The Legislative Budget Board met on September 29, 2022, to address the Legislative Appropriations Request (LAR) of the Department of State Health Services. An archive of the meeting can be found here.

 

This report is intended to give you an overview and highlight of 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.

 

Budget Committee Members

Madelyn Fletcher, Office of the Governor

Amit Patel, LBB
Alyssa Jones, Senate Finance Committee

Jessica Olson, Lt. Gov. Office

Briana Novian, House Appropriations

Molly Czepiel, Speaker’s Office

 

Dr. John Hellerstedt, DSHS

  • Describes recent accomplishments of DSHS to the board including the newborn screening program is now believed to be largest in world, test each newborn twice, new screen for SMA

 

Donna Shepard, CFO at DSHS

  • FY 22-23 biennial budget is $7.8 B, $5.2 B consists of federal funds related to COVID
  • GF funds include $200 M, 40% of non-COVID federal funding is for HIV prevention and treatment, $51.6 for immunization
  • LAR for FY 24-25 funds request is $2B, includes only $331 M in continuing COVID federal funds, general revenue and general revenue dedicated funds $823 M, includes $278 M from dedicated general revenue sources
  • FY 25 FTE cap of 3,558, including 329 COVID staff, 50% decrease from hire in FY 22 for COVID
  • collections of trauma fund 5111 are performing lower than anticipated and appropriated levels
  • HIV med program has policy and IT changes and fluctuating funding from federal funds to state medication rebates
  • Workforce retention difficulties with vacancies and demand for higher salaries
  • Potential supplemental needs related to an emergency response include FEMA funds that require a 10% state match, DSHS response to wildfires and border efforts, FEMA reimbursements for state health COVID expenses continue but slow
  • COVID federal funds of $5 B in FY 22 largely for statewide medical surge staffing tapers down to $62 M by FY 25
  • Request for a total of $169.6 M and 102 FTEs with five additional items; most requests are to maintain base funding
  • Exceptional Item 1: 5 areas for $48.3 M request, $5.4 M to replace base funding reduction in vital statistics and consumer protection licensing programs, continuation of data resources, infrastructure including web application firewall, replacement of 26 vehicles, support operations at Texas Center for Infectious Disease
  • Exceptional Item 2: $8.3 M for business and individual needs, stabilizing customer service staff and vital raises, includes pay raises for 150 staff, pay increase for 148 nuclear materials inspection staff
  • Exceptional Item 3: use of public health information technology for $32.6M and 61 FTEs by 2025, systems modernization and ongoing maintenance, staffing of 20 for data analytics
  • Exceptional Item 4: $28.1M to enhance and expand public health services such as adding 6 additional clinics and 2 mobile units, facility modifications for existing units, $10.3 M for local health department grants, modest increase in rabies treatment and prevention
  • Exceptional Item 5: $56.8 M to cost effective prevention programs for HIV/AIDs and tobacco related diseases; HIV/AIDS $50.8 M for inclusion of medication to drug formulary in AIDS drug assistance programs, and changing eligibility process, $6 M tobacco prevention request such as statewide quit line
  • Patel- Question about ARPA funds, can you give us a status?
    • SB 8 funds new item was $2 B of ARPA funds for medical surge; FQHC expansion for $20 M fully awarded, EMS trauma funds for recruitment is over $21 M and is underway, also working on contract for lab construction in Rio Grande Valley

 

Katherine Wells, Director of Public Health for the City of Lubbock, next President of Texas Public Health Association (TPHA)

  • Supporting DSHS FY 24-25 legislative appropriations request (LAR) with TPHA, an org of local public health entities
  • TPHA supports funding of all goals and exceptional items, but encourage addition of funds stated in EI 4 to be increased to $40 M and go to local public health entities; $30 M would go to expanding footprint of existing local public health entities
  • GR from state to support local public health has remained stagnant
  • Request $10 M for startup funds to establish new local public health entities; areas without these entities only have limited health services from DSHS

 

Ashley Lucke, Neonatologist in Central Texas on behalf of TMA, Texas Pediatric Society and Texas Public Health Coalition

  • Support DSHS LAR to maintain existing services and describes the need for all exceptional items and supports these with data

 

Ann Bishop, Executive Director of Texas Public Employees Association

  • Describes workforce issues within the DSHS and the agency being prepared to address issues such as emergencies
  • Believes we must invest in the workforce to keep turnover from increasing, address salary compression, retirement eligibility, turnover rate, recommend longer term solution for salary raises

 

Daniela De Luna, Texas Association of Community Health Centers

  • Support DSHS LAR and exceptional items, also would like LBB to review issues of preventable diseases funding such as STD and HIV prevention
  • From 2018-2019, there was 45% increase in patients who tested positive for STDs when visiting a community health center
  • During same time period, 50% increase in patients seeking HIV testing, grew to over 230,000 tests conducted in 2021
  • Support enhanced funding for diabetes, heart disease, and hypertension which disproportionately affects community health center patients
  • Support for additional funding for Federally Qualified Health Center (FQHC) incubator program that allows growth of health center capacity, program can meet needs of broad communities across state
  • FQHC is successful so far, but increasing need to keep up with medical and mental health services, continue to see more uninsured patients

 

Dianna Welsch, President and CEO of Texas EMS Trauma and Acute Care Foundation

  • Concerned about declining revenues in GRD Account 5111, has been important source of funding for trauma system
  • Encourage legislature to maintain consistent funding for trauma network
  • Regional advisory groups seek to improve patient outcomes and would like to see the state supporting regional systems of care

 

Maureen Milligan, Teaching Hospitals of Texas

  • Recommend LAR contain funding to address shortfall in trauma fund that’s due to pandemic and change in formula for trauma fund
  • DSHS has requested $3.5 M but believe the amount should be higher, additional $20 M
  • Recommends exceptional item to address shortfall in HIV medication program which has an anticipated deficit of $30 M, support $36.6 M ask of DSHS for Ryan White program and $14.2 M to purchase new HIV treatment CABENUVA