Public Comment to the Legislative Budget Board

Public Input Provided in 2012

Regarding the Department of State Health Services FY 2014 – 2015 Legislative Appropriations Request

September 20, 2012

Thank you for the opportunity to provide input regarding the Department of State Health Services (DSHS) FY 2014 – 2015 Legislative Appropriations Request (LAR). I am Belinda Carlton, Public Policy Specialist for the Texas Council for Developmental Disabilities (TCDD). TCDD is established by federal law in the Developmental Disabilities Assistance and Bill of Rights Act and consists of a 27 member board, appointed by the Governor, 60 percent of who are individuals with developmental disabilities or family members of individuals with disabilities. TCDD’s purpose in law is to encourage policy change so that people with disabilities have opportunities to be fully included in their communities and exercise control over their own lives.

TCDD supports expanding community-based health, behavioral and mental health and housing supports for children and adults that are recovery-oriented, person-centered and link mental and physical health needs. TCDD also supports prioritizing transition from institutional services to community supportive housing.

Children with Special Health Care Needs (CSHCN): The CHSCN program provides preventive and acute health care as the payer of last resort for children with critical health care needs and those of any age with cystic fibrosis who are not eligible for CHIP or Medicaid. Funding was reduced by $12.1M by the 82nd Legislature. The 2014-15 LAR proposes flat funding for the program. The 10 Percent Biennial Base Reduction Options Schedule (10 Percent Reduction Schedule) would cut another $5,487,502 from this same program. CSHCN is the only option for these children and waiting puts them at risk of a health care crisis. DSHS Waiting List Exceptional Item #10 would fully fund the demand for the CSCHN as of May 2012.

Epilepsy Program: Children with developmental disabilities are at four times greater risk of seizure disorders than children without disabilities. The LAR requests funding to assist 9,808 individuals with uncontrolled seizures at an average cost of just $127 each. Administered locally in all 254 Texas counties, this program is funded with general revenue funds only and is also the “payer of last resort.” The 10 Percent Reduction Schedule would eliminate the Epilepsy program. With the implementation of the Affordable Care Act uncertain and the need for these services escalating a proposal to eliminate this program is alarming.

Children’s Community Mental Health: Failure to address children’s mental health needs is linked to poor academic performance, behavior problems, school violence, dropping out, substance abuse, suicide, and criminal activity. Children’s community mental health services received a $20.6m increase over FY 2010‐11, but even this did not move Texas from ranking last among states in providing assistance for children with serious mental and behavioral health needs, nor does it address the severe shortage of professionals with the skills, knowledge, and training to help children with mental health challenges. DSHS LAR requests level funding at $63M to serve 12,206 children with an annual average of $5,100 each in services. Exceptional Item 10 requests $1.5M to fully fund services for the 286 children waiting to be served by local mental health authorities, while the 10 Percent Reduction Schedule would cut $8.5M. The federal Substance Abuse and Mental Health Services Administration estimates that there are 354,000 to 621,000 children in Texas with serious mental health concerns: funding DSHS 2014-15 LAR request plus the exceptional item will only provide mental health services for 28,400 children over the biennium, less than 4 percent of the potential need.

School Health Program: School-based health is not a program in DSHS 2014-15 LAR. Instead there are references to school-based health being supported by funding in other programs, such as diabetes prevention, maternal and child health, substance abuse and tobacco. School health centers blend medical care with preventive and psychosocial services as well as organize broader school-based and community-based health promotion efforts. They coordinate health and education services for students with disabilities. For children with behavioral or mental health concerns they provide the best opportunity to intervene early when mental or behavioral health concerns arise, preventing more significant problems. DSHS states that a priority was placed on prevention in this LAR. School-based health programs that include physical health, mental health, and positive behavioral interventions and supports (PBIS) offer unparalleled opportunities for prevention and need a home and priority in the DSHS LAR.

Adult Mental Health: In Texas individuals with serious mental illness cycle through crisis services, hospitals, jails, and prisons and may never get linked to recovery focused treatment. Though the 82nd Texas Legislature restored DSHS mental health General Revenue funding to FY 2010‐11 levels, the All Funds total was actually less than FY 2010-11 levels because federal stimulus funds were not replaced. Current FY 2012-13 funding puts Texas last among states in the provision of mental health services even though, according to DSHS, Exceptional Item #10 will fully fund the waiting list for community adult mental health services. Texas has a critical shortage of mental health professionals that will not be resolved without adequate provider reimbursement, training and cross-training that is not addressed in the LAR, except perhaps in the LAR expansion of federally qualified health centers that provide integrated health and behavioral health services and an enhanced reimbursement from Medicare and Medicaid.

Community Transition: State psychiatric hospitals are intended to be used primarily as a short-term stop for patients and defendants in need of intensive temporary treatment before moving on to less restrictive facilities or back into the community. However, today one in four beds is used by a patient who has been in that facility for more than a year. In the same way that affordable housing and community based supports are necessary to ensure the least restrictive setting to meet the needs of individuals with intellectual and developmental disabilities, community based alternatives are needed for individuals with serious mental illness who are currently in state psychiatric facilities. DSHS Exceptional Item #7 requests GR funds to match a Medicaid state plan option to provide housing and community based services for individuals with extended stays in mental hospitals. It will also provide supports for those who are homeless or at risk of homelessness because of mental illness and/or substance abuse. Several studies support the cost effectiveness of community based social psychiatric treatment versus inpatient care.

In closing, I would like to express appreciation for DSHS leadership. They have presented an LAR and Exceptional Items that are responsive to stakeholders across age and diagnosis. If funded, children with special health care needs, adults and children with behavioral and mental health disabilities on waiting lists will receive services. And, people with mental illnesses who have been largely left behind in efforts to implement the Olmstead decision will be offered the supports to assist them in successful reintegration into the community.

Thank you for your service to Texas.

Belinda Carlton, CPM
512 437-5414