Senate Finance – February 6, 2019

The Senate Finance Committee met on February 6, 2019, to discuss Article II – Health and Human Services. The Committee heard public testimony on Article II generally as well as invited and public testimony on the Department of Family and Protective Services.

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

 

Public Testimony on Article II

• Heather Pavey – Deaf and blind, representing Texas Support Service Providers (SSP) coalition, supporting a bill now in process.
• Kim Powers – Deaf and blind, SSPs are crucial for deaf and blind community to accomplish needs.
  • Watson – I have a bill draft this session that will allow us to have the discussions on these issues.
• Stacy Wilson, Children’s Hospital Association of Texas – Children’s hospitals rely heavily on Medicaid, in a short period of time Children’s Hospitals are losing $800m in Medicaid funding. Asks legislature for $50m per year to help backfill for the $800m they are losing.
• Jamie Dudensing, CEO Texas Association of Health Plans – TAHP supports improvements to administrative paperwork, quality of care, etc.
• Antonio Falcon, Representing TMA and himself – Asks committee to increase funding for physicians in the Valley.
  • Flores – What percentage of your practice is Medicaid?
  • Falcon – About 80% and it has been 10-years since our Medicaid funding was increased.
• John Wisenbaum, AARP – Raise wages for home attendants. Increase funding for Meals on Wheels, assisted living staff, and Adult Protective Services.
• Richard Thorn, CFO Advo Companies – Wages are not high enough to recruit the needed number of employees. Turnover rates were high.
• Thomas Mueller, Texas Academy of Family Physicians – Asks Committee to implement tailored health coverage for women of child-bearing age, prevent gaps in preventive care, importance of pre-natal care.
• Laura Garricardis, Children’s Defense Fund of Texas – Asks Committee to address the number of uninsured children in the state.
• Alexander Kenton – Medicaid payment rates are too low, asks Committee to raise Medicaid payment rates in order to provide better service to poor patients.
• Steven Marin – Expand access to ABA for autistic children. Autism costs $2m more to the state per person with autism. Children who get 3 years of ABA generally do not need special ed or assistance as adult. Making ABA more available would save the state a significant amount of money.
• Rafael de La Pasa, Community Health Centers of South-Central Texas – Requested increased funding for health care in South-Central Texas.
• Vita Goddell, Fort Bend Women’s Center – Discussed an exceptional item for women’s shelters to improve service.

 

Department of Family and Protective Services

Andrea Nikic, LBB

• $4.3b in all funds, increase by $25.8m from last biennium
• Significant funding increases from additional case workers
• Reviewed funding for individual programs under DFPS
• Recommendations assume DFPS will reach optimal number of caseworkers by the end of 2019
• Exceptional items
  • $349.2m in all funds, 1,149.2 FTEs
• Watson – Rider highlights, item 11, reporting requirement on child removals by race or ethnic group, what specifically are you referring to and what is the content of that rider?
  • Nikic – It was just a name change, there was no content change for that rider, so you will still be able to see child removal percentages by race.
• Nelson – Is the agency in charge of inspections of daycare facilities?
  • Nikic – They are only in charge of investigations for licenses, not inspections
  • Nelson – Do we get federal money for that?
  • Nikic – HHSC is now in charge of inspections, and there is a federal block grant used for those inspections
  • Nelson – And the federal money flows through DFPS to TWC?
  • Watson – Yes.
  • Nikic – We are appropriated some money directly and we receive additional from TWC.
  • Nelson – How much of each of those?
  • Nikic – In 2018 we received additional federal funds for the CCDBG fund, and we funded the supplemental need with those.
• Kolkhorst – LBB staff projections assume a supplemental fiscal need in 2019 of $23.5m, will federal funds cover all of that?
  • Nikic – We assume TWC will work with DFPS to cover that shortfall.
• Watson – TWC is where we provide people with subsidies so they can access daycare, there are an enormous amount of people on the waitlist, and we are on the low end of states based on how many subsidies we provide.
• Nelson – Is this an entitlement program?
  • Nikic – No.
  • Nelson – Aer there any other funds flowing through DFPS to TWC for this program?
  • John McGeady, LBB – No I do not believe so.
• Kolkhorst – Data from DFPS rider 21 does not conclude community based care is leading to a better outcome for foster children, who conducted that study?
  • Nikic – Defer to the agency.
  • Kolkhorst – Did LBB or the agency conduct it?
  • Liz Pardo, LBB – The agency wrote the report, I would defer to them.
• Kolkhorst – Can LBB give an update on where we are on the lawsuit?
  • Nikic – There were new injunctions in November, agency can give more details
• Kolkhorst – Is there an analysis of how much federal money we will be able to pull down when the Family First Prevention Service Act is implemented?
  • Nikic – We do not have that information at this time.
  • Kolkhorst – Who can give us more information on that?
  • Pardo – We are currently analyzing that and the agency is working on it as well.
  • Kolkhorst – Could you get a timeline of about 2-3 weeks for that?
  • Pardo – Yes.
• Huffman – Child care licensing, HHSC exceptional item 40 had 35 FTEs for Child Care Licensing Inspectors, is that different from the DFPS request for child care abuse and neglect investigators?
  • Nikic – There is a difference, DFPS personnel will go and investigate allegations of abuse and neglect while HHSC act in a regulatory manner.
• Watson – 2 Sessions ago, as part of HHSC transformation, they were going to do all investigations. Last session there were a couple bills that said DFPS through CPS would do investigation, is that correct?
  • Nikic – That is correct.
  • Watson – My understanding of the 35 FTEs for HHSCs is to investigate illegal or unlicensed child care facilities, while DFPS handles cases of abuse and neglect?
  • Nikic – That is correct.

Hank Whitman, Commissioner, DFPS

• Reviewed DFPS requests
• Brought information on potential costs for class action lawsuit
• West – IT projects, impact modernization project, there is a $34m overrun and it is 54 months behind schedule. QAT noted vendor would not be able to complete the project. New project completion date is August 2022. How much money did we spend, and will we get any back?
  • Lynn Blackmore, COO, DFPS – We will work with LBB to figure out the difference in costs. Our current project impact modernization phase 2 we have been much more aggressive in our contract management.
  • West – So did the first vendor complete their contract?
  • Blackmore – Yes Accenture was the vendor and completed the project.
  • West – And the coding defects in phase 1 occurred while you were in your current position?
  • Blackmore – Yes.
• West – On page 2 of the Commissioner’s statement, it says TX compares favorably with national average of family caregivers?
  • Kristene Blackstone, Associate Commissioner, DFPS – As the legislature has added support for kin we have seen those numbers go up.
  • West – How is this program working in terms of outcomes?
  • Whitman – It is working well. There are some problems with it, but it is much better than what was in place in the past.
  • West – What are the primary impediments to participation in the program?
  • Whitman – We have to find placements for children with possible mental issues. There is also more we can do to pay people adequately. I will meet with grandmothers, aunts and uncles, to see what their needs are.
  • West – Are federal requirements sometimes impediments to the program?
  • Whitman – There are no federal requirements until they are in a foster program.
• West – SB 355 directs the agency to develop a strategic plan to ensure the agency meets the requirements of the federal Family First Prevention Services Act
  • Blackstone – We do not need additional funding to meet the requirements. We are currently analyzing the federal act to see how we can best draw down those funds and comply with the act.
  • West – Asks about state audit report
  • DFPS – Yes there was a risk audit, they identified that we are not making contacts with some of our clients and in some cases were not in compliance with our own policies.
  • West – What have we done?
  • DFPS – We have provided retraining to all of our staff to ensure compliance with our own policies.
• Nelson – How much prevention money did the agency receive last biennium?
  • $206m for the biennium, which is in the introduced bill this biennium
  • Nelson – Did you spend all that?
  • David Kinsey, CFO, DFPS – We spent 93% in 2018 we are working to spend all of that this year.
• Watson – Question about PAL program, should the independent living assessments be for 14 and 15-year-olds instead of age 16?
  • Blackstone – In terms of the assessment it would be better for 14 and 15-year-olds, for the classroom the curriculum is developed for 16 and up so it would require changes to the curriculum for younger students.
• Watson – Should we expand community-based care before we see positive outcomes?
  • Blackstone – They do certain things better than the state, and we have seen improvement in these programs.
• Kolkhorst – Was rider 21 report written internally?
  • Blackstone – We write it internally with assistance from University of Chicago.
• Kolkhorst – MD vs Abbott lawsuit, where are you on that and where does it put us for the session?
  • Legal counsel for DFPS – We are appealing some of the judge’s ruling where we feel she went outside the 5^th circuit’s ruling
  • Kolkhorst – Is the timeline for that by the end of the session or not?
  • DFPS counsel – There is no deadline for the judge’s ruling, so we cannot say when that will happen.
• Nelson – Daycare was running at a shortfall over the interim, CCDBG money was new money that we cannot rely on long-term, how much new money was that.
  • Kinsey – It was in the hundreds of millions for FY 18 and FY 19, I do not have the exact numbers.
  • Nelson – Do you anticipate these trends to continue, and since we can’t rely on this money what have you done on this issue?
  • Kinsey – We have implemented certain policies to help reduce costs.
• Perry – There is not enough to know yet what the effects of community-based planning?
  • Blackstone – I think there are even some positive results so far.
• Perry – What is your opinion on family termination legal processes and costs?
  • Whitman – It depends on the District Attorney or the judge who is running the case.
  • Perry – I have seen data that family terminations are happening earlier in the process and more frequently, and some CPS caseloads are over by May because they don’t have enough money.
• Perry – I see that there is a $4m cost for a checkbox, why does this cost so much?
  • Kinsey – I do not have that number with me, I can get back to you with the accurate numbers.
• Taylor – Software overruns, I would like an explanation as to why it cost $4m to add something like that. It seems to me we are getting “taken to the cleaners” on these software programs, it seems like some of these contractors are overpricing because it seems complicated when it is not.

 

Public Testimony

• Jason Berry, CEO Berry Family Services – Rate cuts from previous sessions have created serious challenges for certain programs, have increased turnover rates among nurses and support staff.
• Olga Kauffman, Urban Strategies – Spoke about people who lack health insurance, people die if they don’t have health insurance.
• Sandra Britengass, Texas State Independent Living Counsel – Independent living program is important, higher wages could help with recruitment and retainment.
• Rachael Hammon, Texas Association for Home Care and Hospice – Home care is a cost containment solution for the budget. Asking for 7% increase in administrative portion of the rate, higher wages for attendants.
• Tanya Lovell, Hogg Foundation for Mental Health – Exceptional items 20 and 37, funding for services to provide health services to children whose families would otherwise have to relinquish custody to get health care for their children.
• Lee Dunson, Mary Lee Foundation – Requests wage increases for employees.
• Audra Conwell, Alliance of Independent Pharmacists – There is a more efficient way to do MCOs and PBMs. A new fully transparent model for prescription drugs in Medicaid would create savings for the state.
• Carol Naddie, NHMR Tarrant, UNT Health Science Center – Continue funding mental health initiatives.
• Adrianna Coler – Make available the $71m HHSC requested in LAR for children’s health programs. Texas has highest rate of uninsured children in the nation.
• Gloria Terry, Texas Council on Family Violence – Request continued support and exceptional item funding.
• Shannon Hoffman, Hogg Foundation for Mental Health – HHSC exceptional item 21 is necessary to cover a number of gaps.
• Anne Dunkelberg, Center for Public Policy – Children’s health coverage should continue to improve. Enroll more uninsured Texas kids. Support HHSC exceptional item 5.
• James Turner, Austin Police Department, Crisis Intervention Unit – Proper training and resources necessary for crisis intervention. Need to stop putting people with mental illnesses through criminal justice system.
• Jackie Hamm, President of the Board of Meals on Wheels in Texas – Requesting support for a rate increase for Meals on Wheels. 1 year od Meals on Wheels costs the same as 1 day in the hospital.
• Jeffrey Dillon, Texas Association for Behavior Analysis Public Policy Group – Requesting support for HHSC exceptional item 44, coverage of ABA in Medicaid.
• Summer Adame – Provides overview of impact of ABA services for children and adults with autism, especially for young children.
• Hernandez, Autism Treatment Center – Support for HHSC exceptional item 44.
• Inaudible name – Supports HHSC exceptional item 44
• Julie Ross – Exceptional item 3 in reference to Medicaid waivers for people with IDD.
• Kyle Piccola, Arc of Texas – Support for HHSC exceptional item 38, for training for medical personnel for people with higher levels of medical needs.
• Andrew Homer, Director of Public Policy Texas CASA – Supporting the HHSC exceptional item covering CASA.
• John Hawkins, Texas Hospital Association – Thanked the committee for base level funding of certain programs, including a replacement driver responsibility bill with funding for trauma.
• Michelle Dooley – If funding for group homes is cut any more it would be devastating for the programs.
• Charles Barman – Put on waiting list for certain benefits, told it would be 15-20 years before getting off the wait list. Make funds available for these programs.
• David Swallow – Important to put more money into community services.
• Beverly Black – Support funding for community services, care programs for people with mental disabilities.
• Lauren Ronhale, TCCD policy fellow – Supports HHSC exceptional item for ECI funding.
• Brooke Hofield – Supports funding for community services and to reduce waiting list times.
  • Hinojosa – We have been trying to increase funding to reduce waiting list times.
• Susan Murphy, Disability Right Texas – Supports funding for adults with mental disabilities
• Name and organization inaudible – Raise wages for community attendants for people with disabilities.
• Sophia Donnelly, community attendant – Raise wages for community attendants, at current levels many community attendants have to work two jobs well over 40 hours per week.
• Ronnie Browning – Supports programs for adults with IDD.
• Doug Smith, Policy Analyst with Texas Criminal Justice Coalition – Supports programs for substance abuse disorder. Many providers cannot accept certain clients due to the low reimbursement rate from the state. Expansions to provider reimbursement rates.
• Richard Hernandez, Government Relations Director for Rest Care – Supports funding expansion for people with IDD. Cannot adequately support people coming off the waiting list in the existing program. Solely funded by Medicaid, reimbursement rates are lower than they were 10 years ago.
• Jackie Benestante – Supports HHSC exceptional item 44 to cover ABA therapy with Medicaid.
• Dennis Borrell, Coalition of Texans with Disabilities – Increasing elderly populations, increases the disabled populations, community will need higher wages to deal with this.
  • West – How does average wage for community attendants in Texas compare to other states?
  • Borrell – We are the lowest, we also offer no benefits or sick pay.
• Alicia Post– Son has autism, benefited from ABA. Supports ABA therapy expansion.
  • Kolkhorst – Will ABA therapy be used for the entire lifetime?
  • Post – ABA therapy gradually reduces as age increases, sometimes it stops in adulthood and sometimes not.
  • Campbell – There was a bill passed last session to allow more certification of ABA, so why can so many people not get access?
  • Post – If it is a self-funded plan that bill does not cover.
• Kathy Cranston, Adaptive Texas – Should raise community attendant wages.
• Keith Lofton – Should raise community attendant wages.
• Ron Cranston, Adaptive Texas – Should raise community attendant wages.
• Freddie Gonzales – Advocated for funding for home health services.
• Jennifer Riley – Support for home health therapy, reduction in waiting lists.
• Name inaudible, representing Alpha Home – Provide support for indigent women, women with substance abuse issues, and their children.
• Denise Tummer – Restore pediatric therapy reimbursement rates.
• Steven Aleman – Supported HHSC exceptional item for ECI.
• Name inaudible – Should raise community attendant wages. Supported disability rights.
• Nancy Prother, Adaptive Texas and Personal Attendant Coalition of Texas– Should raise community attendant wages.
• Rachael Horaxine, President of Life Ambulance in El Paso – Medicare rates are below the costs of providing service. There are areas in Texas without 9-1-1 services.
  • Kolkhorst – You said there are 2 counties without 9-1-1 service?
  • Horaxine – Yes.
• David Rimer, VP of Government and Pay Relations for Aveanna Healthcare –LPN rate for private duty nursing have been unchanged in years
• David Witty, Adaptive Texas – Should raise community attendant wages.
• Paige Kincaid, CEO Medcare Pediatric Group – Pediatric therapy cuts last session forced the closure of 3 clinics, 250 children were discharged. If there is no rate restoration the therapy industry will disappear.
• Melissa Ensminger – Support ABA therapy, will be cheaper in the long run than having autistic adults dependent on the state.
• Sonia Burns – Brother has a brain injury and has been living at Austin State Hospital. Supports redesign of state hospital. Increase admissions into SSLCs.
• Kerry Stick, Promise House – Shelter reimbursement rates should be increased. Current rate is $129, cost to operate Promise House is $179 per youth.
• Dennis Wilson, Sheriff of Limestone County – Need reforms for mentally disabled people in the criminal justice system.
• Kathy Doty, Texas Advocates – Shared personal story about disability.
• Tyler Sheldon, Texas State Employees Union – State employee turnover is too high.
• Jennifer McVale, Adaptive Texas – Should raise community attendant wages.
• Linda Litzinger, Easter Seals – Expansion of emergency slots, reduce waiting lists.
• Christine Borgol, Texans for Special Education Reform – Requested full funding of ECI. ABA should be covered by Medicaid.
• Kerry Warner, Adaptive Texas – Should raise community attendant wages.
• Emily Briggs – Continued funding for maternal health benefits for low income mothers.
• Judith (last name inaudible), Autism speaks – Supported HHSC exceptional item 44.
• Mimi Garcia, Texas Assoc of Community Health Centers – Childhood trauma treatment and prevention.
• Mason Morgan, Providers Alliance for Community Services of Texas – Should raise community attendant wages. Need a strong provider base and adequate staffing.
• Katy Naranjo, Texas Association of Home Care and Hospice – Pay increases for administrative staff.
• Greg Hanch – Supported HHSC exceptional item 19.
• Hannah Maeda – Support services for medically fragile children.
• Susan Burick – State can save money by revising HHSC policy for Medicaid clients.
• Roberto Herdad – Reinforce the Texas Trauma Network.
  • Hinojosa – Trauma is a leading cause of death for Texans under 44 years old, this would help reduce number of deaths.
• James Lukifer, Texas Medical Assoc – Support increased funding for the Medcares child abuse program.
• Bill Rawl – Supports request for funding for implementation of newborn screening programs for children with ALD.
• Wanda Helderson, Texas EMS trauma and acute care foundation – Significant increases in responsibilities without any increase in funding for RAC system.
• Daryl Pyle, CEO of Southeast Texas Regional Advisory Council – Increase funding for RACs
• Jennifer Lucy, Prevent Child Abuse America – Strengthen prevention programs, evidence-based home visiting.
• Donald Murphy, Texas Medical Assoc – Full funding of exceptional items to address gaps in state health departments laboratories. Support for exceptional item 1.
  • Kolkhorst – What is the threat of TB to communities?
  • Murphy – There is TB in Texas because we are a border state and due to immigration, we still need to make sure we keep screening and trying to prevent.
• Katie Olls, Texas Alliance of Child and Family Services – Fully support DFPS and HHSC LARs.
• Liz Cruz Garbut, SAFE Alliance – Support of DFPS budget and exceptional item 8 expanding prevention program. Support foster care rate increases.
• Wayne Carson, Child and Family Services – Foster care has improved, need foster care rate increases. Supports community-based care
  • Kolkhorst – Rider 21 DFPS, what are the difference between community-based programs and state programs?
  • Carson – Our programs are more stable than state programs. With kids for higher needs we need to train families to support those kids in a family setting rather than an institution. Community based programs do no t have kids sleeping in offices.
• Lauren Rose, Texas Network of Youth Services – Support DFPS exceptional item 8.
• Kimberley Griffin, Nurse Family Partnership National Service Office – For $1 in nurse-family partnership $5.70 can be saved from education, incarceration state funds. Support more funding for nurse-family partnerships.
• Sarah Crockett, Texas CASA – Support DFPS rider number 21.
• Danny Saenz – Should raise community attendant wages.