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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 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222
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Page 1: 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

900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

Page 2: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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•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

Presentation OutlinePresentation Outline

Page 3: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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CPPP ActivitiesCPPP Activities

State Budget

& Taxes

Workforce & Economic

Development

Income/ Support

Health CareChild Well-Being

Hunger & Nutrition

Page 4: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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Facts & the Future:The William P. Hobby Policy ConferenceDoubletree Hotel – Austin, 6500 N. IH-35

Featuring Addresses By: Former Lt. Governor Bill Hobby, Texas Comptroller Carole Keeton Strayhorn,

State Demographer Dr. Steve Murdock

Mark Your Calendars: May 13-14

Mark Your Calendars: May 13-14

Page 5: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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January of odd-numbered years:Budget Bill Filed; Comptroller’s

Revenue Estimate

End of Session: Budget Approved, Sent to Comptroller for Certification;

Sent to Governor for Signature

January-March of even-numbered years: Statewide Goals Established; Instructions

for Agency Strategic Plans Issued

September to December: Budget Recommendations Developed;

Legislative Budget Estimates Issued

February to April: House and Senate Budget Hearings, Mark-Up, and Conference Committee

September: New Biennium Begins; Operating Budgets Prepared

Even Years

Two-Year Cycle

Odd Years

April to June: Instructions for Agency Budget

Requests Issued

June to August: Strategic Plans and Budget Requests Due; Budget Hearings Held

Throughout the biennium: quarterly performance reports due

Where We Are in the State Budget Cycle

Where We Are in the State Budget Cycle

Page 6: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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State Budget, 2004-05 Biennium

State Budget, 2004-05 Biennium

State All-Funds, Two-Year Budget

$7.3 $7.7 $5.2

$23.7$7.0

$7.0$15.4$16.0

$27.3$0.3

$0.3$1.0

$-

$10

$20

$30

$40

Health &Human Svcs

K-12Education

HigherEducation

Business &Econ. Dev.

Public Safety& Crim.Justice

All Other

Billion $

FederalState*

2004-2005 total: $118.2 billion

*"State" is General Revenue, General Revenue-dedicated, and Other Funds.

Page 7: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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All Funds: $59.3 Billion

All Other: $3.2

Public Safety &

Crim Justice: $4.0 b

Business & Eco Devo: $7.4 b

Higher Ed:

$7.8 b

HHS: $20.2 b

K-12 Schools: $16.7 b

General Revenue: $29.4 Billion

All Other: $1.4 b

Public Safety &

Crim Justice: $3.3 b

Business & Eco Devo: $0.4 b

Higher Ed:

$4.9 b

HHS: $7.5 b

K-12 Schools: $12 b

State Budget, Fiscal 2004

State Budget, Fiscal 2004

Page 8: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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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%

Where the GR Is, by Agency

Where the GR Is, by Agency

Page 9: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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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

Major HHS Agencies and Programs Affected by…Major HHS Agencies and Programs Affected by…

Page 10: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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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 initiatives.

HHS Reorganization Update

HHS Reorganization Update

Page 11: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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Governor

Health and Human Services

Commission

Aging and Disability Services

State Health Services

Family and Protective Services

Assistive and Rehabilitative

Services

HHSC Transition Legislative Oversight

Committee

Health & Human Services Council

Office of Inspector General

Post-Consolidation Org. Chart

Post-Consolidation Org. Chart

Page 12: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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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

What’s in the New Agencies?

What’s in the New Agencies?

Page 13: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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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).

What Does this Mean for Providers?

What Does this Mean for Providers?

Page 14: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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Texas Acute Care Medicaid Caseloads

-

0.5

1.0

1.5

2.0

2.5

3.0

3.5

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Millio

ns o

f Tex

ans

Actual through 2003; budgeted in H.B. 1 for 2004-05

Feb. 2003 HHSC Projection before Cuts Made in H.B. 1 and H.B. 2292

Medicaid Acute Care after HB 2292 and other State Budget Cuts

Medicaid Acute Care after HB 2292 and other State Budget Cuts

Page 15: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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Medicaid Caseloads, by Client Category

Medicaid Caseloads, by Client Category

Caseloads for Medicaid Acute Care

-

300

600

900

1,200

1,500

1,800

1998 1999 2000 2001 2002 2003 2004 2005

Children Aged & Disabled

TANF Adults Pregnant Women & Medically Needy

Thousands

Page 16: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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Long-Term Care ClienteleLong-Term Care Clientele

-

30,000

60,000

90,000

120,000

150,000

180,000

1998 1999 2000 2001 2002 2003 2004 2005

Nursing facilities Hospice Clients

Community-Care Clients

Page 17: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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Community Care, by ProgramCommunity Care, by Program

-

8,000

16,000

24,000

32,000

1998 1999 2000 2001 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

Page 18: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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Children's Health Insurance Program (CHIP) Caseloads

-

0.2

0.4

0.6

0.8

2000 2001 2002 2003 2004 2005

Mill

ions

of T

exas

chi

ldre

n

Actual through 2003; budgeted in H.B. 1 for 2004-05

Feb. 2003 HHSC Projection before Cuts Made in H.B. 1 and H.B. 2292

HB 2292 Policy Changes Also Cut CHIP

HB 2292 Policy Changes Also Cut CHIP

Page 19: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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CHIP Enrollment Down 25% Statewide

CHIP Enrollment Down 25% Statewide

Page 20: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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Public Health Programs at TDHPublic Health Programs at TDH

TX Dept. of Health Immunization Programs

-

2.0

4.0

6.0

8.0

1998 1999 2000 2001 2002 2003 2004 2005

In M

illio

ns o

f Dos

es

Doses Administered To Children To Adults

Page 21: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

21

More TDH Programs (moving to HHSC)

More TDH Programs (moving to HHSC)

TDH Medicaid Program Clientele

-

200

400

600

800

1,000

1,200

1,400

1998 1999 2000 2001 2002 2003 2004 2005

In T

hous

ands

Family Planning HealthSteps Medical HealthSteps Dental

Page 22: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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More Public Health Program CutsMore Public Health Program Cuts

TDH Women & Children's Health Services Clientele

-

20,000

40,000

60,000

80,000

100,000

1998 1999 2000 2001 2002 2003 2004 2005

Women Children

Page 23: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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More Responsibilities for Locals, Less $$

More Responsibilities for Locals, Less $$

State Matching Funds for County Indigent Health Care Programs

$-

$2.0

$4.0

$6.0

$8.0

$10.0

$12.0

1991 1993 1995 1997 1999 2001 2003 2005

In million $

Page 24: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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Community MH Services for Adults, Children

Community MH Services for Adults, Children

MHMR: Community Mental Health Services

-

5,000

10,000

15,000

20,000

25,000

1998 1999 2000 2001 2002 2003 2004 2005

Adults receiving Assertive Community Treatment

Consumers Receiving Supported Housing Services

Children Receiving Services in the Community

Page 25: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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Services for Texans with Mental Retardation

Services for Texans with Mental Retardation

MHMR: Community & Campus-Based Mental Retardation Services

-

3,000

6,000

9,000

1998 1999 2000 2001 2002 2003 2004 2005

Consumers Receiving In Home and Family SupportServed in Home & Community-Based Services Waiver ProgramICF/MR Medicaid BedsMR Campus Residents

Page 26: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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Services for Neglected/Abused Children

Services for Neglected/Abused Children

Child Protective Services Programs

-

40,000

80,000

120,000

160,000

1998 1999 2000 2001 2002 2003 2004 2005-

1,000

2,000

3,000

Completed Investigations of Child Abuse/Neglect (left axis)

Families Receiving Intensified Preservation/Reunification Services(right axis)

Page 27: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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Services for Neglected/Abused Elderly

Services for Neglected/Abused Elderly

Adult Protective Services

-

16,000

32,000

48,000

64,000

1998 1999 2000 2001 2002 2003 2004 2005

-

200

400

600

800

1,000

Completed APS Investigations (left axis)

Completed MHMR Investigations (left axis)

APS Clients Receiving Guardianship Services (right axis)

Page 28: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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TWC Child Care Subsidy Programs

-

20,000

40,000

60,000

80,000

100,000

2000 2001 2002 2003 2004 2005

"Working Poor" child care Child care for welfare recipients

Child Care: Less Help for Working Poor

Child Care: Less Help for Working Poor

Page 29: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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Cash Assistance Will be Even Scarcer

Cash Assistance Will be Even Scarcer

Texans Receiving TANF Cash Assistance

-

1.0

2.0

3.0

4.0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Mill

ions

of T

exan

s Below Federal Poverty Line (in 2003, $15,260/yr for a family of three)

Receiving Cash Assistance (in 2003, $2,136/yr for a family of three)

Page 30: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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Nutrition Programs Will Grow, But There’s Still a Large Unmet

Need

Nutrition Programs Will Grow, But There’s Still a Large Unmet

NeedNutrition Program Caseloads

1.4 1.41.6

1.82.1 2.2

0.8590.8380.8170.7990.7610.744

4.8

4.4 4.1

5.2 5.3 5.4

-

1.0

2.0

3.0

4.0

5.0

6.0

2000 2001 2002 2003 2004 2005

Mill

ions

of T

exan

s

Food Stamp Caseloads WIC Caseloads

Estimated Need for Food Stamps

Page 31: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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50-State Ranking

11th

47th

31st

34th

13th

15th

35th

41st

21st

36th

41st

38th

Texas Per Capita State/Local Spending, Fiscal 2000

$550

$470

$345

$313

$180

$154

$111

$87

$65

$58

$50

$1,362

$- $300 $600 $900 $1,200 $1,500

K-12 Education

Medicaid and Welfare

Higher Education

Highways & Streets

Hospitals

Prisons

Police/State Troopers

Public Health

Housing/Comm Dev

Judicial/Legal

Parks/Recreation

Natural Resources

Even Before Cuts, Texas was Low-Spending

Even Before Cuts, Texas was Low-Spending

Page 32: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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Budget Impact Stories Needed!

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.

Page 33: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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• Early April 2004: HHSC reports higher-than-budgeted 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

HHS Budget UpdatesHHS Budget Updates

Page 34: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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• 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

Governor’s Goals for Special Session on K-12

Finance

Governor’s Goals for Special Session on K-12

Finance

Page 35: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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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 HeflinSenator Robert Duncan Representative Brian McCallSenator John Whitmire Representative Fred Hill

Senator Judith Zaffirini Representative Vilma LunaHealth and Human Service Chairs of Budget Committees:

Senator Jane Nelson, HHS Workgroup Chair, Senate Finance CommitteeRepresentative John Davis, HHS Subcommittee Chair, House Appropriations

Committee

(see www.capitol.state.tx.us for more contact info and “Who Represents Me?” search engine)

Contacting State OfficialsContacting State Officials

Page 36: 900 Lydia Street, Austin, Texas, 78702 (512) 320-0222

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• 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)

More Reorganization and State Budget-Related

Information

More Reorganization and State Budget-Related

Information


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