Print 🖨

The Senate Committee on Finance met on February 21st to hear public testimony on Article II agencies. The report below is a spotlight on testimony from the roughly 180 witnesses who signed up to testify. An archive of the hearing can be found here. 

 

This report is intended to give you an overview and highlight 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 Senator Joan Huffman 

  • Public testimony will wrap up SB 1 and workgroups will go as follows
  • Article I, IV, V- Hinojosa (Chair), Campbell, Whitmire, Flores
  • Article II- Kolkhorst (Chair), Hall, Hughes, Paxton
  • Article III- Creighton (Chair), Bettencourt, Hancock, Zaffirini
  • Article VI, VII, VIII- Nichols (Chair), Perry, Schwertner, West

 

Public Testimony 

Bill Combest, Self 

  • In support of increased pay for SSLC staff 

 

Michael Jameson, SSLC Resident  

  • In support of pay for staff that supports him 

 

Debra Kates, Self 

  • Parent of child in an SSLC, thanks Sen. Hancock for assistance 
  • In support of increase of pay for staff at SSLC 
  • Kolkorst- Why did it take a senator to get your son into an SSLC? 
    • Local authority told us they couldn’t help us, took DA and Senator 

 

Brett Cogland, Paramedic 

  • In favor of increase Medicaid service payments for ambulance workers 
  • Since 2009 rates have been cut 7%, asking for 35% increase 

 

Aaron Castro, Texas Ambulance Association 

  • Ask for increase to Medicaid ground ambulance services; operational costs are increasing 

 

Rebecca Jacob, President of PARK 

  • Incredibly difficult to get admitted into SSLC 
  • In favor of exceptional items 2 and 12 for HHSC 

 

Nacy Polard, Friends of the Children Austin 

  • First and only mentoring center in Austin 
  • In FY 2020 we received state allocation 
  • Request $4.5M allowing for expansion of program

 

Hope Osborne, Texas 2036 

  • In favor of new data system for DFPS
  • Current system is based off 1996 guidelines
  • In not operable with other state agencies
  • Estimated 80M need
  • Recommend modular
  • 80% of Texas voters support this

 

Dr. Janeice Houston, Neonatologist 

  • In favor of increased payment rates for Medicaid providers, have not increased in over a decade 
  • Asking for 10% target rate increase to physicians treating children 
  • Zaffirini- How do physicians continue to participate 
    • They don’t 
  • Zaffirini- Why focus on ages 0-3? 
    • The earlier you intervene the better impact it will have on questions 
  • Kolkhorst- which children are you looking at for 0-3? 
    • Both neonatologist and well visits 

 

Dr. Louis Appel, Pediatrician 

  • Supports funding for tobacco cessation & prevention 

 

Kimberly Jeffries, Haven for Hope 

  • Requires 1 to 1 match for local communities 
  • Base appropriation was made to fund 5 communities, its now funding 7 communities 
  • Request increase in base funding from 25M to 75M for HCC 
  • Campbell- Any community across the state can use these funds correct? 
    • Yes, if their willing to fulfill the criteria 
  • Campbell- It can fund more than just than 7 correct, but the funds aren’t there? 
    • Yes 

 

Paul Cardarella, Self 

  • In favor of increase salary for staff at SSLC 

 

Kathy Larkin, Self 

  • Contests future funding of TCCO civil commitment program in Littlefield; seems the goal is to ostracize and not to treat 

 

Beth Lawson, Star Care Specialty Health System 

  • Provides overview of Star Care 
  • Perry- you have a model that does jail-based competency, among others and you touch almost every aspect of mental health 
    • Yes, except for manifestly dangerous 

 

Denise Gasmire, Champion Services  

  • Been paying $12hr which is above what we are reimbursed 
  • Staff working 50-60hs a week 
  • In favor of rate increase to pay $20hr for direct care workers 

 

Sean Delosantos, Self 

  • Supports increase in pay for private duty nurses 
  • Before COVID had 135hrs but now we only get half of that 
  • West- you are approved for 135hr but you’re getting half of that? 
    • Yes, because they can’t find a nurse 
  • Schwertner- Where would family members end up without care 
    • They would have to go to a state facility, there is only one in the state for medically fragile 

 

Marco Hernandez, Thrive Skilled Pediatric Care 

  • Due to inflation, it is almost impossible to hire enough clinicians 
  • In support of proposed rider to increase reimbursement rate to 63%

 

Victoria Jackson, Kids Care Home health 

  • In support of increase Medicaid rates for home health providers 

 

Bo Stallman, Brazoria County Sheriff 

  • Asking for increase rates for IDD workers 
  • Son has been on HCS list for 10 years, currently #40,493 
  • Zaffirini- how many people are on HCS interest list 
    • I believe it is over 100K 
  • Zaffirini- Did they give you any indication on how long he would be on that list? 
    • They said get on as early as you can it may not be until he’s 18-19 till he gets services 

 

Loree Rodriguez, Self 

  • Spoke on how the system failed in Littlefield, Texas; TCCO facility is a former prison listed as outpatient & runs as a prison 

 

Linsey Lanigan, Legacy Community Health 

  • In support of increase funding for HHSC staff
  • Thank you for incubator grant
  • In support of DSHS exceptional item 4 & 9

 

Lynn Rutland, Andrews Center 

  • LMHA has vacancy rate of over 20% 
  • Demand for services have grown 

 

Jason Pointer, NAMI Tyler 

  • 1/6 Texans will suffer from mental health this year 
  • Texas spent 26x more for cancer than mental health 
  • Texas ranked last in mental health 

 

Janet Marcantonio, Evergreen Life Services 

  • Son needs constant care 
  • In favor of increase Medicaid reimbursement rate 

 

Franco Marcantonio, Evergreen Life Services  

  • Costs to run group homes are increasing 
  • In support of increase of funds 

 

Lauren Rose, Texas Network Youth Providers 

  • Asking in prevention and early intervention programs 
  • Both programs in DFPS LAR request 

 

Ronald Smith, TNYO  

  • In support of increased DFPS funding 

 

Amy Stratton, Self 

  • Opposed to funding for TCCO facility in Littlefield, Texas 

 

David Palmer, Self 

  • Opposed to funding for TCCO facility in Littlefield, Texas 

 

John Henderson, Texas Organization of Rural Hospitals 

  • Appreciates targeted rural rate enhancements 
  • Rider caps payments at historical cost 
  • Estimated budgeted amount falls short by $13.1M 
  • Kolkhorst- What challenges are you seeing in rural hospitals 
    • It’s the same as others, challenges to hire and retain 
  • Kolkhorst- Looking at REH, what are your thoughts 
    • Generally supportive of rural hospitals facing closure 

 

Rick Carmona, Mayor for City of Terrell 

  • In favor of funding for new State mental health facilities in Terrell 
  • The jail has become primary center for individuals with mental health services 
  • Hall- Terrell is in dire straits, and is one of the fastest growing areas of the state 

 

Jennifer Williams, Self 

  • Opposed to funding for TCCO facility in Littlefield, Texas 

 

Allison Greer Francis, Center for Health Services San Antonio 

  • In support of funding for Health service centers, direct services for patients with IDD, and per diem rates for psychiatric services 

 

The committee recessed for the Senate floor session and returned 

 

Edgar Pacheco, Self 

  • Supports Medicaid direct care reimbursement rate increases
  • Hinojosa – Spot on in terms of attendants needing a rate increase

 

Evelyn Delgado, Texas Women’s Health Care Coalition 

  • Appreciate funding for women’s health programs in the budget, will fully fund family planning providers
  • Should consider mobile contraception/LARC units to address lack of services in some areas, should fund at least 3 units
  • Should consider funding patient navigators for Healthy Texas Women enrollment

 

Glenn Bradley, Self 

  • Testifying in support of son living in a HCBS waiver home
  • Service provider recently told family of new requirements coming from the state for additional recordkeeping and hours, will only make staff problems worse

 

Justine Botter, Center for Health Care Services 

  • As of Oct 22, people were on interest list 112,805  
  • Pay for direct care services is $10hr 
  • In support for increased wages 

 

Dr. Stephen Holtz, Self 

  • Texas should outlaw sex change surgeries and medications

 

Cody Klein, Self 

  • Has medically fragile child in family, without support and accommodations for childcare, working is impossible; supports reimbursement increases

 

Katie Olse, Texas Children’s Commission 

  • Goal it to have variety of programs that meet needs of children across health care continuum

 

Susan Mahoney, Self 

  • Community attendant base wages should be increased to $15 in 2024 and $17 in 2025

 

Susan McDowell, LifeWorks 

  • Urging support of exceptional item and rate modernization

 

Scott Lundy, Arrow Child & Family Ministries 

  • Appreciates investment in children in the base budget
  • Arrow is focusing on quality care, built new treatment foster care program in partnership with DFPS
  • Supports rate modernization

 

Natalia Castillo, Self 

  • Daughter makes use of ECI services, in support of ECI

 

Jelynne LeBlanc Jamison, Center for Health Care Services 

  • In support of additional 100 beds for Bexar County and psychiatric facility; large need in Bexar

 

Dr. Sally Taylor, University Health San Antonio 

  • In support of HHSC strategy G.2.2 relating to mental health hospitals

 

Eric Epley, South Texas Regional Advisory Council 

  • What happened in Uvalde will happen again, trauma and crisis mental health systems are colliding; Collaborative was established to help navigate
  • Kolkhorst – Psychiatric center?
    • Local center not operated by the state, asking for capital funding & facility to be operated by university or another

 

Amy Price, United Way 

  • Provides overview of 2-1-1 system; asking legislature to support system

 

Dr. Jackson Griggs, Waco Family Medicine 

  • Should establish full year of Medicaid postpartum coverage, increase funding for preventative services, and targeting Medicaid payments to increase access to OB care

 

Evita Moreen, Rise Recovery 

  • Appreciates funding for opioid recovery, need funding for early prevention and intervention, particular for peer support model

 

Brian Broadbent, Self 

  • Daughter in MDCP; should fund meaningful rate increases for private duty nursing
  • Capitated rates are not correct, MCOs are seeing higher profits while medical costs are going down
  • Huffman – Research is impressive, Sen. Kolkhorst should look at this in her committee

 

Cody Clark, Avid Quality Care 

  • Texas is one of the lowest in the country for individuals with IDD; requests for increased funding are ignored & exceptional items are not addresses

 

Texas Panhandle Behavioral Health Task Force 

  • Lack of services in Panhandle; presents proposal for new hospital with 125 beds providing comprehensive services

 

Jana Eubank, Texas Association of Community Health Centers 

  • Should consider $50m into community grants and support FQHC incubator program

 

Jessie Hinojosa, Rise Recovery 

  • Should increase funding for treatment and recovery services

 

Craig Russell, Down Home Ranch 

  • Advocating for increased rates for direct care staff

 

Jason Berry, Berry Family Services 

  • Provides overview of Berry Family Services, services are important & need support

 

Amanda Stone, Sentido Health 

  • Requesting additional funding for home health services; nearly impossible to retain competent nurses for home health due to low rates and high requirements

 

Lindy Borchardt, Tarrant County Attorney 

  • Urging support of study for state mental health hospital in Tarrant County, some inmates have been waiting for 2 years for competency restoration
  • Huffman – Do you have an in-jail competency restoration program?
    • Yes
  • Huffman – Is it working?
    • Will let others speak to that
  • Huffman – Concerned about the issue and there will be some digging into that

 

Susan Garnett, MHMR Tarrant County 

  • Testifying in support of state hospital in Tarrant County, in-jail program is only serving roughly 40 people

 

Tarrant County Commissioners Court 

  • Inmates waiting for competency restoration in Tarrant County jails is one of the largest year-to-year cost increases; new facility would greatly alleviate this
  • Huffman – Have you thought about expanding the jail-based competency restoration program
    • Garnett, MHMR – Maximized the funding available under the bill
  • Huffman – If we gave you more funding could you expand that?
    • Garnett – Could expand, jail is not the best setting
  • Huffman – Need to do this one way or the other so people can move through the system; hospitals are understaffed and can’t keep up; continuing to build hospitals that we can’t staff is an issue
  • Kolkhorst – What state hospitals do you send inmates to?
    • Garnett – Served by North Texas State Hospital at Wichita Falls, has been affected by COVID and other issues
    • Also have funding from HHSC for 30 beds at the local safety net hospital, JPS
  • Kolkhorst – Tarrant County wasn’t part of the 2015 hospital plan?
    • Garnett – Has been a growing challenge for Tarrant County
    • Not asking for build out of hospital, asking for planning & study to find best solution
  • Kolkhorst – Build up Wichita Falls? Move it?
    • SB 1 sticky note is for reconstruction, enough need in 53 county catchment to warrant additional beds
  • Huffman – Discussion will be ongoing

 

Zelia Baugh, JPS Health Network 

  • Asking for state investment in Tarrant County mental health hospital, funding for training & academic programs

 

Henry Reyes, Tarrant County Sheriff’s Office 

  • Need to study need for hospital; large impact on Tarrant County jail

 

Stacy Combest, Self 

  • Son is in Denton SSLC, SSLCs need help for on-campus staff
  • Kolkhorst – If we can staff, how difficult is it to get someone into an SSLC? Confused why LIDDAs don’t allow when parent’s want this option
    • Local authorities are prohibiting access to the SSLCs, not sure why, but violating H&S Code, performance contracts, and LIDDA guidebooks
    • Should have a LIDDA oversight hearing

 

Dr. Brent Fields, Morgan’s Inclusion Initiative 

  • Highlights Multi-Assistance Center which brings services together in one facility
  • Campbell – Asks about staff at the MAC
    • Navigators help clients access services seamlessly
  • Campbell and Fields discuss the MAC as a service coordination entity, pilot program that works with those with disabilities
  • Kolkhorst – What is the ask?
    • Continued and increased funding; not charging for navigation which involves a lot of staff
  • Kolkhorst – So you want us to fund the navigators?
    • Asking for additional $7.5m over the funding period, on top of existing $7.5m
  • Kolkhorst – Only serving Bexar County?
    • Any age, special needs, can be from anywhere in the state

 

Candra Shots, Self 

  • Testifying in support of son with medically complex needs; caregivers are in short supply and SSLC care difficult to access

 

Elizabeth Henry, Recovery People 

  • Testifying in support of recovery funding

 

Meera Riner, Texas Nursing Home Providers 

  • Appreciates funding for LTC in budget, rural providers face greatest risk of LTC closures

 

Eddie Parades, Texas Nursing Home Providers 

  • Appreciate nursing home rate adjustment in SB 1
  • Minor changes are necessary in Rider 24, currently references PHE which ends May 11th and rate adjustment limited to that; should decouple and increase rates
  • Kolkhorst – What is your capacity?
    • Overall at 60%, urban centers have higher occupancy rates, rurals have low; have seen a 13% reduction in utilization over COVID, but slowly growing back
  • Kolkhorst – What percentage of your overall budget goes to direct care?
    • 60%-70%, but variable given acuity
  • Kolkhorst – What are you paying direct care?
    • From $10 in rural areas to $17 in urban, still using staffing agencies

 

Alec Mendoza, Texans Care for Children 

  • Highlights ECI programs, chronically underfunded on the per-child rate; should support ECI

 

Katrina Belt, Evergreen Life Services 

  • Not funding services for those with IDD adequately, TX has the largest waiting list for HCBS

 

Jamica Johnson, Evergreen Life Services 

  • Lack of funding for HCBS is having severe negative impact on care

 

Michael Lindsey Evans, Self 

  • Resident at Evergreen Life Services

 

Haley Vasquez, Self 

  • Resident at Evergreen Life Services

 

Shelby Mace, Evergreen Life Services 

  • Highlights Olmstead Act

 

Linda Bailey, Evergreen Life Services 

  • Highlights employee at Evergreen who works with residents with IDD

 

Karen Towery, Evergreen Life Services 

  • Would like to be involved in LIDDA conversations, LIDDA has interfered with access to beds & classifications are difficult to deal with
  • Kolkhorst and Perry note there was money set aside for these entities, but has had difficult getting out; will check with HHSC

 

Kim Fincanon, Evergreen Life Services 

  • Highlights need for support of HCBS

 

Danielle Davila, Evergreen Life Services 

  • New regulations will impede day program services for some residents

 

Charlie Gagen, American Lung Association 

  • Should increase DSHS tobacco prevention & cessation funding as requested in exceptional item 4

 

Rosalie Tristan, Self 

  • Shares story of daughter who passed away, asking for support of tobacco cessation programs

 

Mandy Harner, Self 

  • TCCO buildings are over capacity, funding is not being used correctly

 

Brenda Hewitt, Nexus Recovery Center 

  • Highlights positive impact of Nexus Recovery Center

 

Ella Troop, Student 

  • Tobacco and vape addiction is very high in TX schools, detection and prevention is lax
  • Asking for increase tobacco prevention and cessation funding

 

Johnathan Wellman, RN 

  • Base nursing rate has not been increased this century, cost of living has grown & now at crisis

 

Rebecca Sorenson, Lone Star Circle of Care 

  • Appreciates support of BCCS over the next biennium, mammogram is the best tool available for most women to detect breast cancer

 

Shannon Hoffman, Hogg Foundation for Mental Health 

  • Appreciated funding for mental health in the base budget, but funding for 9-8-8 was not included in crisis service strategies
  • Grant funding will end in 2024 and no further funding expected
  • Should

 

Lynnel Hanks, Self 

  • Son is a resident in TCCO center in Littlefield
  • 30 states don’t have civil commitment because of the long term burden on the taxpayer
  • Sen. Whitmire was previously concerned about treatment, men in TCCO are not being treated humanely & segregation is overused

 

Rene Lopez, Self 

  • Attendant wages have not been raised, asking for livable wage for attendants; will cost state more money for people to go to nursing homes

 

Robin Hoffpauir, ADAPT of Texas 

  • Previously worked in the community, made $8 in 2006; attendants are overworked and underpaid

 

Bob Kafka, ADAPT of Texas 

  • Largest population needing HCBS are in STAR Plus managed care, need to raise attendant wages

 

Nicole Robinson, Self 

  • Son is a resident in TCCO center in Littlefield, funding is not being used appropriately
  • Perry – Have visited facility; facility houses some violent individuals, need to get the other side of the story

 

Nancy Kroger, ADAPT of Texas 

  • Attendant services are crucial

 

Christopher Potello, Self 

  • Attendants are not treated well & underpaid

 

Danny Saenz, Self 

  • Supports raising attendant base wage

 

Gene Rogers, Self 

  • Should raise attendant rate to at least $15, can’t find attendants without this

 

Pansy Case, Self 

  • Supports raising attendant base wage

 

Albert Nicks, ADAPT of Texas 

  • Attendants need $15 base rate

 

Hunter Atkins, Self 

  • Dependent on caregivers, without attendants would need to be in an SSLC

 

David Perkins, Self 

  • Daughter lives at Abilene SSLC, supports funding for staff and services

 

Jesse Howard, Girling Health Care 

  • Have had significant challenges due to low pay for attendant services; national average is $14, TX is $9

 

Curtis Young, Parkland Health System 

  • Dwell time in ERs is long for those who need psychiatric beds
  • Requesting funding for intensive outpatient and partial hospitalization programs

 

Sharon Butterworth, El Paso Behavioral Health Consortium 

  • Asking for $50m for stage 1 planning for redesign of El Paso State Hospital

 

Marjorie Costello, Disability Services of the Southwest 

  • Attendant services reimbursement rate increases needed, only able to serve about 50% of need
  • Home care will save lives, money, and keep families together

 

Lauren Gerken, Texas Council on Developmental Disabilities 

  • Testifying in support of ECI, provided her and family with a trajectory

 

David Mamen, Self

  • Highlights Prescribed Pediatric Extended Care Centers

 

“Mama PK,” Self 

  • TCCO seems to be unconstitutional, only way to leave TCCO is often by death
  • Bettencourt – What is the solution?
    • Solution is to get nonpartisan psychologists who haven’t worked at TCCO to work with on the system

 

Sydney Carter, Network of Behavioral Health Providers 

  • Asking for increase in Community Mental health Services for Children
  • Supporting salaries increases, but disappointed Harris County IDD authority was not included

 

Jacquie Benestante, Autism Society of Texas

  • Those with autism need support across their lifetimes
  • Finance should improve funding for Medicaid autism services, incl. $70m/year with reporting mechanism
  • HHSC autism programs should get a 13% increase to match case growth in state, e.g. Children’s Autism Program

 

Texas EMS Alliance 

  • Costs have increased significantly, largest cost increase is for workforce

 

Tod Citron, Hill Country Mental Health & Developmental Disability Centers 

  • Asking for support of HHSC exceptional item for the Uvalde assessment

 

Diana Forester, Texas Care for Children

  • Many mothers are losing coverage this year, additional funding would be helpful to handle larger need
  • Should increase postpartum coverage up to 12 months

 

Jane Web Richards, Nurse 

  • Daughter has special needs, supports funding increase

 

Andrea Pearl, AARP

  • Should increase funding for HHSC staffing improvements, increase funding to the Texas Lifespan Respite Care Program, increase base attendant wage

 

Kristen Robison, Angels of Care Pediatric Home Health 

  • With current rates unable to meet staffing needs of medically fragile children in the state

 

Carol Anderson Bell, Exceptional Home Living 

  • Unable to keep staff with current rates, need to increase to at least $15, preferably $17
  • Received some HB 8 funding

 

Brian Ketay, ICL 

  • Thrilled that care providers received a raise, but need to raise attendant wages, losing skilled personnel & can’t continue operating with the current wage

 

Donna Kotzur, the Arc of San Antonio 

  • Asking for attendant wage of $15/hour

 

Dennis Borel, Coalition for Texans with Disabilities 

  • Amount of services for those in community care are significantly reduced from previous levels, turnover is extremely high due to noncompetitive wage
  • Zaffirini – What would you say about reducing number of people on list?
    • Number of people is not the focus, but years of wait
    • Need to make a longer term commitment session-over-session
  • Zaffirini – Would you prioritize certain lists?
    • No, need to look at all equally

 

Hunter Ryan, Harris County Medicaid Expansion Coalition 

  • Supports extending postpartum coverage from 6 to 12 months; coverage would save state money

 

Dr. Rick Ngo, Texas Surgical Specialists, American Cancer Society 

  • Tobacco use has led to large increase in premature deaths, tobacco companies spend $700m annually on marketing in TX
  • Should increase funding for tobacco control to $6.5m annually and breast & cervical cancer screening programs