB 1 • Hospital Facilities and Services total $674.8 million GR and $835.9 million All Funds to operate the 10 state mental hospitals, the Texas Center for Infectious Disease, the South Texas Health Care System and three community mental health hospitals. • Major changes include: • $28 million GR reduction in state mental hospitals - $18 million in efficiencies and $10M related to privatizing one hospital. • $9 million GR reduction in community mental health hospitals. • Consumer Protection Services totals $99 million GR and $129.8 million All Funds. This includes a $14.1 million reduction in regulatory programs and one-time funding for a regulatory automation system. No FTEs were reduced in this goal.

18. Health and Human Services Councils Work Session January 28, 2011 Health and Human Services Commission (HHSC) Budget Presentation

19. Comparison of Current Biennium with S.B. 1 HHSC Differences between Senate Bill 1 and House Bill 1: • S. B. appropriates $8.65 million All Funds more than H.B. 1 and $991.35 million GR less than H.B. 1 • S.B. 1 has a rider directing HHSC to obtain a more favorable Medicaid FMAP and biennially reduces GR by $1.0 billion and increases federal funding by $1.0 billion for the 2012-13 biennium. • S.B. 1 funds Strategy D.1.2, Alternatives to Abortion at $8.3 million AF for the biennium, $4.15 million annually. • S.B. 1 funds Faith and Community Based Initiatives at $0.4 million GR for the biennium, $176,002 annually. S.B.1 also funds associated staff, 4.5 FTEs.

20. Summary of Key Issues Client Services Funding for Medicaid and CHIP 10 percent provider rate reduction. No funding for caseload growth or to replace enhanced federal match that expires. S.B. 1 Savings of $3.6 billion All Funds Assumes LAR net GR cost of $161.8 million to HHSC for 6 managed care expansion initiatives. (DADS is reduced for associated savings). $45 million GR reduction associated with Medicaid optional services. Rider 61 reduction of $450 million GR for Medicaid and other HHS reductions. HHSC Forecasted 2012-13 Caseloads for CHIP, TANF Cash Assistance and Medicaid clients with disabilities are very close to S.B. 1.

21. Summary of Key Issues Eligibility Determination Current staffing levels are maintained in 2012-13. Need additional funding for certain support services to keep pace with caseload growth, such as enrollment broker services, document imaging, EBT transaction fees. FY 2012-13 Capital Budget was funded at LAR base request except for no vehicle replacement and a minor adjustment for Master Lease Purchase debt service. Some administrative and IT reductions: FTE reductions total 179.7 in S.B. 1. Consolidated support FTEs are reduced by 5 percent or 33.2 FTEs. Program support FTEs are reduced by 7 percent, or 51 FTEs.

22. Summary of Key Issues Elimination of funding for some programs Guardianship Program Community Resource Coordination Groups/Texas Integrated Funding Initiative (CRCG/TIFI) Office of Acquired Brain Injury Umbilical Cord Blood Bank Grants Children’s Hospital Payments for Upper Payment Limit Program Frew Strategic Initiatives Physician loan repayments Texas Health Steps laboratory courier service Developmental calendars Texas Health Home Pilot Mobile dental services Healthy Marriage Program *Faith and Community Based Initiatives (Funded in SB 1;Not funded in H.B.1) *Alternatives to Abortion (Funded in SB 1;Not funded in H.B. 1)

23. Summary of Key Issues Reduced funding in other HHSC programs Acute Medicaid optional services ($45 million GR reduced) Nurse Family Partnership Program (50 percent) Office of the Inspector General (16 percent) Medicaid Medical Transportation (33 percent on administration) Ombudsman (21 percent) Office for the Elimination of Health Disparities (No grant funding) Texas Office for the Prevention of Developmental Disabilities (No GR funding)