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