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The Committee met to receive testimony from the Sunset Advisory Commission, Health and Human Services Commission and Department of Family and Protective Services. This report focuses only on Sunset and HHSC.
 
Karl Spock, Sunset Advisory Commission
Sarah Kirkle, Sunset Advisory Commission

  • Spock began to discuss Sunset recommendations for HHSC agencies
  • For 26 advisory committees Sunset recommended dissolution of the committee or continued responsibility under the oversight of the Department of Licensing and Regulation
  • Recommending better support for CPS caseworkers; DFPS should find ways to allow case workers to spend more time with children and families
  • Recommending closing the Austin SSLC and establishing a restructuring commission to take a look at the need for the remaining twelve
  • Rep. Elliott Naishtat asked if there was discussion about closing other SSLCs
    • Ken Lavine, Sunset responded that the original staff recommendation gave a number of SSLCs to close but the Committee only focused on the Austin SSLC
    • SSLCs are drastically underused and the Austin SSLC is having a hard time finding employees because of the good job market in Austin
  • Recommending combining programs for vocational rehabilitation and placing them under TWC for efficiency reasons
  • Naishtat asked if there has been talk about privatizing or outsourcing vocational rehabilitation programs
    • No; did talk about outsourcing independent living services the agency is providing with caseworkers; would be outsourced to the centers for independent living which are federally funded
  • Kirkle noted many HHSC recommendations were adopted regarding contracting, Medicaid, reorganization, etc.
  • Rep. Toni Rose noted the Sunset recommendation for the NorthSTAR counties to find a new plan was done unfairly and without enough time for a good decision to be made for all stakeholders
    • This information gathering deadline was specifically placed in the middle of session to allow for legislative discussion and guidance for the NorthSTAR system
  • Sunset found many problems within OIG and made many recommendations including taking away the Governor’s appointment of the OIG and moving it to the executive commissioner of HHSC
  • Each agency acts as its own independent agency which leads to blurred accountability and lack of authority
  • Fragmentation has caused poorly integrated client services and missed opportunities for integrated care– HHSC structural problem
  • Rep. Four Price asked how the legislative oversight committee would work – his staff had questions related to the committee’ s role throughout transition
    • Committee would be made up of representatives from the Speaker, Lt. Governor and Governor’s office and would have public hearings at least quarterly until 2023
    • Price noted the committee would have veto power over the individual agencies during transition
  • HHSC found that many advisory committees were duplicative and needed to be condensed to efficiently discuss concerning topics – number unclear
  • Rep. Susan King asked why faith and community  based task forces were being removed when the committee is already working effectively
    • There were two advisory committees that would serve the same purpose; committees would be removed and then merged or reformed
    • King wanted to see more information showing  the overlap between these committees and proof that the removal and recreation of a faith and community based task force was necessary
  • King questioned why DADS statement declared every SSLC had poor level of care – condemnation for the actual good services provided
    • Raymond clarified proposals were based on some of the SSLCs and did not make an overarching claim against SSLCs
  • Rose referenced NorthSTAR and asked if there was any indication of a want by local communities to keep or remove current program
    • There were mixed comments from community members – new recommendations are looking at missed opportunities on the state-level
    • NorthSTAR might not be the best use of publicly contracted dollars
  • Rose does not want the new system to be disruptive in her district
    • Providers that are currently serving clients are required to extend contracts for the next three years –locals  will not see a disruption in services
  • Rep. Mark Keough clarified that recommendations suggest NorthSTAR should be restructured to remove Medicaid funds
    • Essentially, NorthSTAR as we know it now would be eliminated
    • Rose noted this will disrupt services and hinder constituents
  • King asked about hotlines referenced in the recommendations
    • There are 28 hotlines in the system and the recommendation is to evaluate those; would like to utilize 2-1-1 as much as possible; will provide the list to the committee

 
Kyle Janek, Executive Commissioner, HHSC

  • Medicaid is a jointly funded state/federal program
  • Medicaid rules are governed primarily by federal law and additionally by state statute and agency rules
  • Most administrative functions of the program are funded by a 50/50 match; for other programs it is mostly matched at a 40% state rate and 60% federal rate
  • Eligibility for CHIP and Medicaid are both financial and categorical
  • King asked if there is a limit on the number of hearing aids a person can get under Medicaid over their lifetime
    • Not aware of a limit on the devices; if a person’s hearing changed they could get a new device if it was necessary
  • Rose asked for Janek’s take on NorthSTAR
    • It was a pilot program implemented in 1999 using Medicaid dollars; there has been a movement toward an integration of physical and mental health that is taking place in the other areas of the state; there is a behavioral health model that many people in North Texas are in favor of but it is not in line with the integration model
  • The CHIP program is a cost sharing program in which members put up an enrollment fee and small copays
  • Each state has an agreement with the federal government on how each state’s program will be arranged and carried out

 
Stephanie Muth, Deputy Executive Commissioner, HHSC

  • TANF is the cash assistance program administered in Texas; federal government funds the program and Texas is responsible for administration
  • TANF is funded through a block grant from the federal government
  • Monthly average of recipients in 2014 was about 80,000; fairly small
  • Eligibility is based solely on wage limits and asset limits
  • King asked how much is given out through TANF in a year
    • $26.8 million in cash assistance annually
  • King asked about the personal responsibility agreement in TANF
    • There are categories that an individual must comply with; there is compliance the agency looks for within those requirements
  • King asked how the state knows what the money was spent on; is there a prohibition on what the money can be spent on
    • There is no way for the state to know how the money is spent but the state can track some of the responsibility requirements such as work requirements
  • King noted it may be appropriate for the state to put those monies toward a program where there is some accountability
  • Naishtat asked about the income limits
    • The annual income limit for a family of three is around $2,200
  • Naishtat asked if Texas has one of the lowest income limits in the nation
    • States have flexibility in setting those limits and Texas’ is one of the lowest
  • Benefit levels are set by a rider and are indexed to 17% FPL
  • Naishtat asked if that is one of the lowest in the nation
    • Yes
  • SNAP program is often referred to as food stamps; administered by USDA; Texas handles eligibility for the program and TWC handles the work requirements
  • Because the program is federally funded 100%, the federal government defines what can be purchased  with program funds

 

  • Janek returned and noted most of the block grant the state receives for TANF isn’t used for cash assistance; about 95% of funds go toward programs that benefit people with higher income levels than the cash assistance program
  • Problems within the agency regarding contracting have been well spelled out by Sunset staff and commission members
  • HHSC has a huge number of contracts including health care providers, transportation providers, etc.; the large contracts have had problems across the five agencies for multiple reasons, not having standardized software is a problem
  • Need to set up a system for all payments made on contracts so they are all tied to a specific provision of the contract
  • The agency has a program for employees to be reimbursed for tuition expenses for continuing education; Janek noted he signed off on a reimbursement for two employees that ended up being paid up front; that is not in line with agency policy; Janek found out and noted some controls needed to be put in place; in both instances the employees will be paying the reimbursements back; changing those systems to require an evaluation committee to sign off on those reimbursements
  • Raymond asked if it is generally up to agencies what their policies on tuition reimbursement are
    • Not sure
  • Also looking at processes to improve emergency contracting
  • Raymond noted he has proposed annual budget sessions; the state is too big to have biennial budgets; proposing this partly because of some of the problems agencies run into; if annual budget sessions aren’t done, the legislature may need to give more guidance on contracts and other issues
  • Raymond noted there are other issues such as the problem with the actuary at the OIG; agencies sometimes go rogue and it happens because the legislature is only in session every other year