House & Senate Appropriations Comparison

27th Jan 2017
New Numbers… Old issues

Both the Senate and the House have announced the filing of their respective appropriations bills.  As backdrop, recall that just the other day, the State Comptroller informed the Legislature that there was just under $105 billion state dollars to fund state operations.  This was a 2.7% decrease from the previous biennial estimate.  Keep that amount in mind as we lay out the different appropriations bills. 

The bills could not be more different regarding health and human services.  The House provides for case load growth, assumes funding of the supplemental appropriations bill, bases costs on 2017 service costs, provides increase for selected programs, including community based services and associated attendant pay.  The Senate Bill does not address any of these.

The Senate provides an appropriations Bill totaling 213.4 billion which is 296 million below the current biennium.  The General Revenue portion (state funds) accounts for $103.6 billion. Of that all funds amount,  $77.4 billion is for Article II, Health and Human Services.  This is also a reduction from the current biennium of $1.2 billion or 1.5% lower than the present biennium. 

The House provides an appropriations Bill totaling $221.3 billion which is an increase over the present biennium of $5.1 billion.  The General Revenue portion (state funds) accounts for  $108.7 billion.  Of that all funds amount, $81.9 billion is for Article II, Health and Human Services.  This is also an increase of $736.4 million over the present biennium. 

As you can see, the Senate Bill falls within the Comptroller’s Biennial Revenue Estimate while the House Bill exceeds the estimate by $3.6 billion. 

Key provisions in the Senate Bill related to health and human services.

The Senate Bill provides $61.2 billion in All Funds, including $24.9 billion in General Revenue Funds and $0.2 billion in General Revenue– Dedicated Funds for the Texas Medicaid program. This is a reduction of $0.8 billion in All Funds, which includes a reduction of less than $0.1 billion in General Revenue Funds.

Included in these amounts is $56.4 billion in All Funds for Medicaid client services, $1.6 billion in All Funds for programs supported by Medicaid funding, and $3.2 billion in All Funds for administration of the Medicaid program and other programs supported by Medicaid funding.

Medicaid client services are maintained at the 2016–17 appropriated level. There is a $0.6 billion All Funds reduction in administrative funding and a $0.2 billion reduction in other programs supported by Medicaid funding.

The Senate does not make the base adjustment assumed if the supplemental appropriations bill would pass

The 2018–19 amounts do not include funding to support projected caseload growth, maintain fiscal year 2017 average costs, or fund anticipated increases in cost due to medical inflation, higher utilization, or increased acuity.  In other words, the Senate Bill assumes no additional people will be served under the program and costs will remain the same. 

Funding includes $3.4 billion in All Funds ($2.7 billion in General Revenue Funds and General Revenue–Dedicated Funds) for non-Medicaid behavioral health services. Funding supports programs at 16 agencies across 5 articles pursuant to the Behavioral Health Strategic Plan, and includes funding for inpatient client services at the state hospitals and community hospitals, outpatient services provided through Local Mental Health Authorities, substance abuse prevention, intervention, and treatment services for adults and children, mental health care and substance abuse treatment for incarcerated offenders, mental health care services for veterans, and a variety of other services.

Funding also includes $95.6 million in All Funds ($62.6 million in General Revenue Funds) for the biennium to address the current and projected waitlists for community mental health services for adults and children.       

Medicaid expenditures for behavioral health services (when including projected caseload and cost growth that is not funded) are estimated to total $3.6 billion in All Funds for the 2018–19 biennium, and CHIP expenditures (when including projected cost growth that is not funded) are estimated to total $47.2 million in All Funds. Total behavioral health funding including estimated Medicaid and CHIP expenditures is estimated to be $7.0 billion in All Funds for the biennium.

The Senate Bill provides $3.2 billion in All Funds, including $1.9 billion in General Revenue Funds, for all Child Protective Services (CPS) functions at the Department of Family Services (DFPS). This is an increase of $260.1 million in All Funds and $310.6 million in General Revenue Funds over the 2016–17 base.

Funding includes 828.8 full-time-equivalent (FTE) positions and an increase of $331.8 million in All Funds in CPS in order to:
  • Maintain the resources provided in fiscal year 2017 to address critical needs in the CPS program; and
  • Improve agency performance related to the average caseload per CPS caseworker and CPS caseworker retention.
CPS funding includes a total of $1.5 billion in All Funds and $0.6 billion in General Revenue Funds for DFPS entitlement programs, and associated administrative costs for these programs, including:
  • $842.6 million in All Funds and $362.2 million in General Revenue Funds, for Foster Care Payments;
  • $573.4 million in All Funds and $292.0 million in General Revenue Funds, for Adoption Subsidies and Permanency Care Assistance Payments; and
  • $24.7 million in All Funds and $5.0 million in General Revenue Funds, for the Relative Caregiver Program.

Funding includes a total of $139.3 million in All Funds and $108.5 million in General Revenue Funds for the Day Care Purchased Services Program

Key provisions in the House Bill for health and human services

The House Bill provides $65.1 billion in All Funds, including $26.8 billion in General Revenue Funds and $0.2 billion in General Revenue– Dedicated Funds, for the Texas Medicaid program. This is an increase of $0.9 billion in All Funds, which includes an increase of $0.7 billion in General Revenue Funds.

Included in these amounts is $60.7 billion in All Funds for Medicaid client services, $1.6 billion in All Funds for programs supported by Medicaid funding, and $3.2 billion in All Funds for administration of the Medicaid program and other programs supported by Medicaid funding.

The net increase in Medicaid funding is due to a $1.8 billion All Funds increase in Medicaid client services offset by a $0.6 billion All Funds reduction in administrative funding and a $0.2 billion All Funds reduction in other programs supported by Medicaid funding.

Increased funding for  Medicaid client services supports caseload growth and maintains fiscal year 2017 average costs for most services, including maintaining rate increases to support attendant wage increases; increased payments to trauma facilities, safety-net hospitals, and rural hospitals; and rate increases for the Home and Community-based Services (HCS) waiver and intermediate care facilities for individuals with intellectual disabilities (ICFs/IID). Net more favorable Federal Medical Assistance Percentages result in a higher proportion of the program being funded with Federal Funds. Full funding for anticipated increases in cost due to medical inflation, higher utilization, or increased acuity is not included.

The 2016–17 amounts for Medicaid assume supplemental funding to complete fiscal year 2017 expenditures.

Similar to the Senate, House funding includes $3.5 billion in All Funds ($2.8 billion in General Revenue Funds and General Revenue–Dedicated Funds) for non-Medicaid/CHIP behavioral health services. Funding supports programs at 18 agencies across six articles, and includes: funding for inpatient client services at the state hospitals and community hospitals; outpatient services provided through Local Mental Health Authorities; substance abuse prevention, intervention, and treatment services for adults and children; mental health care and substance abuse treatment for incarcerated offenders; mental health care services for veterans; and other services.

Funding also includes $95.6 million in General Revenue Funds, contingent on passage of legislation produced by the House Select Committee on Mental Health (Chaired by Representative Price), and $62.6 million in General Revenue Funds for the biennium to address current and projected waitlists for community mental health services for adults and children.

Medicaid expenditures for behavioral health services (when including projected cost growth that is not funded) are estimated to total $3.6 billion in All Funds for the 2018–19 biennium, and CHIP expenditures (when including projected cost growth that is not funded) are estimated to total $47.2 million in All Funds. Total behavioral health-related funding, including estimated Medicaid and CHIP expenditures,  is estimated to be $7.2 billion in All Funds for the biennium

The House Bill provides $3.2 billion in All Funds, including $1.9 billion in General Revenue Funds, for all Child Protective Services (CPS) functions at the Department of Family Services (DFPS). This is an increase of $260.1 million in All Funds and $310.6 million in General Revenue over the 2016–17 base.

Funding includes 828.8 full-time-equivalent (FTE) positions and an increase of $331.8 million in All Funds in CPS in order to:
  • Maintain the resources provided in fiscal year 2017 to address critical needs in the CPS program; and
  • Improve agency performance related to the average caseload per CPS caseworker and CPS caseworker retention.
CPS funding includes a total of $1.4 billion in All Funds and $0.6 billion in General Revenue Funds for DFPS entitlement programs, including:
  • $842.6 million in All Funds and $362.2 million in General Revenue Funds, for Foster Care Payments;
  • $573.4 million in All Funds and $292.0 million in General Revenue Funds, for Adoption Subsidies and Permanency Care Assistance Payments; and
  • $24.7 million in All Funds and $5.0 million in General Revenue Funds, for the Relative Caregiver Program. Funding includes a total of $139.3 million in All Funds and $108.5 million in General Revenue Funds for the Day Care Purchased Services Program.
The session is very young, yet the budget battles ahead already seem very, very old.
Thomas Valentine
Texas Insight