The House Appropriations Committee S/C on Article II met on February 11 to hear invited and public testimony regarding the Health and Human Services Commission and the Texas Civil Commitment Office. The Committee heard from the Legislative Budget Board, the State Auditor’s Office, HHSC, and TCCO.

This report is intended to give you an overview and highlight of the discussions on the various topics the committee took up. It is not a verbatim transcript of the hearing, but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.


Health & Human Services Commission

Mike Diehl, Legislative Budget Board

  • Providing brief overview of HHSC funding recommendations, Office of the Inspector General is under SFR and will have further discussion later
  • HHSC recommendations @$77.4b for 2020-21, incr. of ~$1.1b or 1.4%
  • Largest funding changes are driven by Medicaid and on-time funding for Harvey
  • Recommendations track more favorable FMAP and less favorable eFMAP, assuming an incr. in FMAP of ~61%, and decrease to eFMAP to 94.12% in FY20 73.73% in FY21 & assumes a more favorable base eFMAP
  • Recommendations include $62.9b in AF and $23.5b for Medicaid client services, incr. of $2b in AF; funding includes projected caseload growth and maintains average costs, also a decrease in GR portion due to FMAP
  • $2.2bin AF $459m in GR for CHIP; biennial funding to CHIP primarily due to caseload growth, also includes $300 million incr. due to changes in FMAP/eFMAP
  • S Davis – Just want to make sure everyone understands we are not cutting Medicaid
    • Correct, All Funds is higher & changes due to more favorable FMAP
  • Recommending removing FTEs that were consistently vacant in FY18
  • Medicaid and CHIP Contracts & Admin @$1.2b AF, incr. of $56m in AF


Samantha Brock, Legislative Budget Board

  • $4b in AF for non-Medicaid/CHIP behavioral health services, majority of funding at HHSC, decrease in ~$300m in AF and incr. of roughly $125m in GR
  • Medicaid and CHIP expenditures for behavioral health at an additional $3.5 billion
  • For substance abuse service, $35.7m in AF incl. $93.4m in GR to meet MOE requirements for grants
  • $712.7m in AF for community mental health services for adults
  • $185m in AF for children’s community mental health services, incr. primarily to expand outpatient treatment programs
  • $22.7m to maintain higher FY19 funding for mental health grants levels into 20-21
  • $852.4m in AF for state mental health hospitals, incr. to maintain funding levels and address capacity needs
  • HHSC exceptional item 7 is a placeholder for other construction projects for the legislature to consider
  • $1.4b in AF for SSLCs, recs assume FY18 spending levels for 20-21 with reductions to account for census and reduction of certain grants


Rustin Dudley, Legislative Budget Board

  • $278.8m in AF for Women’s Health Programs, incl. Healthy Texas Women, screening, etc.; decrease of $.2 million in AF and $58.8m in GR & recs assume the 1115 waiver for women’s health is approved by CMS
  • $293.6m in AF for ECI, incr. of $4.2m in federal funds for increased caseload growth
  • $5.8m in AF for HHSC grants under Pediatric Teleconnectivity Resource Program
  • 3 behavioral health boards at HHSC are under review, would consolidate under Texas State Board of Examiners of Psychologists if recs approved
  • $942.5m in AF for system oversight & program support, majority of increase due to HHSC PCAP and resulting from HHS transition and consolidated services from DSHS


Mike Diehl, Legislative Budget Board

  • Integrated eligibility seeing decrease of $99.3m, HHSC saw a 75% matching fund increase & recs assume this rate for these functions
  • TCCO recs maintain FY19 spending level
  • S Davis – On Item 31, it states TCCO issued RFP in February 2018 and HHSC did not publish until Nov. 2018, is this normal?
    • Would defer to the agency
  • TCCO is projecting increase of civilly committed sex offenders, recs do not include exceptional item funding for caseload increase


Rustin Dudley, Legislative Budget Board

  • Provides written summary of contracts for all Art II contracts, 11k active procurements $151b
  • Presents written overview of HHSC’s major IT projects
  • Generally, rider recommendations recommend consolidation, deletion of one-time reporting requirements
  • 59 exceptional items total $6.5b in AF, ~$3b in GR, two are placeholder items


Audrey O’Neill, State Auditor’s Office

  • SAO has conducted a wide variety of audits on HHSC
  • Focusing on contracting audits, managed care monitoring, and MCO audits
  • SAO contract audits have continued to identify high priority issues
  • Most recent audit identified improvements in MCO management


Willie Hicks, State Auditor’s Office

  • Contracting priority issues primarily relate to vendor selection process, including evaluation tool and scoring issues
  • HHSC did not ensure all contracts and amendments & did not ensure values were accurate
  • HHSC also did not involve its legal department in resolutions
  • HHSC also did not ensure staff did not complete required conflict forms
  • Overall, did not have sufficient processes to ensure info entered into state databases and CAPPS was accurate & complete
  • Information was also not always accurate when compared to supporting documentation
  • Cortez – Will you be talking about some of the resolutions to these issues
    • HHSC reported that it made changes while audit was ongoing & hired a consultant
    • HHSC also agreed to implement recommendations


Audrey O’Neil, State Auditor’s Office

  • Recently released report regarding Commission’s oversight of managed care, HHSC made progress in implementation of SB 894
  • HHSC developed & implemented overall strategy for audits of MCOs & followed up on negative performance ratings
  • Commission also developed a risk assessment plan to identify the next MCOs for audit, though these had not begun by Nov. 2018
  • S Davis – Is this odd that there would be a year lag time before the audits start?
    • It is a little odd, but HHSC may be able to speak more on this
  • Delays in FSR checks as well
  • HHSC also implemented process to seek reimbursement for audit cost
  • HHSC intends to monitor MCOs via EQRO survey results, established minimum EQRO standards for 3 Medicaid programs
  • Agreed to validate encounter claims data, but had not established minimum standards by Oct 2018
  • SAO audited 3 MCOs, found that all 3 reported valid prescription, medical, and financial information
  • Audits did identify certain unallowable expenses, including expenses incurred in the wrong fiscal year or costs mismatched with services
  • SAO also evaluated timeliness, e.g. Amerigroup resolved vast majority of claims within required timeframes (~98%), but could work with PBM to find efficiencies


Courtney Phillips, Exec. Dir., Health and Human Services Commission

  • Link to HHSC presentation
  • Provides overview of HHSC, $77.5 billion budget in 18-19, requested $77.3b with $6.5b
  • Highlights HHSC organizational chart, currently recruiting Chief of Staff and Chief Operating Officer positions
  • S Davis – What is the role of the Chief Program & services Officer
    • Coordinating entity rolling in various programs & services (IDD, etc.)


Trey Wood, CFO, Health and Human Services Commission

  • $1.9b supplemental need for 2019, does not include HB 30 transfer of >$500m to TEA
  • HB 1 funds $21b in GR, key assumptions include more favorable FMAP, approval of 1115 waiver for Healthy Texas Women, etc.
  • Key budget drivers include caseloads, Medicaid case growth (can be impacted by utilization, population factors, changes in medicine); notes Texas Medicaid cost growth is slower than national trends
  • Exceptional items @$3.2b in GR, divided into 8 categories incl. client services, state and federal regulation compliance, etc.
  • Hunter – So the budget does fund the projected caseload growth?
    • For Medicaid, yes
  • Hunter – Can you explain cost growth?
    • Base budget does not include cost growth, exceptional item 1 funds this


Victoria Ford, CPO & Interim COO, Health and Human Services Commission

  • Speaking on audits related to procurements and contracting
  • HHSC internal audit: of 9 recommendations open, 5 will be complete this month
  • Scoresheet related improvements: HHSC created Office of Compliance and Quality Control (CQC) to check scoresheets, created new base template, scoresheets are locked down after initial entry, each evaluator has limited access, etc.
  • Emergency purchase process did not cover all required steps, many issues due to simple procedures
  • Ultimately, when team took over it found all conflict/nepotism forms, or issued new ones, file system was left in difficult position after previous administration fired the file manager; working to put crucial pieces into digital files
  • Hired Ernst & Young to suggest recommendations & beginning to implement, in process of setting up long-term reforms while being complaint currently
  • Regarding SCORE audit, HHSC has ability to put components needed for business processes, but was not done well in 2017; currently working on CAPPS and SCORE improvements; has exceptional item related to contracting IT
  • S Davis – Have heard from HHSC over last 2 years about contracting reforms, when do you think HHSC will be able to handle contracting and procurement without scandals and without need for SAO
    • Implementation of improvements is working over 2019 and scheduled to be complete by 2020
    • Compliant today, but working on systemic changes
  • S Davis – Have you changed the method of scoring contracts, e.g. HHSC is using excel spreadsheets; is there scoring software available?
    • Yes, there is software, have not had funding to implement so far; currently investigating best tool
  • S Davis – Asks after CQC office and if it is connected with contracting quality control
    • CQC reports to management directly, will generally have oversight on process internally and checks documents before they leave HHSC


Stephanie Muth, State Medicaid Director, Health and Human Services Commission

  • Have had 2 audits focused on overall contract management and oversight (2016, 2019)
  • 3 additional audits of health plans, which included recommendations to clarify contract provisions
  • Discusses evaluation of new contract risk assessment tool, checked scoring with contract holders to validate that tool
  • A number of entities are auditing MCOs, wanted to ensure that there is no duplication of effort, e.g. AG audit of PBMs and HHSC planned audit of PBMs
  • HHSC is currently procuring auditors for the PBM audit and expects this to be completed by the end of the year
  • Next round of financial audits is scheduled to be completed by the end of June, prepared to act on these
  • Will have EQRO results this Summer, dashboard was established and waiting on required year of data before taking contractual action
  • Cortez – What will PBM audits look like and what will we be looking for?
    • Will be looking at various areas like complaints, etc.; risk tool identifies specific topics for each audit
    • PBMs are subcontractors of MCOs & this audit is designed as a general audit of these operations
  • S Davis – Are you planning on going through the exceptional items this morning?
    • No
  • S Davis – Earlier had questions about the RFP for TCCO, Pg 33 of LBB presentation notes that TCCO issued RFP through HHSC in early 2018 and wasn’t posted until Nov. 2018
    • Ford, HHSC – TCCO got caught up in the transition period & protests over scoring problem which created delays in some procurements
  • S Davis – I’m correct in thinking this is a significant delay?
    • Yes, would say its an unusual delay, we caught up with this in August and then completed processing
  • S Davis – Regarding the Women’s Health Program and the 1115 waiver, how are the negotiations going?
    • Wood, HHSC – Currently with CMS legal for review
  • S Davis – How long have they had it?
    • Submitted in June 2017, CMS has had it for nearly 2 years now
  • S Davis – So what can you do? This is the second budget we’re drafting assuming we will get this
    • Phillips, HHSC – CMS requested data on who we’re serving, can get the complete data request to you
  • S Davis – Regarding Home Health Therapy, we about $350m from all therapy 2 sessions ago, restored parts of this in 2017; what was the impact of this?
    • Muth, HHSC – Yes, HHSC rider requires a quarterly report on therapy utilization and first report was submitted in December
    • One of the datapoints surrounded waiting lists, HHSC noted that bulk of people on the waiting lists were from one provider
    • Providers generally are reluctant to share with MCOs, currently checking encounter data to check if services are being received
    • Have seen a stabilization on therapy utilization overall; we have seen some declines, but it has stabilized
  • S Davis – I’m sure we will here public testimony to the contrary later on
    • Reports will evolve and enhance depth of data each quarter this is active


Marsha McLane, Texas Civil Commitment Office

  • Provides overview of TCCO, tiered system set up to house adult sexual offenders
  • TCCO will need case managers assigned in other areas of the state as individuals as released from Littlefield facility, not necessarily asking for more staff
  • From FY14 to FY18, caseload has grown by 83%
  • Despite expectations that civil commitments would grow much higher due to recent legal requirements, have seen less civil commitment in the last 2 years; caseload costs are still growing however
  • Regarding the delayed RFP at HHSC, TCCO gives the full RFP at the beginning and then it goes through HHSC review; time delay meant that TCCO couldn’t get numbers
  • Futures challenges include, caseload growth, ongoing contract monitoring, health care costs, etc.
  • S Davis – Who monitors contracts at TCCO?
    • TCCO hires its own staff
  • S Davis – HHSC does not?
    • Not that I’m aware of, there is an HHSC mental health unit, but unsure about monitoring functions
  • S Davis – They haven’t asked you for any info?
    • No, would think coordination would be good, unsure what they look at
  • Current contract has vendor paying first $25k for health care costs, over and above that it falls to the county or TCCO


David Flores, Texas Civil Commitment Office

  • TCCO’s baseline request was fully funded in HB 1, also had 4 exceptional items related to caseload growth, including differences between previous daily rate and expected costs, incentives for case managers, etc.
  • J Turner – 471 SVPs from around the state, how do these relate to 319 cases at TCCO?
    • Many of these have not been released from prison yet
  • J Turner – Caseload increasing from 174 to 319 between 2014 and 2018, is this unexpected?
    • Result of increase in civil commitments, case growth numbers difficult to estimate; currently 1,100 offenders in prison that get reviewed for TCCO


Spotlight on Public Testimony

Jon Wiezenbaum, AARP

  • Formerly with DADS
  • Provides overview of AARP operations in Texas
  • Has 8 recommendations, 3 cover raising minimum wage for home & community-based care attendants
  • Supporting HHSC’s exceptional item relating to background checks, recent reports have shown background checks have not been sufficient
  • Also recommend adding regulatory, ombudsman staff, etc. for assisted living programs


Heidi Schwarzwald, Texas Children’s Health Plan

  • Provides overview of TCHP
  • Recommendations: 12 months of continuous eligibility for children in Medicaid, better Medicaid access for women of childbearing age, & support integrated care; concerned that carve-outs of STAR Kids and pharmacy benefits could damage care
  • S Davis – Right now Texas requires reenrollment every 6 months?
    • Income verification check at these points
  • S Davis – Did we move to 6 months?
    • CHIP has always had 12 months, for Medicaid it has always had this income check every 6 months
  • S Davis – Do you think there are lessons to be learned from Harvey with the eligibility requirements waived?
    • Yes, families remained in care longer and reduced ER utilization; you rarely see families increasing income enough to stay permanently off of Medicaid
  • S Davis – So for instance if you allowed a mother to remain in the program for 12 months postpartum, would you anticipate better mortality outcomes?
    • Yes, 12 months of coverage afterwards would significantly increase outcomes


Laura Guerra-Cardus, Children’s Defense Fund of Texas

  • Texas needs to take action to reverse child uninsurance rates, 12 months of continuous coverage in Medicaid would help; income checks have significantly complicated ability of children to stay on Medicaid
  • Reasons to fix this include increasing damage to rural areas, increased public health risk due to missed vaccines, MCOs cannot measure quality adequately without 1 year of data, etc.
  • S Davis – So a family would deal with a renewal every 6 months, but also there are periodic income checks?
    • Yes, it is complicated; 12 months of coverage in CHIP, while Medicaid remains on 6 months renewal periods
    • ACA required no more than 1 renewal per year, so renewals happen yearly, but state implemented this via 6-month continuous care and then month-to-month income checks & any issue cause difficulties for families and can disrupt coverage


Joseph Potts, Self

  • Shares experience of raising son with IDD; Texas can do better at supporting families and individuals with IDD, funding in Texas is significantly lower than other states & wait lists are very long


Fedora Galasso, Young Invincibles

  • One of the large issues facing young people is cost of health care
  • Women should have access to health care before, during, and after pregnancy; 12 months of coverage for women of childbearing age is important part of this
  • Autoenrollment should also be pursued, should include full cost of projected caseload increase
  • Should also prioritize young adult mental health on college campuses, particularly for new mothers; should continue supporting mental health first aid


Transitional Learning Center in Galveston & Lubbock

  • Grateful to Committee for restoring CRS funding last session
  • Funding in HB 1 this biennium is a little less than last biennium, reduction could impact services; CRS funding is critical for the individuals in the program


Christina Green, Children’s Advocacy Centers of Texas

  • Even with growth, still reaching only half of cases & growth largely due to federal and private funding; requesting $12m to help close service gap, state share per case has dropped recently as cases have grown


Jamie Dudensing, Texas Association of Health Plans

  • Provides overview of TAHP operations and history of managed care transition; managed care has supported increased prevention, wellness, and care coordination with savings estimated between $5b to $13b to Texas
  • TAHP is committed to improving the managed care program, has been working with TMA & THA to develop recommendations & sent some that may be implemented quickly to HHSC; asks that state


Doug Curran, Texas Medical Association

  • Maternal morbidity & mortality is a serious issue for Texas, many still are uninsured, insurance payments are very high
  • Need to look at revitalizing Medicaid payment, have not had sustainable change in payments; proposing to begin with $500m through the Medicaid/CHIP Physician Payment Advisory Council


Carla Hughes, Advo Companies

  • Provides overview of Advo, provider working with IDD individuals, current provider environment has threatened the viability of Advo due to Medicaid eligibility issues, paperwork issues, and payment issues through MCOs


Fanya Randall, Texas Autism Society

  • ABA therapy should be available for all children & not only available for private payers; ABA therapy can dramatically improve outcomes for individuals with autism
  • Cortez – Inaudible
    • Patients will always be on the losing end of for-profit operations in areas like innovative medications or ABA therapy


Brett Coghlan, Texas Ambulance Association

  • High deductible from ACA has resulted in many not paying ambulance balance, Medicaid reimbursements are below provider costs, with rates low there are many areas in Texas without proper service


Marilyn Hartman, Self

  • Recommends: curricula on mental illness in schools, first-episode psychosis coordinated specialty care, support community care through ICFs


George Linial, LeadingAge Texas

  • State should focus on accessibility, transparency, and staff support in Texas’ nursing homes
  • Still unclear if managed care has increased outcomes, but it is clear that provider costs are increasing
  • Also requesting increased funding for staff, Medicaid rates


Audra Conwell, Alliance of Independent Pharmacists

  • State is overpaying for prescription drugs to MCOs and PBMs, state can see significant savings by removing PBMs and moving to transparent reimbursement methods
  • Other states like West Virginia have seen savings by eliminating PBMs
  • Concerned that HHSC has been slow to scrutinize the PBM system, e.g. with the delayed PBM audit
  • S Davis – I think this is a big issue that this Committee and the House will need to deal with; do you have concerns with MCOs brining PBMs in?
    • We’re suggesting one statewide claims processor, state can continue to manage formulary effectively and have access to data


Rany Tommen, ABA Today

  • Urges supports for HHSC exceptional item 44 which would allow the Commission to support children with autism through ABA; cost savings through treating autism with ABA is undeniable


Tony Ritter, Advantage Behavioral Services

  • Providers are facing financial pressures from many different vectors (staffing, insufficient room & board support, etc.), providers need Medicaid rates increased to be able to continue to provide services


Mark Stoeltje, San Antonio Clubhouse, Clubhouse Texas

  • Clubhouses provide crucial services to IDD individuals, working to bring more clubhouses to Texas
  • HB 1 has a current rider for a renewal of $1.7m for the biennium for clubhouse contractors, seeking to have this increased to $5m to support expansion & to allow this for new clubhouses
  • Cortez – You’re asking for an increasing, what can you do with this?
    • This will let more clubhouses open in Texas
  • Cortez – So this is for new clubhouses?
    • This is for new and existing clubhouses, improvements depend on how funds are distributed


Claudia Vargas, San Antonio Clubhouse, Clubhouse Texas

  • Shares experience of receiving services and working at San Antonio Clubhouse, asks Committee to support request to increase rider funding from $1.7m to $5m


Heather Pavey, Deaf-Blind Individual

  • Urges support for deaf-blind individuals and Support Service Providers (SSPs), provides overview of SSPs who assist deaf-blind individuals
  • Highlights SB 704 (Watson) relating to the provision of certain support services to persons who are deaf-blind


Kim Powers, Deaf-Blind Individual

  • Deaf-blind individuals need SSPs to be able to access community, education, etc.


Heather Withrow, Deaf-Blind individual

  • Deaf-blind individuals need intervenors & intervenors are not properly supported in the state; most other states around Texas have SSP programs
  • S Davis – Notes that the bill creating the SB 704 SSP program would not come through this committee
    • Understands, also asking for more funding through HHSC to help support the program


Larry Gonzales, Autism Speaks

  • Asking for support for exceptional item 44 to fund ABA therapy


Anne Dunkelberg, Center for Public Policy Priorities

  • Need to improve eligibility issues for children’s Medicaid and work to correct uninsured rate for children
  • Should extend Medicaid coverage period to 12 months after baby is born, not in the exceptional item list, but something CPPP strongly supports
  • Should support exceptional item 5, $71m to improve ECI funding and recover some capacity
  • Supports Medicaid managed care oversight and performance improvements, supports exceptional items, but expects legislation to be filed that will need additional appropriations
  • Also supports exceptional item 36 to increase attendant care rates, though even with the item 36 $.50 improvements attendant wages are well below other basic wage jobs
  • CPPP is concerned about phasing out of services of the 1115 waiver funds and services, need to be looking at ways to keep these funds & services; one of the best ways could be to find a solution for low-income adults in Texas
  • As a percentage of Texas personal income, in 1991 we were taxing roughly 4.9%; today we are down to 4%, difference is huge and would have had an additional $12b in tax collections last year if this was still near 4.9%, has implications for struggle with cost growth
  • S Davis – Regardless of the 4% or 4.9%, we have a spending cap, and the rate of growth of the state budget cannot exceed growth of personal income
    • I believe you stay comfortably below that cap, however
  • S Davis – I don’t know that we could if we’re talking about $12 billion, even if we collect it, it does not mean we could appropriate it


Alex Cogan, The Arc of Texas

  • Asking for support of exceptional item 22 to expand and create mental health services for individuals with IDD; can help to avoid costly mental health ER visits


Tanya Lavalle, Hogg Foundation

  • Supports HHSC exceptional items 20, 37, 22
  • Item 20 increases funded diversion beds for children with SED, which can be prohibitively costly through other methods & often requires parents to surrender children to CPS
  • Item 22 maintains funding for 8 community coordination teams, expands crisis intervention services, establishes outpatient services


Ginger Mayeaux, The Arc of Texas

  • Supports HHSC exceptional item 3 priority funding for Medicaid waiver waitlists; waitlist numbers are significant & there was no funding for waitlist reduction last session


Roney Browning, Self

  • Shares experience with IDD, testifying in support of funding for waitlist reductions and expanded services for individuals with IDD


Andy Homer, Texas CASA

  • Texas CASA funding is very strained, mostly funded through private donation, asking for additional $2.25m to support CASA operations


Kyle Piccola, The Arc of Texas

  • Exceptional items 3 and 22 are very important to The Arc
  • Also supports item 39, funding for individuals with complex support needs; there is a gap currently in services for these individuals, rider would create an enhancement to allow for attendants to assist in facilitating services
  • Relatively low amount compared to other items, can go a long way and help meet needs
  • Also supporting exceptional item for state compliance with IDD services


Denise Stahmer, Pediatric Therapist

  • Funding received is not covering operating cost, therapists are close to abandoning practice; funding generally is not enough to support the therapy industry


Bryan Mares, Texas CASA

  • Asking for funding and support to provide continued health care services to children aging out of foster care, many experience disrupted services because they have difficulty renewing coverage with the state


Stacy Wilson, Children’s Hospital Association of Texas

  • Children’s hospitals receive a high number of severe cases, disproportionately impacted by Medicaid changes as Children’s hospitals are highly dependent on Medicaid funding
  • Medicaid funding is leaving children’s hospitals behind; over 9 years children’s hospitals lost over $800m in Medicaid funding that mostly went to hospitals treating low income adults
  • HHSC Rider 27 is a placeholder rider that looks at recommendations to increase children’s hospital funding, looking for roughly $50m/year to backfill the $800m loss & can match this with federal funds
  • J Turner – Is there a source for the breakdowns of those losses by service areas?
    • Yes, losses in Medicaid result from a series of different state and federal decisions, can get this information to you
  • Sheffield – Asks that this information be provided to his office as well


Ellen Rose, Behavior Analyst

  • Asks for support of HHSC exceptional item 44 ABA funding, ABA has the strongest evidence for efficacy of treatment, endorsed by many national and federal medical authorities


Dawna Lawrence, Self

  • Shares experience as parent of children with IDD and complex medical needs, should restore cuts and increase rates for direct care staff


Rachel Hammon, Texas Association for Home Care & Hospice

  • Home care is a cost containment solution that can affect several areas of Art. II; appropriate use can keep individuals in the home and avoid ER visits, has been successful at keeping nursing home spend flat
  • Should include funding for administrative portion of community care services & increase attendant wages
  • Home care rate restorations from the 84th cuts were never realized and providers are not recovering, accompanied by decrease in utilization


Gloria Terry, Texas Council on Family Violence

  • Asks Committee to protect base funding of HHSC in HB 1, also asks for priority for funding of shelters


Beverly Black, Self

  • Shares experience with receiving services through HHSC


Erika Ramirez, Texas Women’s Health Care Coalition

  • Dedicated to preventative care for women, including contraceptive
  • Supports several initiatives, including coverage continuity between foster care and Healthy Texas Women, 12 month coverage for women postpartum, etc.
  • Providers generally are not receiving adequate funding, HHSC exceptional item 8 will help ensure funding


Barbara Lundgren, Meals on Wheels Tarrant County

  • Provides overview of Meals on Wheels’ operation in assisting potentially isolated senior individuals, asks for continued support


Mel Hocker, Self

  • Shares his experience with receiving services under the ACS waiver, asks for continued support


Emilee Whitehurst, Houston Area Women’s Center

  • Testifying in support of funding for family violence services, supports baseline funding in HB 1 & urges exceptional item request for family violence funding


David Swallow, Self

  • Should put more money into community services


Vicki Gilani, Speech Language Pathologist

  • Requests full restoration of therapy fund cuts


Dennis Borrell, Coalition for Texans with Disabilities

  • Speaking to demographic and economic forces, looking at 90% incr. in senior population in TX by 2030 & can be included in population with disabilities if receiving services
  • Younger population with disabilities is also growing
  • Wage/hour rate for attendants has declined by 30%, far below entry level jobs; Medicaid does not respond to market forces
  • Community attendant jobs are significantly growing, TWC does not refer individuals to these jobs due to federal regulations requiring them to be economically self-sufficient postings
  • Asking that committee look at a rate increase of beyond $.50 HHSC exceptional item
  • Regarding Clubhouses, $1.75m to expand centers from 4 to 22 is a bargain
  • Exceptional item 22 mental health crisis for individuals with IDD keeps people out of institutions, etc.
  • Therapy cuts from last session did not have proper hearing and the A&M creators of the report used as justification disavowed the report’s use as a basis for rate cuts
  • S Davis speaks to difficulty of situation and high amount of denial of care


Carroll Rabalais, Mary Lee Foundation

  • For Texas to make progress on the waiting list, there need to be community resources, need staff to populate these services for this to happen


Susan Murphree, Disability Rights Texas

  • Presents written list of priority funding items in HHSC’s exceptional items
  • Exceptional item 39 regarding complex medical needs should be moved up the priority list
  • Needs to be a more comprehensive look at situation for IDD individuals
  • Funding being looked at for improving Medicaid due process hearings is important, looking forward to the possibility of hearing officers being attorneys; very pleased to see that this item includes posting the hearing details online