8080thth Session Post-Legislative HHS Forum Session Post-Legislative HHS ForumUnited Way Tarrant County, Sept. 17, 2007United Way Tarrant County, Sept. 17, 2007

Implications of Health & Human Services

Accomplishments for the State Budget Eva DeLuna Castro, Senior Budget Analyst

deluna.castro@cppp.org (512) 320-0228 x 103

Tuesday, Nov. 13, 2007, 7:30 to 9 AM

Fort Worth Botanic Gardens

Full Report and Metro Data: www.cppp.org/fbe

Where the Money Would Go: Texas State Budget, 2008-09

K-12 Education 23%

K-12 Education 36%

Property Tax Cuts

Higher Ed. 13%

Higher Ed. 16%

HHS 31%

HHS 26%

Prisons 6%

Prisons 10%

Highways 10%

All Other 8%

All Other 6%

$-

$30

$60

$90

$120

$150

$180

General Revenue $81 b All Funds $168 b

Bie

nn

ial

Bil

lio

n $

8%

Source: Legislative Budget Board; HB 1, 2 and 15, before Governor’s vetoes.

84%

75%

How Much for Tarrant County?$3.4 billion in 2006; $4 billion per year in ’08-09

HHSC (Medicaid,

CHIP), $991 m, 28%

School District Aid, $881 m,

26%

Community & Jr. Colleges,

$43 m, 1%

Prisons/ Corrections,

$61 m, 2%

Higher Ed. - Four-Yr/Prof.,

$171 m, 5%Other HHS, $396 m, 12%

TRS/ERS, $121 m, 4%

All Other, $305 m, 9%

Highways (TxDoT/DPS),

$233 m, 7%

Workforce Comm.,

$209 m, 6%

Source: Comptroller of Public Accounts, State Expenditures by County 2006.

Remaining, $1.9 b, 13%

"Truth in Spending", $2.5 b, 17%

HHS, $3.7 b, 26%

Higher Ed., $1.7 b, 12%

Other K-12 , $0.6 b, 4%

2008-09 Tax Cuts, $3.9 b,

28%

What a “Current Services” Proposal Would Have Done with $14.3 Billion

(public employee pay/ health ins./pension; prisons; all other)

(would restore state parks funding; utility

discount; more)

All other, $1.6 b, 11%

HHS $2.7 b, 18%

K-12 and Higher Education, $2.6 b, 17% Replace TIF &

Rainy Day $, $0.8 b, 5%

Undo Deferrals, $1.1 b, 7%

2010-11 Tax Cuts, $2 b?,

14%

2008-09 Tax Cuts, $3.9 b,

27%

What the 2008-09 State Budget Will Do with “New” GR

27% of revenue ($3.9 billion) would not increase

state spending

Source: Legislative Budget Board; HB 1, 2 and 15, before Governor’s vetoes.

2010-2011 Budget: $5.8 Billion Gap Between Tax Cut Cost & Revenue

$0.5

$4.1 $4.2 $4.4 $4.7

$7.6$7.3$6.9$6.6

$2.1

$0.0

$2.5

$5.0

$7.5

$10.0

2007 2008 2009 2010 2011

Cost of property tax cut

Revenue from special session tax changes

Billions

The 2008-09 Budget: Medicaid

•Acute-Care caseloads would increase 2.8% by 2009 (from 2.8 million in 2007 to 2.9 million; more than two-thirds are children). Nursing homes: 1% increase (≈70,600 in ’09)

•Cost increases not fully covered; may require supplemental funding in 2009, along with caseloads. Health care provider rate restorations and increases authorized, some to comply with Frew ($707 million GR). Nursing home rate increase in Article IX of almost 4% in ’08, 10% in ’09.

•Total Medicaid funding (long-term care, acute care, prescription drugs, etc.): will increase by 8.7% overall, from $36.6 billion in 2006-07 to $39.8 billion All Funds. General Revenue-related change: from $13.4 billion to $15.8 billion.

Tarrant County Medicaid/CHIP Enrollment (September 2005-2007)

Source: Texas Health and Human Services Commission.

108,714

Sep '05 Nov '05 Jan '06 Mar '06 May '06 Jul '06 Sep '06 Nov '06 Jan '07 Mar '07 May '07 Jul '07 Sep '07

About 43,500 in July 2007

40,800 adults on Medicaid in Sept. 2005

117,800 children on Medicaid or CHIP in Nov. 2005

122,300 in Sept. 2007

The 2008-09 Budget: CHIP•HB 1: Caseloads increase 7.5% by 2009 (from ≈309,000 in 2006 to 332,262, not counting perinates). Perinatal CHIP: ≈14,000 in April ’07; 65,817 in ’08, 69,316 in ’09.

•HB 109 restorations: 96,400 children (beyond HB 1 levels) added by 2009. Less restrictive asset test & waiting period; some income disregards restored; 12-month eligibility with 6-month income review for those above 185% of poverty

•Cost increases only funded for fiscal 2008, not 2009. Health care provider rate restorations and increases authorized.

•Total CHIP funding: up 105% overall, from $1.0 billion in 2006-07 to almost $2.1 billion All Funds. General Revenue increase of 90%: from $335 million to $638 million. Half of the GR increase is for the perinatal program.

Tarrant County: CHIP only Enrollment (Sept. 2005-2007, and projected)

Source: Texas Health and Human Services Commission; LBB/HB 1.

Sep-0

5

Nov-0

5

Jan-0

6

Mar

-06

May

-06

Jul-0

6

Sep-0

6

Nov-0

6

Jan-0

7

Mar

-07

May

-07

Jul-0

7

Sep-0

7

Fisc

al 2

009

19,754 children enrolled in Dec. 2005 By Sept. 2007, up to 21,485

19,039 in Sept. 2006

26,100 in Fiscal 2008, 28,100 in 2009 (assuming same share of state caseload)

Not included in previous chart: CHIP Perinates

Source: Texas Health and Human Services Commission; LBB/HB 1.

Tarrant County

Jan. 2007 127

Feb. 2007 342

March 2007 991

April 2007 1,578

May 2007 2,310

June 2007 2,854

July 2007 3,578

Fiscal 2008 ? 6,700

Fiscal 2009 ? 7,100

The 2008-09 Budget And Community Care/Other HHS Waiting Lists

ProgramServed in

Fiscal 2006Added by

2009Increase

from 2006

Community-Based Alternatives 26,733 1,607 6%

Home & Community-Based Svcs. 10,318 2,676 26

Community Living Assistance 2,044 586 29

Deaf-Blind Multiple Disabilities 131 16 12

Medically Dependent Children 960 415 43

In-Home and Family Support 3,944 1,374 12

Independent Living Services (DARS) 2,301 102 4

Comprehensive Rehab.Svcs. (DARS) 380 92 24

Children w/Special Health Care Needs 646

Children’s Community MH Services 288

DADS Non-Medicaid Community Svcs. 2,228

The 2008-09 Budget and Child Protective Services

•Provides funds needed to keep Child Protective Services reform going (caseloads/pay as of Aug. 2007; 2,523 added staff) and to implement next round of reform to further reduce caseloads and improve services (another 1,092 staff added by 2009)

•Foster care has a new rate to pay for post-psychiatric hospitalization; also a 4.3% rate increase. Budget assumes a decrease of almost 1,100 children in foster care by 2009 (5% drop from 2007). Almost 3,700 more children will get adoption subsidies by 2009 (17% increase from 2007).

•Prevention programs: All-Funds increase of almost 12% for the biennium.

The 2008-09 Budget: Other Article II Health Care Programs

• More than 21,000 community care clients will move to a managed

care model (STAR+PLUS) by 2009 • Repairs and renovations for State Schools (mental retardation) and

State Hospitals (mental health)

• $88 million in new General Revenue for community mental health crisis services and a public safety triage/detox unit in Bexar County

• 65% ($8.5 million) increase in funding for tobacco prevention and control programs, including smokeless tobacco use by rural youth

• $17 million GR for tuberculosis and HIV services/medications

• Breast and cervical cancer: more sites to provide screenings/ diagnosis; easier access to treatment for low-income women

• Nurse Family Partnership grants program (SB 156)

2008-09 Budget: Other HHS Programs

•HHS eligibility determination/enrollment staff: HB 1 funds 7,202 state workers (6,700 in local offices) at HHSC; more can be requested if needed to deal with changes to outsourcing/privatized call center plan. (In 1996, state had 12,000 local staff; in 2003, 8,000).

•Cash welfare (Temporary Assistance for Needy Families): 133,330 Texans—the vast majority of them children—are budgeted to receive TANF cash aid in 2008-09, down from 163,800 in 2006, 137,100 in 2007. Monthly grant per client will average just under $66 by 2009, vs. $64.46 in 2007.

Recent Changes, TANF Enrollment in Tarrant County

Source: Texas Health and Human Services Commission

State Budget for 2008-09: a 2.7% decrease in TANF caseloads statewide

7,990

6,0805,021

2,250

1,635

1,273

0

2,500

5,000

7,500

10,000

AdultsChildren

Sept. 2005 Sept. 2006 July 2007

24,983 24,945 26,079

40,676 41,301 43,222

42,534 42,293 43,454

5,148 5,5165,909

0

40,000

80,000

120,000

65 and over

18 to 64

5 to 17

Under 5

Total: 113,341 Total: 114,055 Total: 118,664

Sept. 2005 Sept. 2006 Sept. 2007

Recent Changes, Food Stamp Enrollment in Tarrant County

Source: Texas Health and Human Services Commission

What Else Would the 2008-09 Budget Do?

•UTMB Charity/Indigent Health Care: continues at 2007 levels

•Reduces subsidized child care slots for “working poor” families from 104,439 in 2006 to 96,964 in 2009 (7% cut). But, also designates $18 million in federal funds for rate increases for services to children under 6 years old; $2 million for early childhood projects.

•Higher Ed scholarships: Texas Grants for 69,320 students in 2009, 14% more than 61,067 served in ’06

•Restore System Benefit Fund support for electric utility discount program (summer months only)

Preparing for 2009 Session• CHIP Reauthorization by Congress

• Immigration reform (federal/state)

• Interim House and Senate committee reports

• Sunset Commission reviews originally scheduled for 2009 (DADS, DARS, DSHS, DFPS, HHSC and others) were changed to 2011 (HB 3249)

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