Transcript Text

900 Lydia Street, Austin, Texas, 78702 (512) 320-0222
State Budget Developments:
A Legislative Update from
Austin
Presentation to St. Luke’s Episcopal Health
Charities
Eva De Luna Castro, Analyst, [email protected]
Janet Hutchison, Development Specialist,
[email protected]
April 22, 2004
Presentation Outline
• First, some CPPP information
• Update on Effect of State HHS
Consolidation on State Agencies
and on Providers
• Budget Impact by Program at
State and Local Level
1
CPPP Activities
State Budget
& Taxes
Health Care
2
Workforce &
Economic
Development
Income/
Support
Child WellBeing
Hunger &
Nutrition
Mark Your Calendars: May 13-14
Facts & the Future:
The William P. Hobby Policy Conference
Doubletree Hotel – Austin, 6500 N. IH-35
Featuring Addresses By: Former Lt. Governor Bill Hobby,
Texas Comptroller Carole Keeton Strayhorn, State
Demographer Dr. Steve Murdock
3
Where We Are in the State Budget
Cycle
June to August: Strategic Plans and Budget
Requests Due; Budget Hearings Held
April to June:
September to December: Budget
Instructions for Agency Budget
Recommendations Developed;
Requests Issued
Legislative Budget Estimates Issued
Even Years
January-March of even-numbered years:
Statewide Goals Established; Instructions
for Agency Strategic Plans Issued
Two-Year Cycle
January of odd-numbered years:
Budget Bill Filed; Comptroller’s
Revenue Estimate
Odd Years
February to April: House and Senate
Budget Hearings, Mark-Up,
September: New Biennium Begins;
Operating Budgets Prepared End of Session: Budget Approved, and Conference Committee
Sent to Comptroller for Certification;
Sent to Governor for Signature
Throughout the biennium: quarterly performance reports due
4
State Budget, 2004-05
Biennium
State All-Funds, Two-Year Budget
Billion $
2004-2005 total: $118.2 billion
$40
$30
$23.7
Federal
State*
$7.0
$20
$0.3
$27.3
$10
$16.0
$7.0
$0.3
$7.3
$7.7
Business &
Econ. Dev.
Public Safety
& Crim.
Justice
$15.4
$Health &
Human Svcs
K-12
Education
Higher
Education
$1.0
$5.2
All Other
*"State" is General Revenue, General Revenue-dedicated, and Other Funds.
5
State Budget, Fiscal 2004
All Funds: $59.3 Billion
K-12
Schools:
$16.7 b
General Revenue: $29.4 Billion
Higher
Ed:
$7.8 b
K-12
Schools:
$12 b
HHS:
$20.2 b
All
Other:
$3.2
6
Public
Safety &
Crim
Justice:
$4.0 b
Business
& Eco
Devo:
$7.4 b
Higher
Ed:
$4.9 b
HHS:
$7.5 b
All
Other:
$1.4 b
Public
Safety &
Crim
Justice:
$3.3 b
Business
& Eco
Devo:
$0.4 b
Where the GR Is, by Agency
7
2004-2005
GR Budget
Percent of
All GR
Texas Education Agency
$20.7 billion
35%
Health and Human Services Commission
$7.4 billion
13%
Dept. of Criminal Justice
$4.6 billion
8%
Teacher Retirement System
$3.9 billion
7%
Department of Human Services
$3.3 billion
6%
State worker retirement and health insurance
$2.6 billion
4%
Mental Health and Mental Retardation
$2.1 billion
4%
Higher Education Coordinating Board
$675 million
1.1%
Family and Protective Services (formerly
PRS)
$483 million
0.8%
University of Texas at Austin
$483 million
0.8%
Major HHS Agencies and
Programs Affected by…
House Bill 1: General Appropriations Act for 2004-05
(charts later in this presentation show budgeted outcomes)
House Bill 2292: Cut $1 billion in General Revenue out of
Medicaid, CHIP, and other HHS programs; reorganized
HHS agencies
Federal budget decisions: 2005 has not yet been decided by
Congress
School Finance Session: Governor’s proposal limits future
uses of General Revenue for HHS & other non-K-12 needs;
limits ability of local governments to make up for state cuts
8
HHS Reorganization Update
February 1, 2004: Department of Family and Protective
Services is launched
March 1: Department of Assistive and Rehabilitative Services
is launched
September 1: Departments of State Health Services and of
Aging and Disability Services will begin operating
Other: Eligibility determination (for cash welfare, Food
Stamps, Medicaid) moves to Health and Human Services
Commission, along with Nutritional Services and Family
Violence programs. HHSC also responsible for centralized
administrative services, HHS program policy, and interagency
9 initiatives.
Post-Consolidation Org.
Chart
Governor
HHSC Transition
Legislative Oversight
Committee
Health & Human
Services Council
Aging and Disability
Services
10
Health and Human
Services
Commission
State Health
Services
Family and
Protective Services
Office of Inspector
General
Assistive and
Rehabilitative
Services
What’s in the New
Agencies?
Department of Family and Protective Services: Everything that was overseen by
Protective and Regulatory Services (child abuse and neglect investigations, foster
care and adoption payments, at-risk prevention and intervention programs, adult
protective services, child care licensing and regulation, MHMR investigations)
Department of Assistive and Rehabilitative Services: everything that was at the
Rehabilitation Commission, Commission for the Blind, Commission for the Deaf
and Hard of Hearing, and Interagency Council on Early Childhood Intervention
Department of State Health Services: programs provided by the Department of
Health, the Commission on Alcohol and Drug Abuse, and the Health Care
Information Council, and mental health community services and state hospitals run
by the Dept. of Mental Health and Mental Retardation (MHMR)
Department of Aging and Disability Services: mental retardation and state schools
run by MHMR, community care and nursing home services at the Department of
Human Services, and services of the Department of Aging
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What Does this Mean for
Providers?
 Many contractors and vendors will now only have to deal with HHSC
(because of consolidation of leasing/facilities management, legal services,
human resources, purchasing, information resources management,
financial management, and other admin. functions).
 Some providers may have to work with MORE agencies (for example, a
provider helping people who have mental retardation AND mental illness
now works with MHMR, but in the future may have to deal with DADS
and DSHS).
 Consolidation of central administrative functions is supposed to result in
716 fewer employees by the end of fiscal 2005, saving the state almost
$46 million in General Revenue.
 Not a lot of information yet on what will happen to staffing at local
offices; outcome depends on decisions about call centers (eligibility
determination).
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Medicaid Acute Care after HB 2292
and other State Budget Cuts
Texas Acute Care Medicaid Caseloads
3.5
Feb. 2003 HHSC Projection before Cuts
Made in H.B. 1 and H.B. 2292
Millions of Texans
3.0
2.5
2.0
1.5
1.0
Actual through 2003;
budgeted in H.B. 1 for 2004-05
0.5
1996
13
1997
1998
1999
2000
2001
2002
2003
2004
2005
Medicaid Caseloads, by Client Category
Caseloads for Medicaid Acute Care
Thousands
1,800
1,500
1,200
900
600
300
-
1998
14
1999
2000
2001
2002
2003
2004
2005
Children
Aged & Disabled
TANF Adults
Pregnant Women & Medically Needy
Long-Term Care Clientele
180,000
150,000
120,000
90,000
60,000
30,000
1998 1999 2000 2001 2002 2003 2004 2005
Nursing facilities
Community-Care Clients
15
Hospice Clients
Community Care, by Program
32,000
24,000
16,000
8,000
1998
1999
2000
2002
2003
2004
2005
Community-Based Alternatives
Community Living Assistance and Support
In Home and Family Support
STAR+ PLUS: Aged and Medicare-Eligible
STAR+ PLUS: Disabled and Blind
16
2001
HB 2292 Policy Changes Also Cut CHIP
Children's Health Insurance Program (CHIP) Caseloads
Millions of Texas children
0.8
Feb. 2003 HHSC Projection before Cuts
Made in H.B. 1 and H.B. 2292
0.6
0.4
0.2
Actual through 2003;
budgeted in H.B. 1 for 2004-05
2000
17
2001
2002
2003
2004
2005
CHIP Enrollment Down 25% Statewide
18
Public Health Programs at TDH
TX Dept. of Health Immunization Programs
In Millions of Doses
8.0
6.0
4.0
2.0
1998
1999
2000
2001
2002
2003
Doses Administered To Children
19
2004
2005
To Adults
More TDH Programs (moving to HHSC)
TDH Medicaid Program Clientele
1,400
In Thousands
1,200
1,000
800
600
400
200
1998
1999
Family Planning
20
2000
2001
2002
HealthSteps Medical
2003
2004
2005
HealthSteps Dental
More Public Health Program Cuts
TDH Women & Children's Health Services Clientele
100,000
80,000
60,000
40,000
20,000
1998
1999
2000
2001
Women
21
2002
2003
Children
2004
2005
More Responsibilities for Locals, Less $$
State Matching Funds for County Indigent
In million $
Health Care Programs
$12.0
$10.0
$8.0
$6.0
$4.0
$2.0
$1991
22
1993
1995
1997
1999
2001
2003
2005
Community MH Services for Adults,
Children
MHMR: Community Mental Health Services
25,000
20,000
15,000
10,000
5,000
1998 1999 2000 2001 2002 2003 2004 2005
Adults receiving Assertive Community Treatment
Consumers Receiving Supported Housing Services
Children Receiving Services in the Community
23
Services for Texans with Mental
Retardation
MHMR: Community & Campus-Based
Mental Retardation Services
9,000
6,000
3,000
1998
1999
2000
2001
2002
2003
2004
2005
Consumers Receiving In Home and Family Support
Served in Home & Community-Based Services Waiver Program
ICF/MR Medicaid Beds
MR Campus Residents
24
Services for Neglected/Abused Children
Child Protective Services Programs
160,000
3,000
120,000
2,000
80,000
1,000
40,000
-
1998 1999 2000 2001 2002 2003 2004 2005
Completed Investigations of Child Abuse/Neglect (left axis)
Families Receiving Intensified Preservation/Reunification Services
(right axis)
25
Services for Neglected/Abused Elderly
Adult Protective Services
64,000
1,000
800
48,000
600
32,000
400
16,000
200
-
1998 1999 2000 2001 2002 2003 2004 2005
Completed APSInvestigations (left axis)
Completed MHMR Investigations (left axis)
APSClients Receiving Guardianship Services (right axis)
26
Child Care: Less Help for Working
Poor
TWC Child Care Subsidy Programs
100,000
80,000
"Working Poor" child care
60,000
Child care for welfare
recipients
40,000
20,000
2000
27
2001
2002
2003
2004
2005
Cash Assistance Will be Even Scarcer
Texans Receiving TANF Cash Assistance
Millions of Texans
4.0
3.0
Below Federal Poverty Line (in 2003,
$15,260/yr for a family of three)
2.0
Receiving Cash Assistance (in 2003,
$2,136/yr for a family of three)
1.0
1996
28
1997
1998
1999
2000
2001
2002
2003
2004
2005
Nutrition Programs Will Grow, But
There’s Still a Large Unmet Need
Nutrition Program Caseloads
6.0
5.3
5.2
4.8
5.0
Millions of Texans
5.4
4.4
4.1
4.0
3.0
2.0
1.0
1.4
1.4
0.744
1.8
1.6
0.761
0.799
2.2
2.1
0.817
0.838
0.859
2000
2001
2002
Food Stamp Caseloads
Estimated Need for Food Stamps
29
2003
2004
WIC Caseloads
2005
Even Before Cuts, Texas was LowSpending
Texas Per Capita State/Local Spending, Fiscal 2000
$-
$300
$600
$900
$1,200
$1,500
11th
K-12 Education
$550
Medicaid and Welfare
$470
Higher Education
$345
Highways & Streets
$313
Hospitals
$180
Prisons
$154
Police/State Troopers
Public Health
Housing/Comm Dev
50-State Ranking
$111
$87
$1,362
47th
31st
34th
13th
15th
35th
41st
21st
Judicial/Legal
$65
36th
Parks/Recreation
$58
41st
Natural Resources
$50
38th
30
Budget Impact Stories Needed!
• CPPP’s web site (at http://www.cppp.org/stories.html) is collecting
information about the impact of state budget cuts and policy changes
made during the 78th Legislature.
• We are interested in hearing about the impact of budget decisions at all
levels, from individuals to businesses/organizations to units of
government. Social service agencies; advocacy organizations; schools
and teachers; hospitals and clinics; agency caseworkers; Medicaid,
CHIP, TANF, or Food Stamps recipients; city or county government
officials; non-profit leaders; and anyone else who was affected are all
encouraged to participate.
• If you have a personal story or a report to share about how 2004-05
state budget decisions have changed your life, your work, your
organization, or your community, please use the online form.
31
HHS Budget Updates
• Early April 2004: HHSC reports higher-thanbudgeted costs in Medicaid and CHIP (vendor
drugs); shortfall of $582 million?
• Comptroller urging restorations to CHIP.
Unused funds: $583 million (April 13th
estimate)
• Leadership so far has been reluctant to undo
HHS and other budget cuts, arguing that unspent
funds may be needed for Medicaid or other
shortfalls that develop before January 2005
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Governor’s Goals for Special
Session on K-12 Finance
• Eliminate “Robin Hood” system that redistributes local property
tax revenue and benefits 88% of Texas school children
• Lower school property taxes and limit the ability of other local
governments (counties, cities, hospitals, special districts) to raise
property taxes in the future
• Make some small changes to state/local funding for K-12
(cigarette tax increase, new tax on adult entertainment, revenue
from video slot machines, business school property taxes
considered state rather than local revenue, etc.), but nothing that
will significantly increase what Texas spends on K-12 or any
other public service
33
Contacting State Officials
Governor Rick Perry (www.governor.state.tx.us) Citizen's Opinion Hotline: (800) 252-9600; Fax:
(512) 463-1849; Office of the Governor, P.O. Box 12428, Austin, Texas 78711-2428
Lieutenant Governor David Dewhurst (P.O. Box 12068, Austin, TX 78711)
Speaker of the House Tom Craddick (P. O. Box 2910, Austin, TX 78768)
Your Own Legislators: Representative (P. O. Box 2910, Austin, TX 78768) and Senator (P.O. Box
12068, Austin, TX 78711)
Other Members of the LBB:
Senator Steve Ogden
Representative Talmadge Heflin
Senator Robert Duncan
Representative Brian McCall
Senator John Whitmire
Representative Fred Hill
Senator Judith Zaffirini
Representative Vilma Luna
Health and Human Service Chairs of Budget Committees:
Senator Jane Nelson, HHS Workgroup Chair, Senate Finance Committee
Representative John Davis, HHS Subcommittee Chair, House Appropriations Committee
(see www.capitol.state.tx.us for more contact info and “Who Represents Me?” search
engine)
34
More Reorganization and State
Budget-Related Information
• www.hhsc.state.tx.us/Consolidation/Consl_home.html
(Health and Human Services Commission webpage on HHS
Transformation)
• www.lbb.state.tx.us (Fiscal Size Up 2004-05; Texas Budget
Source; Federal Funds Watch; appropriations act)
• www.cppp.org (William P. Hobby Conference, May 13-14;
Policy Page subscriptions, policy briefs, presentations, and
other reports)
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