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The House Committee on Appropriations met on September 8th to hear invited testimony on the following interim charges:

  • Space Exploration and the Space Economy: Explore potential state, federal, and industry partnerships to advance the role of Texas in the space economy.
  • Employee Retirement System of Texas: Provide an overview of the ERS Fund and implementation of SB 321.
  • Teacher Retirement System of Texas: Provide an overview of the TRS fund, and examine the current status of TRS Care and TRS ActiveCare.
  • Department of Family and Protective Services
  • Monitor efforts by the Department of Family and Protective Services to implement Section 11, HB 5 (87S2), relating to foster care capacity improvement.
  • Examine the current status of children without placement in the State’s care.
  • Health and Human Services Commission
  • Review the Texas Medicaid Program including the status of the 1115 Waiver, end of the Public Health Emergency, and implementation of HB 133.
  • Explore the goals of and eligibility for the Alternatives to Abortion Program and opportunities for enhancing services across the state.

This report is intended to give you an overview and highlight of the discussions on the various topics taken up. It is not a verbatim transcript of the discussions 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.

 

Opening Comments

  • Chair Bonnen – Will be taking testimony on remaining interim charges over the next two days; goal today is to be done by 4 pm

 

Space Exploration and the Space Economy

Panel 1

Vanessa Wyche, Director, NASA Johnson Space Center

  • NASA and industry across the state are supporting more space missions than ever Houston has played a prominent role & ready to continue
  • Provides overview of the international space station, 7 multinational astronauts on the space station & some flew there on an American commercial rocket
  • In the next 10 years will see expansion of commercial flights to low-earth orbit
  • Artemis I will launch soon, will send unmanned mission around the moon; mission incl. new orbital platform, new suits, robots, etc.
  • $228m awarded to Axiom Space yesterday to develop Artemis spacesuit
  • Exploration of the moon will eventually lead us to Mars; Perseverance is on Mars currently collecting samples & will return these to JSC
  • Highlights JSC’s efforts to support STEM education
  • Dedicated to working together with international partners; NASA and JSC are building a digital collaboration environment to assist with this
  • Released Notice of Availability for federal lands to attract space industry participants like industry, academia, and international partners; potential to create aerospace hubs that will grow the industry & benefit Texas
  • Texas aerospace industry accounts for 140k jobs across the state

 

William Harris, Space Center Houston

  • Strategic decisions of policy makers over the years has been critical in stimulating economic growth and Texas having a leadership role in space exploration
  • Nationwide aerospace manufacturing will grow 5.6% per year over the next decade; double any other manufacturing sector
  • Texas’ economy will be worth $135b by 2050, can grow more
  • Top attraction in Texas; activating strategic plan on how the public is engaged with space exploration and STEM
    • Decline of interest in STEM while the industry is increasing in roles needed
  • Texas is ranked 42nd nationally for STEM employment and is currently 10% of the national space economy
  • Have 17 of the top 20 space companies in the nation; lack adequate infrastructure
  • Working on constructing a lab where NASA and commercial/academic partners can research and have workforce development; Lunar Mars Surface Integration Facility

 

Dr. Rob Ambrose, Texas A&M University

  • Previously worked for the Johnson Space Center
  • Notes the 17 companies in the state including aircraft manufacturing, SpaceX, Johnson, and Ellington
  • Have an opportunity to “up our game” in robotic capability; Rice University will speak more on that
  • Have a lack of STEM educated worked in Texas; are 10k jobs unfilled now and will grow
  • Aerospace and human space program will help inspire younger Texans to join the workforce
    • Consortium may be a way to help cultivate this
  • Investment making in aerospace will positively impact agriculture, medicine/telehealth, and electric cars

 

Dr. Tom Killian, School of Natural Sciences Rice University

  • Time is now to position Texas for the growth in commercial space exploration
  • Rice leads in Astro-materials research
  • Need to ensure leadership continues and plan expand the Astro-materials research program in collaboration with other scientists, students, and universities
  • Will require advanced robotics and diagnostics that will have widespread positive impacts to other sectors

 

Q&A Panel 1

  • Schaefer – Financial focus for broadband has been building land lines; what should lawmakers be thinking about in terms of space and internet access?
    • Ambrose – Communication network you describe will be the one built on the moon; sometimes other counties skip entirely to wireless; combine surface and orbital network
  • Schaefer – Number of males seeking four-year degrees is shrinking, lawmakers need to consider this; have not addressed the cost of higher education
  • Schaefer – Asks the panel to reach out to rural universities or community colleges
    • Wyche – Have partnerships with community colleges and have virtual experiences for students; trying to expand virtual connections
    • Harris – Is something we are focused on, have a 10% decline in primarily men attending college; one of the factors is pre-school education and
    • Killian – Are looking to address access issues; trying to stand up programs with community colleges to help with the overall pipeline
  • Schaefer – Should look at how Purdue controlled costs; need to consider that next legislative session
  • Dominguez – How many jobs can be filled without going to college
    • Wyche – Workforce is Masters and Undergraduate degrees; mainly technicians and administrative staff do not need advanced degrees
    • Wyche – Working certain universities to increase minority student representation
    • Harris – Are STEM jobs in all industries; have a partnership with Microsoft with reskilling and need to upskill these efforts
    • Harris – Running wires in terms of broadband will be obsolete in 5 years
    • Ambrose overviews community college partnerships and need to expand them especially to draw more technicians
    • Killian – Large manufacturing component as well
  • Dominguez – What is the urgency in this investment now, who are we competing with?
    • Wyche – The opportunities are now as we will be building now; do not want Texas to miss out as competitors China and Russia are working on their own follow-on projects
  • Bonnen – Want to clarify the need; do not have a state master plan or focus
    • Harris – Is an urgency in these projects and do want to partner with the state for additional resources
  • Toth – Early reading is critical; provides a personal anecdote of their struggles with dyslexia; still in Texas schools we are not identifying students with dyslexia and this is at the heart of the problem
  • Toth – Notes one of the schools in their district is one of the wealthiest and is not identifying students with dyslexia
    • Wyche and Killian discuss exploration park; would be done like a real estate investment with funds from federal, state, private, and the tenants
    • Ambrose – Shift in focus to surface exploration and need those unique facilities
  • Sherman – Universities actively participating in consortium, how do they become a part? How do we get high schools to be a part of these programs?
    • Wyche – Specifically connect with the schools in the Dallas area; virtual tools allow to expand boundaries
    • Ambrose – Can design a consortium well aligned and can set it up quickly
    • Killian and Harris discuss their early education programs and collaborations
  • Sherman – Centralized contact person for the consortium?
    • Ambrose – A&M is the agency in charge of this
  • Wilson – What other states in competition with?
    • Ambrose – Florida, Washington State, Pennsylvania, California, Alabama, etc.
  • Wilson – Vast majority of federal dollars are not going to Texas and vast majority of manufacturing is not here; what is the total cost associated with this?
    • Harris -$290m Lunar Mars Surface Integration Facility; $150m Exploration Park; $80m for the consortium
  • Wilson – How much federal dollars out there for this?
    • Harris – Do not have an exact amount, but expect federal support for research and to spur additional investment
  • Wilson – Federal government does not want to build the facility, they want to invest in R&D; any other states already moving toward facilities?
    • Ambrose – Is pressure for a curation facility; everyone will go to those who have it
    • Killian – Florida has outpaced in terms of economic development; but Texas is the first with the SIF
  • Wilson – Want to ensure there is a firewall around proprietary research
    • Wyche – Are focused on that
  • Zwiener – How is work in space used to address climate challenges, adjustments to prepare for additional challenges?
    • Wyche – Studying climate challenges are priority; looking at ways to mitigate things like that water crisis in terms of sharing data on water reclamation
    • Harris – Discusses climate education programs and specially concerning carbon capture
    • Panelists discuss how climate variability has not significantly affected operations
  • Walle and Wyche discuss reason we are here today due to someone’s forward thinking; this plan is just the extension of that
  • Schaefer – Who would govern this new consortium?
    • Ambrose – A&M has a firewalled group that manages the consortium and the members bid on projects
  • Schaefer – Who determines board of directors?
    • Ambrose – It is not a nonprofit, do not have a board
  • Schaefer – What are the guardrails on who gets access to this research?
    • Ambrose – Have a vetting system
  • Schaefer – Receiving contract or gift money from Russia or China?
    • Ambrose – No
  • Schaefer – Has received money from them before?
    • Ambrose – Have no intent to do that here; intend for the benefits to go to funding universities in this state

 

Panel 2

Tim Kopra, Former Astronaut, President OneWeb Technologies

  • Role of the private sector in space exploration is expanding; new space economy is flourishing
  • Is clear competition among states to find unique facilities, collaboration with the state/federal government, etc.
  • Proposed government and commercial collaboration can be foundational to the future of professionals in STEM

 

Joan Higginbotham, Former Astronaut, President Ad Astra

  • Provides a personal anecdote of their participation in early education STEM programs
  • Exposure, experiences, and representation are important to build STEM careers
    • Lunar Mars Surface Integration Facility will launch the careers of students to come

 

Jack Fischer, Former Astronaut, Intuitive Machines

  • If Texas is going to have a future in leading space exploration, need the legislature’s help
  • Need to leverage the resources we already have and expand in order to compete with the world
  • LMSIF and Exploration Park will be unlike anything in the world; space port is well suited to development and manufacturing
  • Notes the work being done by Intuitive Machines; including the recent infrastructure expansion
  • Alabama, Florida, New Mexico, Colorado has targeted this industry sector; do not have the luxury of waiting to lead this

 

Gwen Griffin, Club of the Future at Blue Origin

  • Private non-profit with the mission to engage students to pursue STEM and aerospace careers
  • Texas is 3rd in aerospace employment, revenue, and value add
  • STEM-ready workforce is the backbone of all these businesses; essential to close this gap
  • Provides an overview of the work of Blue Origin
  • Bonnen – What is the one thing the state can do to help?
    • Kopra – Is always more to be done to recruit companies to come to the state; this new facility gives a leverage and will greatly attract people here
    • Higginbotham – Pipeline is important; need to expose children to different opportunities
    • Fischer – Do not have aggressiveness other states have; need facilities and consolidation of effort that make us unique
    • Griffin – Ask the state help reach into local communities early to reach kids as soon as possible

 

Employee Retirement System

Porter Wilson, Employee Retirement System

  • Administer 4 pension plans; will be talking about three pre-funded plans today
  • Were previously on the path for funds to be depleted within 30-40 years
  • Are now on a path to be 100% funded by 2054; bills last session set us on that path
  • Have been working to implement bills and have been making system changes
  • Still some work to be done with the Law Enforcement and Custodial Supplemental and Judicial Retirement Fund; both are on a path to depletion
  • Just submitted our LAR and recommend two things for these plans: covering the normal cost and put together a plan to pay off the unfunded liability
  • Schaefer – Assumed rate of return versus actual rate of return?
    • 7% and is somewhat lower than actual rate of return which is around 8%
  • Schaefer – From a future liability perspective, impactful way for us to reduce future liabilities?
    • Have done that with the creation of group 4; quicker you can pay off unfunded liability the more will save
  • Schaefer – Lump sum payment into the system would save tax dollars in the future?
    • Correct
  • Schaefer – Concerned about how ERS has implemented proxy voting that would be damaging to the oil and gas sector
    • Are not due to an activist agenda and were due to administrative errors; have come a long way to ensure they are cast in line with fiduciary responsibilities
  • Schaefer – Knew beforehand those votes were going to be casted that way?
    • Not aware about the Exxon board vote and did not know about the most recent ones concerning lending
  • Schaefer and Wilson discuss how the proxy vote system has been changed; now have a stewardship committee to review how votes are cast
  • Howard – Speak to benefit enhancements?
    • Pension fund has to be sound before any COLA or benefit enhancement can be considered
  • Howard – Would be advantageous to pre-fund? Needs to be actuarily sound 31 years is in statue? What is it outside of Texas?
    • Correct, yes, and board’s funding policy considers 20 years
  • Howard – When could we do a 13th check? Could make a move to pre-fund next session?
    • Will be actuarily sound in about a year or two; and correct that is the expectation
  • Howard – Could make larger payments to have less of a timeline, but 2054 is in statue?
    • Would be able to do it in a sooner period of time
  • Howard – Have talked about setting up a fund to be used for underfunded and unfunded liabilities; will have a large amount of excess funds that we could do something like this next session
  • Howard and Wilson discuss differences between a COLA and a 13th check; COLA would be more beneficial to retirees
  • Howard – What is the current cost retirees are currently getting a month?
    • About $1.7k a month; last time a benefits enhancement was in 2002
  • M. González asks Wilson to discuss the people included in the plan
  • Stucky – Can do a 13th check before we are actuarily sound
    • Our board’s guidelines prioritize ensuring actuarial soundness before benefit enhancements and if you do any benefit enhancements you should pre-fund them
  • Schaefer – How much does healthcare cost per year? Claims data Blue Cross Blue Shield provides?
    • About $3b in claims; data is very detailed
  • Schaefer – Get deidentified data and shows bill specifics; done any analysis to determine if overpaying/underpaying?
    • Do claims audits every year and Blue Cross does that internally as well
  • Schaefer – Do analysis on how much we pay versus Medicare and Medicaid payments?
    • Yes
  • Thompson – Violation of fiduciary duty concerning ESGs?
    • Do not have an ESG funding strategy and do not have any investments that have that element
  • Thompson – So there is no involvement with Blackrock, Vanguard, State Street?
    • They do not handle our funds, looking into them due to a SB last session

 

Teacher Retirement System

Panel 1

Brian Guthrie, Teacher Retirement System

  • TRS is actuarily sound majority due to SB 12 and legislation passed two sessions ago put on a path to actuarial soundness
  • Currently new contribution rates for both state and members are 8%
  • One more tranche of funds will be appropriated next session
  • Every four years do an experience study that looks at assumptions, longevity of membership, inflation, return assumption
  • Recommendation from actuary to lover investment assumption to 7% and board did that in July; did not have a significant negative impact on the fund
  • Are on a path to be 100% funded by 2048
  • Will update actuarial soundness in February and will have a new number for consideration in March
  • Two supplemental payments from the legislature since 2019; both times were paid up front
    • First payment cost $650m and second was $701m
  • Is significant interest in a COLA from retirees; are being significantly impacted by current economic environment and inflation
  • Capriglione’s bill that passed out of the House last session would have authorized a COLA
    • Had a 6% COLA capped at $100; would cost $3.6b
  • Lump up-front-cost would be the most prudent way to finance a benefit enhancement
  • Schaefer – Safeguards in place for ESGs and proxy voting?
    • Have an internal committee that oversees proxy voting, use ISS like ERS
    • Board reviews proxy policies every December; any vote related to oil and gas or ESG have to be notified beforehand
  • Schaefer – Controversy with corporate boards concerning abortion; speak on that
    • Would follow guidelines in statue; have no stance either way
    • Will look at each on a case-by-case basis to ensure not violating fiduciary duty
  • Schaefer – Say you have a lack of guidance on how to deal with major corporations who are attempting to circumvent Texas abortion law; would need legislative action next session to do this?
    • Is a slippery slope on how to proceed on something like that
  • Capriglione – Actual rate of return two years ago? How often are projections correct?
    • Was 25% and was not a part of the projections; generally are on target
  • Capriglione – COLA was important then and now; how much does a one-time payment cost?
    • $701m and was capped at $2.4k
  • Bonnen – If financed the one-time payment through the fund, how much ultimate cost?
  • Capriglione – Do not want people to see the lower cost of a one-time payment and assume that is cost savings over a COLA
  • Capriglione – How much more should state and participants pay to fund a COLA?
    • On 6% a lump sum of $3.6b or a contribution 0.45% increase in contribution rate
  • Capriglione – One time payment means less an less each year due to inflation
    • Would be a fair statement
  • Bonnen – Would be a 0.45% of payrolls
    • Correct
  • VanDeaver – Explain what the benefit to the retiree is if it is $100 per retiree?
    • $100 cap is a policy decision to ensure that those on the higher end are not unnecessarily getting a huge amount more
  • Sherman asks Guthrie to define actuarial soundness; based on 31 years same as ERS
  • Sherman notes there is work needed to get a COLA across in the Senate
  • Thompson – Increase percentage of state participation, could be used for COLA?
    • Method of financing could be to increase state, member, or district contribution rate
  • Howard – Wanting to make it clear that TRS is not out there circumventing Texas law
  • Howard – Are some that get less that 1k a month; proportionally how many have that?
    • Vast majority fall between 2k-3k a month; those on the lower end have less time of service or were in a low paying position
  • Howard – What percentage do not receive social security?
    • 95% of districts do not pay social security and vast majority do not have it
  • Howard – Have any sense with members with preference to COLA or 13th check?
    • Members are very focused on getting a COLA
  • Howard – Have we looked at a greater amount that were capped more than $100?
    • Did not last session and did in the past; would be probably significantly more than the proposal last session
    • Previously suggested creation a tier effect
  • M. González – Do surveys on if retirees are able to pay their bills, for medications, etc.?
    • Have not surveyed members or run a model on this, but anecdotally hearing that
  • M. González – Would love to see a graduated COLA plan
  • Will now move on to discuss TRS Care and TRS Active Care; legislature added supplemental funds last session
  • Provided a one-time payment to TRS Care recipients; Provides an overview of TRS Active Care
  • 10% of total employers left Active Care, but retained the other 90%
  • Governor’s Office provided an $460m to offset full impact of premiums due to COVID; were able to hold premiums constant
  • Most members are paying 50% or more of actual premium cost
  • Is a delta of where the premiums are and where they should be; is a temporary plug with federal funds in talk with leadership to consider options
  • VanDeaver – Health care costs?
    • In the Valley is significantly less than other parts of the state; metroplex is a bit higher
    • At least 17% higher
  • Stucky – some went to a different insurance because cost was so high, what does state need to pay compared to 2001?
    • Have not run numbers to see what amount would be today if you want same ratio in 2001 -but will do the math
    • The number would be significant, several hundred dollars more
  • Zwiener – You were thinking of premiums increasing by at least 17% if something is not done to address, how does that impact the paycheck? How does this impact the workforce, retaining educators?
    • Assuming a $600-700 month premium and a $20 increase on a monthly basis depending on coverage
    • Agrees they may look at insurance increases and wages and look at other areas to see if there is another field
  • Avg contribution for districts is about $330 for those in active care and about $380 for those that have their own health plan
  • M. González – teachers could move to another state to stay in the profession, anything we could do to make Texas comparable to other states?
    • TRS Active Care was created in 2001 and deliberate decision on legislature to make it a sum certain cost to the state, was concerned about making it an ongoing liability
    • Formula has stayed in place and achieved policy objective, as decision makers they need to decide if it’s still the appropriate policy and cautions it may be expensive to unravel all at once
  • Sherman – asked if current structure penalized school districts going into open market; the more data they can provide will be extremely helpful
    • Does not believe that but it does give them a fair comparison
    • Hopefully will have more information from education service centers to see what the markets look like and other opportunities

 

Panel 2

Tim Lee, Texas Retired Teacher Association

  • Provided background of the association and said Texas has made significant progress on working toward a well-funded pension system
  • Want to ensure the system is actuarily sound and can pay benefits now and in the future
  • Would like to see a benefit increase, possibly a cost-of-living adjustment (COLA)
  • Members were surveyed about how they spent the last supplemental check: unpaid bill, property taxes, and health care costs

 

Dr. Scott Muri, Ector County Independent School District Superintendent and representing TSA

  • Functioning retirement system is a key driver in recruitment and retaining
  • 3 main points: 1) legislature authorized a one-time payment, support another one-time payment or COLA 2) workforce shortage is in all areas, costs and admin burden with rehire of a retiree is prohibitive, 3) concerned about health care cost, without an infusion of funds there will be a significant premium increase which will have a direct affect on employees
  • Surcharges can be approx. $15k to bring a retiree in the district
  • Used federal funding to hire retirees, but once a district hires a retiree there can be an onerous paperwork process – request the elimination of the surcharge and the return to work penalty
  • M. González – do you consider this a crisis in recruitment and retention, are employees asking questions about health care, do they worry the legislature will not put more funding in?
    • Yes, would use the word crisis
    • Teachers do pay attention to the legislature actions
    • Discussion continued with Rep. González about recruitment and retention and use of ESSER funds
  • VanDeaver – voted to shift surcharge from retiree to district, what has been the impact of that move?
    • It’s a burden no matter who is paying it, does not want to see that burden on the retiree
  • Toth – wants to know if we state met TRS obligation, 1200 districts in the State of Texas and it’s the Superintendent and board that have more attention on football fields than at the classroom level, what do we do?
    • Muri – Have an accountability system, responsible to public and community and ultimately answer to them
    • Muri – clear expectations is vital
  • Toth – don’t pay teachers enough money in the state, but in appropriations will hear about importance of funding education. Believes there is a wall between the lawmakers and classroom, boards are prioritizing sports or whatever, or building a beautiful education building, etc
    • Muri – would say his board has continued to fund compensation increases
    • Muri – is highest paying district in their region and that is due to board leadership
  • Toth – how many years were you in classroom before you went into administration? Tells story of teachers he sat with and heard teachers move into administration after only three years. Many classroom teachers know more than administrators, is that a valid concern?
    • Muri – Almost a decade in classroom before moving to admin, would answer it is situational
  • Toth – ISDs treating everything similar and if the student is acting out, cursing at teacher and throws a chair what type of discipline would that student receive
    • Muri – its important to understand the totality of the circumstances, have seen mental health challenges over the last few years
  • Toth – hearing this is the #2 reason teachers are leaving so they feel safe and secure in the classroom
    • Muri – every teacher should feel safe in the classroom

 

Health and Human Services Commission; Medicaid, HB 113, and Alternatives to Abortion

Panel 1

Michelle Irwin, State Medicaid Health and Human Services

  • Walked through slides
  • Provides background and notes CHIP funding is capped where Medicaid is entitlement program
  • Managed care model is the way most Medicaid services are provided
  • Managed care has evolved over time, moving more people into the model at direction of the legislature
  • Covered focus areas which includes leveraging the managed care integrated delivery system, increasing access to services and the type of services available, using innovation and incentives to improve quality of care, and strengthening operations and oversight

 

 

Trey Wood, Health and Human Services

  • Continued walking through slides, starting with slide 15
  • Anticipates 60-day notice before end of “Public Health Emergency” (PHE), have not gotten notice yet
  • Key budget drivers include: Medicaid entitlement caseloads are projected to increase by 2.9 percent in SFY 2022 and decrease by 5.2 percent in SFY 2023, CHIP caseloads are expected to decrease by 51.3 percent in SFY 2022 and increase by 86.9 percent in SFY 2023, Cost (per client) growth is projected to decrease by 3.7 percent in SFY 2022 and increase by 3.2 percent in SFY 2023 due to changing case mix resulting from the PHE
  • Majority of spending is in non-disabled children but caseload is about aged and disability related
  • HHSC currently estimates the “Tipping Point” in which the monthly costs associated with receiving the increased FMAP begin to exceed the monthly benefit of FMAP to have occurred in May/June 2022
  • 1115 Waiver was set to expire this month, timeline of waiver was provided, in April of this year CMS withdrew and they are now operating under that previous wavier
  • As part of waiver did several things such as maintain uncompensated care through 2030 and the pool will be resized twice, overall addressed certain supplemental payment programs and directed payment programs

 

Michelle Irwin, State Medicaid Health and Human Services

  • Picked up on presentation with slide 31 on HB 133 implementation
  • Postpartum eligibility extension wavier submitted in May 2022 for federal approval, eligibility system changes are in process while the wavier amendment is pending federal approval
  • Transition of the Healthy Texas Women, transition will require an amendment to the 1115 waiver

 

Molly Lester, Health and Human Services Commission

  • Picked up presentation with slide 35 on End of Public Health Emergency Activities
  • States have up to 12 months to complete pending eligibility actions, which can begin up to 60 days before the first disenrollments will begin
    • Disenrollments cannot be effective before the first of the month after the PHE ends
  • Uncertain on end of PHE, because they have not received notification they assume PHE will be extended and next extension will take state through January of next year
  • The PHE is currently slated to end on Oct 13 and it can be extended in increments up to 90 days
  • HHSC has extended Medicaid coverage for as many as 2.7 million members and all these members will need to have their Medicaid eligibility redetermined when continuous coverage ends
  • The unwinding approach timeline was reviewed and Medicaid redeterminations will be staggered over multiple months
  • May 1, 2023 is the estimated completion of pending eligibility actions
  • Ambassador program created as a communication plan to help members prepare for the end of continuous coverage

 

Q&A of Panel

  • Schaefer – asked about a specific case of an person aging out, what happens to single or what if person was pregnant, not disenrolling anyone?
    • Will look to see if they are eligible for another program
    • Policy is not to disenroll anyone
  • Schaefer – of all births that take place, how many are covered by Medicaid?
    • 51%
  • Schaefer – a majority of all births in the State of Texas are funded by Medicaid
    • Yes
    • HB 133 requires extension of coverage from 60 days to several months regardless of outcome (delivery)
  • Walle – Under normal circumstances?
    • Would be doing regular eligibility renewals which occur annually for Medicaid but there can be periodic income checks made
    • There are individuals outside the PHE population so they have been doing regular reviews of them
  • Walle – believes there are aspects of IT limitations to recertify/reenroll people?
    • Agree people can still use fax machines but they encourage upload in online format
  • Walle – confirms no one is being kicked off at this point?
    • Certain women would still be in the program regardless of if they have given birth
  • Howard – recruitment and retention, hearing for some it is becoming a more challenging process with a lengthier form or hold times on call in…sounds like hurdles for people to work through process
    • Able to offer a small salary increase, seeing results of that
    • Seeing 211 wait times down to know around 10 min, before peak time could have been 2 hrs
    • Working with 211 vendor, working to automating some process, and recruitment and retention of staff help as well
  • Howard – asked about FMAP enhancement
    • Wood – Did not have a supplemental need last session due to 6.2% is easiest way to point to “savings”
  • Howard – because of enhanced FMAP we were able to provide services without disenrollment which mean a large population serving over a longer period of time without using additional state dollars
    • Wood – Agrees
  • Howard – anticipates PHE will end during session and at that time disenrollment will occur, moving people into eligible programs
  • Howard – what do you anticipate the supplemental need will be?
    • Wood – $3.7 billion in terms of supplemental need but this depends on PHE being extended
    • Wood – Working on assumption it will be extended so they are re-calculating
    • Wood – It could be less or more, points out again they have hit the tipping point
  • Howard – asked about disenrollment
    • If PHE ends in January, it most likely would not happen until March
    • Howard – if Governor makes this an emergency item then legislature could revisit in time
    • Howard – pregnancy can cause medical issues, see an opportunity with timing to correct things and prevent a gap from occurring
    • Lester – in theory assume disenrollment would happen two or three months after end of PHE

 

Rob Reis, Health and Human Services Commission

  • Began his presentation on page 44
  • Alternative to Abortion Major programmatic changes include
    • Expanded the definition of a client to include the parent, legal guardian, or adult caregiver (as defined in Texas Family Code) of a minor who is a program client
    • Enhanced connection to other HHSC programs, such as referrals to HHSC women’s health programs and mental health services
    • Added classes on substance abuse, parenting, and healthy relationships
    • Required contractors to provide employment readiness services, based upon needs of the clients
    • Extended maternity home eligibility from 90 days to up to 180 days postpartum
    • Refined programmatic reporting requirements to better capture services provided
    • Pilot projects include mental health disparities and modern adoption
  • Howard – unique thing with subcontractors, there are 4 contractors and one has subcontracts, do you have compliance requirements on personnel licensure or expertise in an area
    • Have monitoring activities in place
    • Do look at staff development plans and training, provided an example on mental and counseling services
    • Howard – confirms way to confirm who is providing counseling services, do you have process that assures it
    • Does have a process but says there is always room for improvement
  • Howard and Reis discuss the type of classes being taught and can get stratification to the committee
  • Reis – about half of pregnancy services come through educational materials about parenting
  • Howard – asked how they determine what is in the material? Does a pamphlet count as a service?
    • Has not seen all, but guessing there are pamphlets and confirms that is counted as a service
  • Howard –alterative to abortions discussion, wants certain metrics
  • Howard – any metrics on if goals were met on alternative to abortions?
    • Enrolled in Medicaid
    • Howard and Reis discuss various measure and metrics that are available
  • Reis confirms if certain costs are exceeded then they would be negotiated
  • Howard – confirmed there are no medical services provided
    • Correct, refers to them as social services
  • Provides statistics on those going through the program, clarifies not all data is in the report
    • Confirms nothing in the report tells us who is pregnant
  • Howard – there is no pre-natal care?
    • Correct
  • Howard – don’t know how many are pregnant, no pre-natal care, no medical care
    • Correct
  • J. Johnson – what is alternative if termination is wanted?
    • Adoption or childbirth
  • J. Johnson –  are you working directly with CPS? Is your program adaptive or ready for the potential thousand of children ready for adoption?
    • Have facilitators in place if that is the decision of the mother
  • J. Johnson – asks multiple questions about supports for medical and placement services needed
    • This program is focused on social support services and not direct provision of clinical or medical approach
    • Any pregnant mother that wants support will have access to support
  • Bonnen – legislature is policy maker and witness will execute strategy, ask for additional individuals from panel 2 to go ahead and come up and ask Reis to stay put

 

Panel 2

Chelsey Youman, Human Coalition

  • Texas has unprecedented infrastructure to empower women with comprehensive care
  • They assist in this process, need to adapt to legal landscape
  • Provided car seats, references for child care, etc
  • Has a telecare model to help reach people in rural areas…including all 254 Texas counites
  • Abortion ends a life and harms women posing mental and physical risks
  • Have licensed nurses which can also provide medically accurate information about abortions

 

Debbie Simmons, Anchor Point

  • Agrees, can give stories of lives impacted because someone stood in the gap for them and walk along side of them

 

Sylvia Johnson, Houston Pregnancy Help Center

  • 38 years into serving agrees with Youman to have this program in place post Roe was vital, structure is in place to address

 

Q&A of Panel

  • J. Johnson – thanks them for their work with the mothers who have made the decision to continue their pregnancy, but there are thousands more forced to have a child that may have abnormalities and how do we address those moms?
    • Youman – getting the mom care, but find most would rather parent than go to adoption and points out 1-2 million couples on adoption wait list
    • J. Johnson – says so many children in CPS waiting to be adopted, wants them to address in totality
    • S. Johnson – says even with babies born with deformities, some still really want their baby
  • J. Johnson – wants to know if we will re-state mission statement and goals to be in totality
  • M. González – what is different between contractor and sub-contractor?
    • Does not have relationship with the subcontractor
  • M. González – concern about allocation taken and sending out funds to subcontract, couldn’t state just contract with people directly
    • If there were 170 resource providers there would be one time and ongoing cost to address
  • Cost are $34.7 million for one year with the Texas Pregnancy Care Network (TPCN) but confirms they are administrative (approx. 170 resource providers as subcontractors)
    • Building out networking and providing oversight
    • M. González  and Reis continue to dialogue about the structure
  • Capriglione – wants to know more about services provided
    • Simmons – was able to set down with mom and provide a list of services available which began a relationship that goes on for years, resources can be provided at a financial level such as donations to help them get on their feed
    • Simmons – provided details on one case saying they see a lifelong relationship where mom can turn to them over and over again
    • Youman – 17 agencies they could apply to for assistance but those applications are lengthy, they can come along and help with the application
    • Youman – some ask for housing, and material services, etc
    • S. Johnson – also provides examples and notes they get to work with fathers as well
  • Capriglione – sounds like services for those who may be discouraged by all the barriers for assistance
  • Toth – number of foreign adoptions have dropped, there are not excess numbers of babies in foster care system, abortion is not illegal in all states
  • Toth – hopes they will maintain goal to eliminate or reduce number of abortions
  • Zwiener – asked Reis about administration, are there limitation on what funding contractors can spend funding on?
    • Reis – in the contract, medical procedure would not be allowed
    • Reis – there is an outreach mechanism that is allowable
  • Zwiener – any requirements that prohibit people from lying who seek their service? Concern with increasing criminalization of pregnant women. Do have concerns about confidentiality.
    • Reis – have to have programs, policy and procedures to meet the objective of the program
    • Reis – there are safeguards in place
  • Zwiener – do any of your hotlines maintain confidentiality?
    • Youman – Yes through HIPAA and licensed as a entity under Texas law must maintain/comply with HIPAA
    • Youman – Nurses on phone must also maintain confidentiality as part of their requirements
  • Zwiener –Do you maintain that same level with private entities that you contract with?
    • Yes
  • Zwiener – shares the story that was in the Dallas Morning News about a woman who called them and then was harassed after she hung up
    • Youman – not sure about this instance
    • Youman – after three times will not text again
  • Zwierner – what happens if someone tells them they plan to get an abortion?
    • Youman – entire focus is to serve and care for women, protect her, protect her confidentiality and protect her from criminalization
    • Youman – agree that women are the second victim from abortion
  • Zwiener – is 22 weeks to far along?
    • Youman – service planning to carry clients, planning to abort and post abortion clients
  • Zwiener – goes through some of the examples in the article and asks specifics, Youman notes the article may not have gotten the details right
  • Zwiener – also wants to know how they funnel people to their calls line?
    • Youman – every advertisement has disclaimer and is told on the phone, they do provide an abortion review that will let them know what is available and what those services entail
  • Howard – picks up asking additional questions on services, why and what they provide
    • Youman – do several things in house, including following upon enrollments
    • Youman – 24k clients last year and believes they were all pregnant and reports data to HHSC
    • Reis – will follow up on and get data back to members
  • Howard – points out you need to be pregnant to get into Medicaid
    • S. Johnson – help people with Medicaid process on the spot
  • Howard – notes written testimony was presented by Youman so focusing questions on her, 64% are forced to abort by partner but curious on research because reading they are more often coerced into continuing the pregnancy, restricting access to abortion also impacts mental health needs
    •   Youman – can provide more details, one of the studies is a newer study and points out there may be international studies
  • Howard – what else would you call this system?
    • Youman – Rescue
    • Simmons – Safety Mechanism
    • S. Johnson – name should be service based, friendly, welcoming and specific
  • Sherman – looked at definition of coerced, asked about several individuals who had stories of medical issues including James and Elizabeth Weller, says women in Texas don’t have a choice anymore so they are coerced and wonders if maybe they should push for vasectomies
  • Toth – asked about bills and exceptions for woman’s life, nothing made people carry a dead baby and that is not acceptable
    • Sherman and Toth have a heated exchange
  • Bonnen – understand everyone has an option but the panel is here to talk about their services
  • Simmons – Use woman’s right to know who has all the options there, the woman gets the choice and those who walk out and get an abortion are deeply loved
  • Zwiener – asked about them receiving about $8 million, how much was spent on outreach
    • Youman – Just over 20% (roughly $2 million) on outreach
  • Bonnen – what is needed or recommended as we go forward?
    • S. Johnson – as a subcontractor, don’t want to have to do all the reports, appreciates TCPN providing oversight and would like the model to stay that way
    • Simmons – expanding services more for adoptive families
    • Youman – prioritizing higher risk clients and measuring maternal health outcomes or birth outcomes

 

 

Monitor Efforts by the Department of Family and Protective Services to Implement Section 11, HB 5 (87 S2), Relating to Foster Care Capacity Improvement

Panel 1

Andrea Nikic, Legislative Budget Board

  • Walks through slides beginning with slide #3 covering appropriations, FTEs, non-child protective services expenditures and child protective services annual expenditures
  • Relative caregiver payments have seen the largest increase
  • Stages of services have remained constant over the last several years
  • Exceptional items and supplemental funding spotlight over the years was provided

 

Panel 2

Jamie Masters, Commissioner Department of Family and Protective Services

  • Last summer saw an unprecedented peak of children without placement
  • Staff working to reduce number of children without placement by 60%
  • Last session and during special session, $70 million was allocated to help address providers and services
  • Targeting most challenging to place population
  • RFP released in May 2022 and the proposals are being reviewed
  • 99% of efforts are being spent on less than 1%, DFPS is being used as fallback for everything else and that is not sustainable

 

Jillian Bonacquisti, Department of Family and Protective Services

  • Walked members through handouts
  • Chart covered children without placements, peaked on July 29, 2021 with 206 children statewide
    • Reduced number by 70% and number continues to decline and has stabilized for the past several months
    • Chart also shows average number of children per night without placement
    • Actively finding placements, working faster, reduction in capacity does impact
  • Slide 3 shows general residential operational capacity over time, about 50% are residential treatment centers
    • Notes license may not explain all available beds, since they are restrained by available staffing
    • Statewide have about 1300-1500 residential treatment center beds at any given time
    • Don’t have enough beds to adequately move kids through the foster care continuum
  • Slide 4 shows 61 children statewide in 2022 without placement
  • Following charts show trends of children without placement, and those kids have specialized or intense service level need and most are 13-17 years old
  • Many kids are without placement only for a couple of nights, for example new removals
  • Children without placements for longer period of times, they struggle with finding a provider that is able to meet the needs
  • Legal status and gender trends, most have parental rights terminated and typically it was even but over the past couple of months they are seeing an increase of males without placement
  • Slide 7 shows were kids were without placement, most are coming from psych hospital or runaways
  • Working on building programs within psychiatric hospitals
  • Excited about their capacity building grant opportunities, proposals are all very promising
  • Last slide emphasis the need for capacity stabilization, working with inner agency team
  • When child is placed then they follow that child, really focus on the kids
  • Evaluating residential providers
  • Supplemental payment to residential providers is very important

 

Lea Ann Biggar, Interim CFO Department of Family and Protective Services

  • Walked through slides
  • They provide a range of services
  • Breakdown provided of placement types
  • Reviewed appropriations which also targeted foster care grants of up to $1milion and they will assist with capacity
  • Funds also targeted funds for supplemental payments
  • Decline of conservatorship and foster care, biggest driver is change in law
  • 3 targeted strategies
    • Enhanced supplemental payments to state providers
    • New program for in-patient psychiatric stabilization
    • Performance incentive program and still working through process on this program

 

Q&A of Panel

  • Capriglione – discussed a video he saw, wants to know more about the difficulties
    • Masters – sitting down with case workers to talk to them, noted Austin staff was in tears talking about some concerns with staff safely caring for children without placement (CWOP)
    • Masters – CWOP has taken a life on its own, children placed in CWOP and in some cases cannot remove them when they find a placement
    • Masters – have kids in care because parents are afraid of their children, not the other way around and notes the agency cannot be everything to everyone
    • Masters – turnover is 40-45% because of forced to work CWOP, kids saying they plan to age out of CWOP
    • Masters – not every child in care, is in care because of current abuse and neglect
    • Masters – they have become the safety net for parents when they can’t manage the child’s behavior
  • A. Johnson – got confused on slide 7 and 8, psychiatric facility question
    • Bonacquisti – when children enter the psychiatric facility they meet acute definition but then not meeting the definition just days following, told behaviors for that child are baseline
    • Bonacquisti – residential providers not equipped to meet mental health needs, hoping stabilization programs, etc can help address this gap
    • Masters – a child was released who swallowed a hair brush, the agency was told it was the child’s baseline
  • A. Johnson – asked about applications coming in, next steps
    • Bonacquisti – more often than not the psychiatric programs shut down because they can not find staff or because they are not use to dealing with the aggression the kids are showing
    • A. Johnson – asked how many in the population being diverted into TDJCC
      • Masters – has data and will send to the committee
  • Walle – appendix on page 20, peak was almost 200 and any thoughts on why peak occurred? And resources to bring the peak down?
    • Masters – in height of pandemic there was so much fear, judges have put kids in CWOP or kids can appeal to judge about leaving CWOP because they don’t like the place the agency found for them
  • Walle – does department think some of the children have learned to gain the system?
    • Masters – yes, they knew where each other were and surprised they have any staff
    • Masters – put a new policy in place to remove cell phones, but trying to implement this is a whole other issue
    • Masters – don’t have ability to enforce rules
  • Walle – after January of 2022 it plateaus, what do you contribute to the decline?
    • Masters – ones left are those that have significant behavior concerns
  • Walle – how many are in hotels?
    • Masters – kicked out of many placements because of destruction of property, about 90% are in hotel rooms and they have staff staying with the student 24/7 and it has to be DPS staff
  • Walle – what did $70 million help with?
    • Masters – children that come into care, DFPS is here for children who are at risk of harm, DFPS cannot serve all needs
    • Masters – they should be able to asses safety before they come in for care, parents should have to spend time with child in CWOP
  • Walle – it sounds like you are asking about legislative needs
    • Masters – for providers to care for kids with these kinds of needs there needs to be a lower ratio and that requires funding
  • Bonnen – is there a proper placement for these children with serious/complicating factors, does the right place event exists
    • Masters – have a population they have not build capacity for, there is a step down
    • Masters – gives example of mental health challenges, they are not equipped to provide treatment
    • Masters – there needs to be a conversation upstream about what to do for the kids they are not equipped to address
  • J. Johnson – agrees psychiatric care needs to be provided, makes sense to create a psychiatric facility so kids can get the best care they need but doesn’t think that is the biggest problem and curious what has lead to staffing shortage
    • Masters – CWOP is the number one reason because of forced overtime
    • Masters – Also the pay and the job itself
  • Zwiener –  goals long term and treatment foster care
    • Bonacquisti – Multiple stabilization programs across the state, when you have more than a handful of kids then can begin to struggle
    • Bonacquisti – Treatment foster care was released under competitive procurement and they have 3 providers across the state but contact limited them to a certain area of the state, why they choose open enrollment
    • Bonacquisti – 112 treatment homes statewide, only allowed two kids in home
    • Bonacquisti – Most providers require treatment foster homes to take a break
  • Sherman – encourages members to do ride along, thanks them
  • Toth – believes this issue is something they all come together on to address, thanks them
    • Also notes remarks to Sherman from earlier exchange of admiration
  • Gates – HB 3041 testimony, asked about a CPS pathway with judiciary and collaboration with courts, asked about several parts of the bill such as kinship care increase
    • Masters – Piloted a program in Waco
    • Masters – Bill had a significant impact on removal
  • Gates – has reached out to the agency in a number of letters, wants to understand several things like when they get involved in the family
  • Gates – reviewed 241 cases out they sent to him and saw a massive number of investigations, seems like a lot of wasted time, continues to walk thought his findings in research
    • Masters – If investigation comes in, they have to address
    • Masters – they have to work intake to a certain level
  • Gates – maybe something legislatively could be done to reduce the calls?
    • Masters – they do all sorts of things to promote education and nothing they can do to actually stops call
  • Gates – CPS stats on death by abuse, most people think of physical abuse but wonders if the number is being inflated; gave examples in his findings
    • Masters – they are NOT inflating numbers to get more funding because that leads to headlines, Texas records everything in a certain way
    • Masters – record it all for transparency, if it meets definition of neglect then it gets counted in numbers
    • Gates and Masters continues to discuss this
  • Masters and Gates continue to discuss his questions including removing for future risk not immediate harm
    • Masters – her expectation is that there is an immediate risk of harm
    • Gates – appears investigations are being conducted under administrative code, concern process they use could after negatively someone getting a job and provides a case example of someone getting out of the central registry
      • Masters – agrees changes need to be made to the child abuse registry
  • Gates inquired about a shredding document example, Masters replied they do not shred documents like that
  • Gates and Masters discuss training, Gates concerned they are providing up to $6k a year for training for judge and is concerned about independency of judiciary
    • Masters – will follow up and get more details to member

 

 

Panel 3

Katie Olse, CEO Texas Alliance of Child and Family Services

  • Represents the providers
  • Agrees its about building out the continuum
  • Legislature tried to address, provided funding for capacity based care and $90 million in supplemental
    • Some of the funding has been circulated but not all, but as a result unable to report on results
  • Need rate modernization, value to provide services
  • Reviewed programs and services they have that help but notes key is community based providers
  • Doing a better job assessing kids, response to trauma may be on behaviors that are challenging, response should not get caregiver or provider in trouble
  • Safety vs normalcy decisions caregivers and providers make every day
  • Workforce issue a high priority now