Summary of DADS, DARS, SDHS, HHSC, TCHCA and TEA Fiscal Years 2014-15 Legislative Appropriations Requests

 

Background

Prior to the start of each legislative session, the Legislative Budget Board and the Governor’s Office of Budget, Policy and Planning jointly issue instructions to each Texas state agency regarding how to develop their Legislative Appropriations Request (LAR) which is their request for money to operate their programs over the next two-year biennium (fiscal years/FY 2014-15). Appropriations requests for state general revenue (GR) funds may not exceed the sum of those amounts expended in FY 2012 and budgeted in FY 2013. A supplemental schedule must show how agencies would cut an additional 10% (in 5% increments) in GR funds. Agencies may submit exceptional item (EI) requests for priorities that the agency considers of great importance in addition to the base budget. Each agency LAR can be several hundred pages in length are available online:

Below is a summary of the key items in various agencies’ LARs that are important to individuals with developmental disabilities. For more information, contact Jessica Ramos at (512) 437-5417.

Department of Aging and Disability Services (DADS)

DADS administers long-term services and supports for seniors and people with cognitive and physical disabilities. DADS also licenses and regulates providers of long-term services and supports. DADS programs include State Supported Living Centers (SSLCs), home and community-based Medicaid waiver programs, nursing facilities and privately operated Intermediate Care Facilities (ICFs).

DADS Base Request

DADS FY 2014-15 base level request will provide services for about 220,900 Texans with 141,700 of those in community settings. The base request is $131.94 million GR less than the current biennium, primarily because the expansion of STAR+PLUS managed care moved a large number of persons previously served by DADS to services provided by the Texas Health and Human Services Commission (HHSC). Budget instructions also prevent DADS from including funding in the base to serve an anticipated 284 persons who are expected to receive services by the end of FY 2013.

DADS Exceptional Items

  1. Maintain Home and Community-based Services (HCS) for 284 persons that will be enrolled in services by August 2013, but not included in the 2014-15 request because budget instructions required that funding limits be set at the two year biennial average vs. “ramp up” methodology for program enrollment use by DADS: $9.1 million GR.
  2. Increases in average cost per person due to increased utilization or acuity: $114.6 million GR.
  3. Promoting Independence: $32 million GR.
    1. Home and Community-based Services (HCS) Medicaid waiver services for 400 persons to transition from large Intermediate Care Facilities (ICFs) and State Supported Living Centers (SSLCs);
    2. HCS waiver services for 192 children aging out of Department of Family and Protective Services (DFPS) foster care;
    3. Crisis/diversion services for 400 persons at imminent risk of institutionalization (300 in the HCS waiver and 100 in the Community Based Alternatives (CBA) Medicaid waiver); and
    4. HCS waiver services for the diversion of 360 persons with intellectual and developmental disabilities (IDD) from nursing facilities.
  4. Community expansion with comprehensive waiver services to 16,628 persons: $223.7 million GR.
    1. 20% interest list reduction: Community Living Assistance and Support Services (CLASS) and HCS.
    2. 10% service level increase: Community Based Alternatives (CBA), Medically Dependent Children Program (MDCP), Texas Home Living (TxHmL), STAR+PLUS and others.
  5. Community First Choice (CFC) Option would provide 11,902 persons with a combination habilitation and attendant care service via a managed care organization: $35.8 million GR.
  6. Protecting Vulnerable Texans: $15.6 million GR includes six exceptional items that request funding for, additional waiver reviewers ($1.4 million GR), regulatory certification of day habilitation providers and other items: $1.4 million GR.
  7. Support for SSLC residents: $27.7 million GR.
    1. Electronic health records: $7.8 million GR.
    2. Construction to provide physical security of IT equipment at SSLCs: $2.7 million GR.
    3. Computers: $317,129 GR.
    4. Recruitment and retention of qualified developmental disability professionals: $2.1 million GR.
    5. Statewide video conferencing: $528,953 GR.
    6. Furniture and equipment: 7.4 million GR.
    7. Vehicles – $6.8 million GR.

DADS 10% Reduction Schedule

32 items make up the 10% reduction schedule. The first 19 items make up the first 5%. Items 20 through 32 make up the second 5%.

  1. Eliminate the In-Home and Family Support (IHFS) program; 5,799 persons would no longer receive services: $10 million GR.
  2.  Hiring and salary freeze in central administration: $1.266 million GR.
  3. Hiring and salary freeze in Information Technology (IT): $1.575 million GR.
  4. Non-Medicaid Service Reductions (contracts) of 11.4% would eliminate services for 631 persons: $3.37 million.
  5. IDD Community Services 11.4% reduction would eliminate services for 476 persons: $7.843 million GR.
  6. Promoting Independence Plan reduction in outreach awareness of 11.4%: $619 thousand GR.
7-19.  Across the board rate reduction of 1.173%.
20-32.  An additional across the board rate reduction of 1.752%.
  1. If items 7-32 are implemented, long-term services and supports providers, with the exception of SSLCs, would take a 2.925% rate reduction. For some this would be in addition to a 2% rate reduction required last session.

Department of Assistive and Rehabilitative Services (DARS)

DARS provides a variety of services to help individuals with disabilities improve function and become employed including: vocational rehabilitation to help people with disabilities prepare for, find, and keep employment; assistive technology and specialized telecommunication equipment; independent living services; deaf and hard of hearing services; Early Childhood Intervention (ECI); behavior supports for children with autism; and, comprehensive rehabilitation services (CRS) for individuals who have experienced a traumatic brain injury or spinal cord injury.

DARS Base Request

The DARS LAR base level request for 2014-15 is $281 million GR and $1.14 billion AF. There is a $17 million All Funds reduction over the 2014-15 biennium in vocational rehabilitation. The request for the following DARS services are the same as budgeted for 2013: state independent living centers at $5.3 million GR; DARS independent living services at $15.7 million GR; Comprehensive Rehabilitation Services at $24.8 million GR; autism services at $3.3 million GR; and Early Childhood Intervention services (ECI) at $154.7 million GR.

DARS Exceptional Items

  1. Fund ECI services for children who met criteria in 2011 and fund the forecasted caseload of 27,424 children in 2014 and 28,951 in 2015: $17.7 million GR.
  2. Provide services to children currently eligible under the narrowed eligibility for ECI who have significant developmental delays: $11.9 million GR.
    1. DARS narrowed eligibility to stay within funds appropriated for FY 2012-13 because IDEA, Part C requires all eligible children to receive services. The narrowed eligibility increased the number of children with a medically diagnosed condition by 10 percent and those with delays in more than one area by 28 percent. These delays and medical conditions require more costly services.
    2. If the above two Exception Items are not funded, DARS would have no choice but to further narrow eligibility for the second consecutive biennium.
  3. Expand the Autism program to the Lower Rio Grande Valley, Far West Texas, the Panhandle and Northeast Texas: $4.7 million GR.
  4. Increase by $25 million federal vocational rehabilitation grants: $7 million GR.
  5. Add three new independent living centers to the current 27 centers: $2 million GR.

DARS 10% Reduction Schedule

  1. Reduce match for federal VR funds by $3.9 million GR over the biennium, reducing the number of individuals receiving VR services by 2,680 per year. Because state VR funds receive a 4:1 match, this would result in $18.5 million All Funds reduction.
  2. Reduce match for Medicaid-funded ECI services by $2.5 million GR, eliminating services for 600 children per year.
  3. Reduce CRS by $5.5 million GR which reduces the number of individuals with traumatic brain or spinal cord injuries who receive services by 60 per year and increases the waiting list for these very time- sensitive services.

Department of State Health Services (DSHS)

DSHS administers the Children with Special Health Care Needs (CSHCN) program, community mental health services, in-patient psychiatric services (state hospitals) and a far-reaching list of other public health programs from family and community health services to infectious disease prevention and tobacco reduction.

DSHS Base Request

The DSHS base level request for 2014-15 LAR is $2.4 billion GR. Mental health services account for 70 percent the agency’s of general revenue. The base budget does not provide any increases over the current budget for Children with Special Health Care Needs (CSHCN), Epilepsy Program or Community Mental Health and Crisis Services for Children and Adults. If the base request plus exceptional items were funded Texas would provide mental health services for 28,400 children over the biennium, less than 4 percent of the potential need and would remain last in the United States in funding mental health services.

DSHS Exceptional Items

  1. Provide state match to establish a Medicaid state plan option to provide housing and community-based services so that people with extended stays in state mental hospitals can transition back to the community: $7.9 million GR.
  2. Fully fund waiting lists for Adult and Children’s Community Mental Health Services and CSHCN: $80.8 million GR.
  3. Address security and capacity issues at state mental hospitals: $17.7 million.
  4. Fund adult safety net immunizations, as anticipated federal funding was reduced: $26.7 million.

DSHS 10% Reduction Schedule

  1. Eliminate services for 837 children currently receiving help through the Children with Special Health Care Needs program: $1.9 million GR
  2. Eliminate the Epilepsy and Hemophilia Program that assists 20,000 individuals with uncontrolled seizures or hemophilia with no other options. Children with developmental disabilities are at 4x greater risk of seizure disorders: $5.5 million GR
  3. Reduce funding to Children’s Mental Health Services: $8.5 million GR.
  4. Reduce Adult Community Mental Health: $19 million GR.
  5. Reduce funding for state and community mental health hospitals: $67.9 million GR.

Health and Human Services Commission (HHSC)

HHSC is responsible for the planning, operation and administrative oversight of Texas health and human services agencies and eligibility determination. HHSC administers Medicaid, Children’s Health Insurance Programs (CHIP), STAR+PLUS Texas Medicaid managed care and long-term services that serve around 164,000 seniors and people with disabilities.

HHSC Base Request

The HHSC base level request for FY 2014-15 totals $48.8 billion. Of the total, $19.1 billion is general revenue. Medicaid and CHIP costs were held flat at FY 2013 levels except for $0.9 billion to cover population growth and the individual mandate under the Affordable Care Act. The budget also contains 18 cost containment strategies such as Medicare equalization and expansion of Medicaid managed care.

HHSC Exceptional Items

The LAR has 30 exceptional items, including:

  1. 1. Maintain current services and administration in Medicaid, CHIP and others programs: $1.37 billion GR.
    1. a. Medicaid cost growth averages 2.3% per year.
  2. Expand STAR+PLUS to Rural Service Areas: $17.7 million GR.
  3. Cognitive therapies to over 700 individuals with an acquired brain injury in STAR+PLUS and certain long-term services and supports waivers at DADS: $1.9 million GR.
  4. A 10% salary increase for certain health professionals delivering client care at DADS State Supported Living Centers and the DSHS state hospitals: $28.8 million GR.
  5. Increase in reimbursement for primary care: $48.0 million GR.

HHSC 10% Reduction Schedule

  1. Rate reductions of 1% across the board for Medicaid and CHIP providers: $117 million.
    1. a. Disability related-$32 million GR; EPSDT-$9.9 million GR; and prescription drugs-$763,454 GR.
  2. Salary freezes and reductions in staff and contractors: $7.7 million.

Texas Department of Housing and Community Affairs (TDHCA)

TDHCA administers federal housing and community services grants and acts as a housing finance agency for several low-income housing and assistance programs, including housing development, rental assistance, energy assistance, the Bootstrap Loan program and Amy Young Architectural Barrier Removal. TDHCA also ensures program compliance with state and federal housing laws and provides essential services and affordable housing to low-income individuals, including people with disabilities.

TDHCA Base Request

The majority of TDCHA housing programs are 100% federal funds, limiting general revenue demand. The Project Access program, for example, is a partnership between TDHCA, DADS and DSHS that utilizes federal Housing and Urban Development (HUD) Housing Choice Vouchers administered by TDHCA to assist low-income persons with disabilities in transitioning from institutions to the community by providing access to affordable housing. The Housing Trust Fund that includes the Bootstrap Loan and Amy Young Architectural Barrier Removal Program is in the base budget at the FY 2012-13 level of $11.9 million GR which is $9 million less than funds received for FY 2009-11. By statute, $6 million of the Housing Trust Fund must be applied to the Bootstrap Loan program.

TDHCA Exceptional Items

None.

TDHCA 10% Reduction Schedule

  1. Reduce funding for the Housing Trust Fund: $304,500 GR.
  2. Reduce funding for Housing and Health Services Coordinating Council: $484,000 GR.

Texas Education Agency (TEA)

The Texas Education Agency (TEA) helps guide and monitor activities and programs related to public education. Texas public schools served over 4.9 million students during the 2010-11 school year. TEA provides federal and state policy/program implementation and oversight of the state’s design for the education of students with disabilities under the Individuals with Disabilities Education Act (IDEA) and provides administrative support to the Texas Council for Developmental Disabilities.

TEA Base Request

The total LAR for TEA is $24.4 billion GR and $51.5 billion AF. The agency receives appropriations through a variety of sources, including the Permanent School Fund, property tax receipts, and the lottery among others. Funding for programs for students with disabilities is $1.9 billion Federal Special Education and IDEA grants. Rider 37 sets aside $32.9 million of the federal Special Education allotment for transfer to the Department of Assistive and Rehabilitative Services to support Early Childhood Intervention eligibility determination and comprehensive and transition services. The FY 2014-15 LAR reduces special education full-time positions from 120,351 in 2011 to 102,906 in 2015 and special education preschool is flat funded at $22.2 million in federal grants only.

TEA Exceptional Items

None for students with disabilities. Exceptional items address technology, instructional materials, assessment and accountability.

TEA 10% Reduction Schedule

The majority of the 10% Reduction Schedule impacts all students by reducing GR funding to the Student Success Initiative by $4.5 million; Academic Innovation by $3 million; Humanities Texas by $1 million and Amachi, the program for students with incarcerated parents by $2.5 million. The following programs have a more direct impact on students with disabilities:

  1. Reduces Best Buddies, a national mentoring program for approximately 575 students with disabilities in 32 high schools: $500,000 GR.
  2. Eliminates the Community in Schools program: $19.6 million GR.
  3. Eliminates Early Childhood School Readiness in 35,542 school districts, Head Start and local child care settings: $7 million GR.
  4. Reduces funding to Regional Education Service Centers: $2.5 million GR.