The House Committee on Human Services met on February 26, 2019 to take up several bills. This report covers discussions of HB 72 by White relating to the continuation of Medicaid benefits provided to certain children adopted from the conservatorship of 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.
HB 72 (White) Relating to the continuation of Medicaid benefits provided to certain children adopted from the conservatorship of the Department of Family and Protective Services.
Children can receive multiple placements while in foster care which can lead to gaps in coverage or inconsistent coverage.
Children often lose access to providers because STAR Health terminates contracts with providers; current system is dysfunctional.
Already know who the youth are, where they live, so it is unclear what are the additional technology costs that are in the fiscal note.
Unclear what the service coordination costs are – fiscal note says cost is $20/month, multiply that by 50,000, that comes up to $12m per year in all funds. That will come out to $4m-5m in GR.
It is “sickening” for outside groups to say this bill is outside the role of government.
This program will save money for the state compared to the kids being in an RTC.
Frank – Try not to bring outside groups into this, everyone is entitled to their opinion. Your point on the fiscal notes is well taken, our inability or unwillingness to do dynamic fiscal notes prevents us from doing good policy. This bill is a good concept, we will need to discuss if it is good policy.
Clardy – You laid out a committee sub, was the fiscal note based on the original or the sub?
White – Based on the original.
Clardy – So there is an opportunity for a revised fiscal note that will match up with the sub.
White – Yes. We already know the cost of residential rates, the per-day cost for a foster parent, etc., so those should be included in the note.
Frank – The unwillingness to do dynamic fiscal notes is a problem. The LBB will not consider the cost savings if more kids are adopted.
White – I should not have someone from Lumberton, TX drive 5 hours to bring me this information, the department should bring this information to my office.
Clardy – The LBB is still trying to hit their stride, they now have an opportunity to correct this issue with the committee sub. The LBB generally does a good job, but it seems that the LBB is sometimes very creative in coming up with certain numbers that might not fit the appropriate narrative and at other times they are unwilling to find accurate numbers that are important to the members.
John Mark McMullen, Arrow Health Solutions
Difficult to find families who will adopt children with primary medical needs.
Families who move toward adoption will often lose benefits. For this reason, it is almost negligent on the part of Arrow Health Solutions to recommend adoption.
During transition periods it is almost impossible as a provider to receive authorization.
Frank – What do you mean by “primary medical needs”?
McMullin – Children who are on G-tubes, vents, etc., means they are on an intense or high level of service.
Frank – Is that defined anywhere?
McMullin – Yes the state has adopted our terminology.
Deshotel – What does it mean for the child if you can’t get prior authorization for 60 days?
McMullin – If a child is G-Tube fed, the child has to eat. When that child moves from foster to adoption and we need a new authorization, it takes 60 days in that situation to get food for the child. Under the current system we have absorbed the cost because we will not let a child go hungry.
Deshotel – You are not reimbursed for that?
McMullin – No.
Deshotel – Why does it take 60 days, why is it not automatic?
McMullin – There are simple fixes to that with continuity of care. That was in the program at rollout 2 years ago, but only lasted about 5-6 months.
Liz Kromrei, DFPS
Deshotel – Question about 60-day authorization time, is that a budget issue?
Kromrei – When a child is adopted, there is a transition from the STAR Health Program. In that transition period it is briefly fee for service before they have the new MCO.
Frank – What are the alternatives the adopted home has?
Kromrei – We have negotiators who look at adoption assistance. Benefits include adoption assistance payment depending on child’s needs.
Frank – Is that federal or state?
Kromrei – It is a mix.
Frank – 90% of adoptive parents get that adoption assistance?
Kromrei – Yes. There are a handful who get enhanced adoption assistance, some of our most disabled children qualify for that.
Hinojosa – Why does it take 60 days to transition from STAR Health to STAR Kids?
Kromrei – With STAR Kids there is not an immediate enrollment and that produces the gap.
Hinojosa – What is the reason for the gap?
Kromrei – My understanding is there is not the immediate enrollment option.
Frank – The bill would give parents the option to stay on STAR Health.
Frank – Differences between STAR Health and STAR Kids?
Kromrei – Health is a robust program, has immediate eligibility. STAR Kids does not have those characteristics.
Meghan Young, HHSC
Frank – Explain 60-day gap
Young – The federal government gives people a choice of MCO. People who have been approved for the STAR program receive a letter from HHSC giving them 15 days to choose an MCO.
Frank – So coverage is not interrupted but it is difficult to change providers?
Young – Every STAR Health provider is also a traditional Medicaid provider, so they should be covered during the transition.
Deshotel – Who is providing the care while the child is under STAR Health? Is it an MCO
Young – It is the STAR Health MCO.
Deshotel – Who pays during the 15-day period? Who during the transition and who pays before the transition?
Young – During transition it is TMHP and before it is under the STAR Health MCO.
Deshotel – The eligibility of the child doesn’t change; why can’t they find out before the transition and make a choice of service?
Young – We have different authorities under which we operate STAR Health, one which we operate Medicaid FFS, and one which operates other Medicaid functions
Deshotel – There is a day certain when the child will transition, you will find out that day ahead of time. Why not give the parents the ability to chose before the date so there is no break in service?
Young – We could discuss the technical feasibility of that with DFPS. That would require system changes on the HHSC side.
Deshotel – Why would it take a system change?
Young – When we get a notice that a child is no longer in STAR Health and is now in adoption assistance that triggers the system.
Deshotel – You know that date ahead of time, why do you wait until the transfer date
Young – Our system does not know that the child will be transitioning until we get that trigger.
Frank – Two issues this bill addresses. There is the technical fix which is one issue. The other issue is do we want to give a higher level of coverage to encourage adoption.
Frank – Is that technical system update something that is feasible?
Young – Should discuss with DFPS.
Frank – 60 days seems like it should not be an issue. The adoption transition should be pretty seamless.
Tammy Leger, Self
DFPS and HHSC systems do not work together, that is the reason for the issue.
Adopted daughter went 6 months without insurance paying for feeding tubes because did not have an authorization.
60 days is too long, when a child is adopted they are not covered. Healthcare is too expensive for many families to afford during that gap.
Deshotel – Question about Star coverage.
Leger – State has an influx of children who have been born addicted. These children often have behavioral problems. People in Star are not trained to handle that.
Meza – The way we are currently handling this is costing the state more?
Leger – Yes, considerably more.
Meza – It sounds like the current set up is a disincentive for foster parents to adopt when they want to?
Leger – Yes.
Liz Kromrei, DFPS
Called back to answer questions
Frank – Question about difference in cost between Star, Star health, and STAR Kids
Kromrei – Star is lowest cost, STAR Health in the middle, STAR Kids most expensive.
Hinojosa – Is one of the differences between Star and STAR Health the behavioral services that are in STAR Health?
Kromrei – STAR Health has a robust physical and behavioral health program. I would defer to the specifics of STAR Kids to what is covered in their Medicaid plan.
Frank – Higher level needs program?
Kromrei – That is the enhanced adoption assistance program. That can be negotiated up to what the foster parent was receiving during foster care.
Penny Wimberly, Self
Shared personal account of problems with changing MCOs and STAR Health for adopted children. In favor of HB 72.
Frank – Was the switch of MCOs at adoption?
Wimberly – No.
Bryan Mares, Texas CASA
Supports HB 72
Bill would encourage adoption and support children with severe needs.
Rep. White closes on HB 72
We must address these issues.
Deshotel – Might be helpful to sit down with the agencies, discuss how we can coordinate the transition. This problem does not need to exist.
Frank – There is one issue that can be fixed by the agencies, there is another issue that will need appropriations.
HB 72 left pending.