Texas Budget and DADS: Shifting to Managed Care

The Texas Legislature has released their budget bills, House Bill 1 and Senate Bill 1.  When passed, these bills will be the funding for state agencies in 2014 and 2015.    This information is important because it has an impact on the various state agencies to provide services.

 

In the current biennium (2012/2013), the Department of Aging and Disability Services is receiving approximately $12.5 billion in funding for providing long-term services and supports to the aging, disabled, and individuals with intellectual and developmental disabilities.  For the upcoming biennium (2014/2015), DADS has asked for $13.5 billion (or an 8% increase).  Both HB1 and SB1 fall well short of DADS’ ask.  HB1 provides for $12.7 billion (or a 1.8% increase over the current biennium), SB1 provides for $12.59 billion, or a .6% increase over the current biennium.

 

There are a number of programs that are seeing reductions in HB1 and SB1.  These include:

• Primary home care (~50% reduction): Provides non-skilled personal care services.  Reduction is due to STAR+PLUS and this service will eventually be eliminated.
• Day Activity and Health Services (~67% reduction): Another casualty to STAR+PLUS.
• Community-Based Alternatives (~24% reduction): due to STAR+PLUS.
• ID Community Services (~7% reduction): Administrative expenses are being transferred elsewhere and some of the individuals receiving services are being transferred to the Texas Home Living Waiver.
• Promoting Independence Services (~5% reduction): Another casualty due to STAR+PLUS.
• State Supported Living Centers (~3% reduction)

 

There are also a number of programs that are seeing increases in HB1 and SB1, these include:

• Community Attendant Services (11% in HB1, 6% in SB1): Seems to be balancing out the reduction in primary home care.
• Home Community-Based Services (HCS) (7% increase)
• Medically Dependent Children (4.6% increase)
• Nursing Facility Payments (3.4% in HB1, 2.2% increase in SB1)
• Medicare Skilled Nursing Facility (14% in HB1, 8.7% in SB1)
• Hospice (7.4% in HB1, 5.5% in SB1)
• Balancing Incentive Program (140% in both bills)

 

Basically these recommendations reflect a shift to providing services via managed care (see Senate Bill 57 for an example of what this could look like).  For some populations, this may be a good thing.  For individuals with intellectual and developmental disabilities, this may or may not be helpful.  There are several concerns with this.  First, managed care is using a medical model to treat diseases and apportion services accordingly.  People with IDD’s don’t have a medical condition that needs treated, so it’s difficult to fit their long term needs into a managed care setting.  Second, managed care organizations may not have experience with the IDD population, which may profoundly impact services.  Third, it’s unclear if managed care can quickly react to changing situations with people with IDD and provide the fast, flexible services that they sometimes need.

 

While both HB1 and SB1 provide an increase in funding (which is a positive), they do not come near to addressing the needs to the aging and disabled in Texas.  Now, neither budget bill is set in stone.  There will be lots of opportunities for input.  First, you can contact your representative and senator and provide feedback.  Second, there will be plenty of budget hearings over the next few months where written testimony and in-person testimony can be provided.  The budgets will go through a cycle of hearings, adjustments, and both the Senate and House versions will need to be reconciled before it goes to the Governor for his signature.

 

ECI and the Texas Budget: Missing the Mark

The Texas Legislature has released their budget bills, House Bill 1 and Senate Bill 1.  When passed, these bills will be the funding for state agencies in 2014 and 2015.    This information is important because it has an impact on the various state agencies to provide services.

The proposed budget for Early Childhood Intervention, administrated by the Department of Assistive and Rehabilitative Services, is mixed.  In the current biennium, ECI will receive $274,144,828 to provide services, provide respite services, and ensure the quality of ECI statewide.  This current biennium represented a sharp decrease in funding compared to the previous one.  As a result, DARS had to implement a number of changes to help contain costs while continuing to provide services.

These changes included implementing a family cost share.  In other words, families paid for a portion of their child’s ECI services according to a sliding scale based upon family income (families with more income paid more).  Another change was to require ECI providers to directly bill Medicaid to be reimbursed.  This saved DARS money because it meant that DARS no longer had to do this.  However, this was a skill set that many providers did not have and has led to challenging decisions such as: Do I hire a provider or someone knowledgeable about Medicaid billing?  Finally, DARS narrowed the criteria of who is eligible for ECI services, which meant that fewer children are receiving services today.

Now, this last change especially has had some ramifications.  By narrowing the eligibility, the make-up of the children receiving ECI services has changed.  This has resulted in their being more severely impacted by delays, requiring more services, increasing the cost of those services.   As a result, DARS is projecting that if funding for ECI remains flat over the 2014/2015 biennium, they will have to narrow eligibility even further.

In the current biennium, DARS is receiving approximately $274 million for ECI.  They asked for approximately $334 million, which took into account the state’s population increases, projected future demand, and the change in the make-up of children receiving those services.  Both HB1 and SB1 are recommending that ECI receive $297 million in funding, which represents an 8.5% increase over the current biennium.

While the increase in funding is a positive thing, it does come close to what DARS needs to continue offering services at the current eligibility level.  It is likely that if the budget passes as is, that DARS will have to narrow the eligibility in the upcoming biennium.

Now, neither budget bill is set in stone.  There will be lots of opportunities for input.  First, you can contact your representative and senator and provide feedback.  Second, there will be plenty of budget hearings over the next few months where written testimony and in-person testimony can be provided.  The budgets will go through a cycle of hearings, adjustments, and both the Senate and House versions will need to be reconciled before it goes to the Governor for his signature.