HHS Overview PRESENTED TO THE HOUSE COMMITTEE ON HUMAN SERVICES - PowerPoint PPT Presentation

HHS Overview • PRESENTED TO THE HOUSE COMMITTEE ON HUMAN SERVICES • LEGISLATIVE BUDGET BOARD STAFF February 2019

Presentation Overvie iew • Overview of Article II; • Medicaid financing, caseloads, and cost drivers; • State Supported Living Centers; • DFPS overview; • Foster care funding and caseloads; • TANF cash assistance and caseload; • House Bill 1 as Introduced February 11, 2019 LEGISLATIVE BUDGET BOARD ID: 5654 2

Art rticle II II General Revenue Expenditures, , FY FY 2009-2018 $60.0 Billions $50.0 $40.0 $30.0 $20.0 $10.0 $- 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 HHS Statewide N OTE : Amounts for fiscal year 2018 are estimated. February 11, 2019 LEGISLATIVE BUDGET BOARD ID: 5654 3

Art rtic icle le II II All ll Funds Exp xpendit itures, FY 2009-2018 $120.0 Billions $100.0 $80.0 $60.0 $40.0 $20.0 $- 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 HHS Statewide N OTE : Amounts for fiscal year 2018 are estimated. February 11, 2019 LEGISLATIVE BUDGET BOARD ID: 5654 4

Medic icaid Overview • Medicaid is a jointly funded State/Federal program providing health insurance primarily to low-income parents, non-disabled children, pregnant women, the elderly, and people with disabilities. As a requirement of participation, states must cover certain groups and have the option to cover additional groups. • The Health and Human Services Commission (HHSC) is the single state agency responsible for Texas’s Medicaid program, but services are administered by a variety of state agencies. February 11, 2019 LEGISLATIVE BUDGET BOARD ID: 5654 5

Med edic icaid Average Mon onth thly Full ll-Benefit t Ca Caseload by Enroll llmen ent t Group Fis iscal l Yea ears 2009 to o 2018 IN MILLIONS 5 Children Aged Disabled Other Adults 4 7.0% 7.2% 6.8% 7.2% 6.5% 11.4% 11.2% 11.5% 7.0% 6.7% 10.5% 7.3% 11.0% 11.5% 11.2% 7.6% 10.0% 9.9% 10.0% 9.2% 11.3% 3 8.1% 10.9% 10.1% 11.4% 10.6% 11.8% 10.4% 11.8% 11.8% 2 71.5% 71.4% 72.1% 73.0% 72.4% 70.1% 71.5% 69.6% 69.7% 1 69.7% 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 N OTES : (1) Other adults includes TANF Adults, Pregnant Women, Medicaid for Breast and Cervical Cancer, and Medically Needy clients. (2) Amounts for fiscal year 2018 are estimated. February 11, 2019 LEGISLATIVE BUDGET BOARD ID: 5654 6

Budget Driv ivers: Caseload and Cost • Medicaid expenditures are primarily a function of two factors: caseload and cost. • As caseloads increase or decrease (due to factors such as population growth, the economy, or policy changes), Medicaid expenditures fluctuate. • Medicaid expenditures also fluctuate as a result of cost growth (tied to rate changes, medical inflation, utilization, and acuity), which can be negative or positive. February 11, 2019 LEGISLATIVE BUDGET BOARD ID: 5654 7

Fin inancin ing • Financing of the Medicaid program is based on an array of matching rates that determine the amount of state funds (General Revenue, General Revenue-Dedicated, and Other Funds) and the amount of Federal Funds. • The primary matching rate for client services is the Federal Medical Assistance Percentage (FMAP). • Each state has a different FMAP based on its per capita personal income (PCPI) relative to the nation’s PCPI. o Federal Fiscal Year (FFY) FMAP is generally announced in November of the previous FFY. o FMAP is based on the three most recent years of income data available. o FFY 2020 FMAP was announced in November 2018 based on PCPI data for calendar years 2015 through 2017. • State FMAPs can range from 50 to 83 percent. o Below 55 percent: states with PCPI higher than the national average. o Above 55 percent: states with PCPI below the national average. February 11, 2019 LEGISLATIVE BUDGET BOARD ID: 5654 8

Medicaid id Fu Fundin ing by y Method of of Fin Finance Fisc Fiscal l Years 20 2000 00 to 20 2021 21 IN BILLIONS $35.0 GR-Related Federal Funds Other Funds $30.0 $25.0 $20.0 $15.0 $10.0 $5.0 $- N OTE : Fiscal years 2000 to 2017 are expended, fiscal years 2018 through 2021 are amounts included in the Legislative Budget Estimates, House. S OURCE : Legislative Budget Board. February 11, 2019 LEGISLATIVE BUDGET BOARD ID: 5654 9

State Supported Liv ivin ing Centers • Texas operates 13 intermediate-care facilities known as state supported living centers (SSLCs). Residents at SSLCs are individuals with severe or profound intellectual disabilities and those with intellectual disabilities who have behavioral health conditions or are medically fragile. • Nationwide trends have been toward deinstitutionalization and the expansion of community-based services. As demand for institutional services has decreased and community-based services are made available in Texas, the population served at SSLCs has decreased. • From 1977 to 2018, the average monthly census for all SSLCs has decreased by 75.6 percent, from 12,132 to 2,962. February 11, 2019 LEGISLATIVE BUDGET BOARD ID: 5654 10

SS SSLC Average Month thly ly Ce Census and St Strategy Fundin ing, g, FY 2009-2018 SSLC Census and Strategy Spending, Fiscal Years 2009-2018 $800 6000 Millions Census $700.2 $694.0 $687.9 $681.9 $674.8 $700 $667.8 $659.7 $659.7 $590.5 $639.4 5000 4627 4337 $600 4071 3880 4000 3650 $500 3411 3240 3125 3026 2962 $400 3000 56.9% 57.2% 57.5% 57.9% 57.9% 58.2% $300 58.4% 61.3% 2000 67.4% $200 70.6% 43.1% 42.8% 42.5% 42.1% 42.1% 41.8% 41.6% 1000 38.7% 32.6% $100 29.4% $0 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 General Revenue Non-GR Census N OTE : Amounts for fiscal year 2018 are estimated. February 11, 2019 LEGISLATIVE BUDGET BOARD ID: 5654 11

Overview of Child ild Protective Services • The Department of Family and Protective Services (DFPS) pays a daily rate for the care and maintenance of children who have been removed from their homes and placed in foster homes or residential treatment facilities as a result of abuse or neglect allegations. • In 2012, DFPS began implementing a redesign of the foster care program that utilizes single-source continuum contractors in a DFPS catchment area to provide a full continuum of services to children in foster care. • In the Eighty-fifth Legislature, Regular Session, 2017, Senate Bill 11 was implemented to outsource case management and Full-time-equivalent (FTE) positions and continue expansion of Foster Care Redesign, now known as Community-based Care to continue to provide child welfare services. February 11, 2019 LEGISLATIVE BUDGET BOARD ID: 5654 12

Child Protective Services Expenditures by Category Fiscal Years 2009 to 2018 $2,000 Millions $1,800 $1,600 $1,400 $1,200 $1,000 $800 $600 $400 $200 $- FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015 FY2016 FY2017 FY2018 Direct Delivery and Program Support Day Care Purchased Services Foster Care Adoption/PCA Relative Caregiver Community-based Care N OTE : Amounts for fiscal year 2018 are estimated. February 11, 2019 LEGISLATIVE BUDGET BOARD ID: 5654 13

Foster Car are Payments an and Community-based Car are Str trategy Expendit itures, FY FY 20 2009 09-2018 2018 $600 $510.3 Millions $500 $440.5 $422.6 $403.4 $399.3 $383.2 $400 $376.8 $375.2 $366.8 $354.2 54.7% 56.1% $300 58.1% 50.7% 59.2% 57.2% 60.7% 56.8% 62.9% 62.8% $200 45.3% $100 49.3% 43.9% 41.9% 40.8% 42.8% 43.2% 39.3% 37.1% 37.2% $0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 General Revenue Non-GR February 11, 2019 LEGISLATIVE BUDGET BOARD ID: 5654 14

Average Nu Number of of Child ildren (F (FTE) Se Served in in FP FPS-Paid id Foster Car are per r Mon onth, FY FY 20 2009 09-2018 2018 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 - 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 N OTE : Amounts for fiscal year 2018 are estimated. February 11, 2019 LEGISLATIVE BUDGET BOARD ID: 5654 15

Paid Caseworkers and Caseload Per Worker by Type Fiscal Years 2009 to 2018 3,000 50.0 45.0 2,500 40.0 35.0 2,000 30.0 Caseload per Worker Paid Caseworkers 1,500 25.0 20.0 1,000 15.0 10.0 500 5.0 0 0.0 FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015 FY2016 FY2017 FY2018 Conservatorship Foster/Adoptive Home Dev. Family Based Safety Services Kinship Investigations Paid Caseworkers Caseload per Worker Conservatorship Foster/Adoptive Home Dev. Family Based Safety Services Kinship Investigations N OTE : Amounts for fiscal year 2018 are estimated. February 11, 2019 LEGISLATIVE BUDGET BOARD ID: 5654 16