1. 80 th Session Post-Legislative HHS Forum United Way Tarrant County, Sept. 17, 2007 80 th Session Post-Legislative HHS Forum United 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

2. Tuesday, Nov. 13, 2007, 7:30 to 9 AM Fort Worth Botanic Gardens

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

5. Where the Money Would Go: Texas State Budget, 2008-09 Source: Legislative Budget Board; HB 1, 2 and 15, before Governor’s vetoes. 84% 75%

6. How Much for Tarrant County? $3.4 billion in 2006; $4 billion per year in ’08-09 Source: Comptroller of Public Accounts, State Expenditures by County 2006.

7. 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)

8. 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.

9. 2010-2011 Budget: $5.8 Billion Gap Between Tax Cut Cost & Revenue

10. 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.

11. Tarrant County Medicaid/CHIP Enrollment (September 2005-2007) Source: Texas Health and Human Services Commission.

12. 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.

13. Tarrant County: CHIP only Enrollment (Sept. 2005-2007, and projected) Source: Texas Health and Human Services Commission; LBB/HB 1.

14. Not included in previous chart: CHIP Perinates Source: Texas Health and Human Services Commission; LBB/HB 1. Tarrant County Jan. 2007127 Feb. 2007342 March 2007991 April 20071,578 May 20072,310 June 20072,854 July 20073,578 Fiscal 2008 ?6,700 Fiscal 2009 ?7,100

15. The 2008-09 Budget And Community Care/Other HHS Waiting Lists Program Served in Fiscal 2006 Added by 2009 Increase from 2006 Community-Based Alternatives26,7331,6076% Home & Community-Based Svcs.10,3182,67626 Community Living Assistance2,04458629 Deaf-Blind Multiple Disabilities1311612 Medically Dependent Children96041543 In-Home and Family Support3,9441,37412 Independent Living Services (DARS) 2,3011024 Comprehensive Rehab.Svcs. (DARS) 3809224 Children w/Special Health Care Needs646 Children’s Community MH Services288 DADS Non-Medicaid Community Svcs.2,228

16. 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.

17. 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)

18. 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.

19. 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

20. Recent Changes, Food Stamp Enrollment in Tarrant County Source: Texas Health and Human Services Commission

21. 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)

22. 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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