HB 54

HB 54

TCDD Bill of the Week: House Bill 54 Featured Graphic

For this weekly feature, the Texas Council for Developmental Disabilities (TCDD) profiles a noteworthy bill that is going through the legislative process. The bill may relate directly to TCDD’s Public Policy Priorities or another disability-related issue.

Table of Contents

Bill: House Bill (HB) 54, relating to the personal needs allowance for certain Medicaid recipients who are residents of long-term care facilities.

Bill Author: Rep. Senfronia Thompson, House District 141 (Houston)

What does the bill do?

HB 54 would increase the personal needs allowance for a resident in a long-term care facility to at least $85 a month. These facilities include nursing facilities, assisted living facilities, intermediate care facilities such as state-supported living centers, and other similar long-term care facilities that administer medical assistance.

The Texas Health and Human Services Commission (HHSC) would be allowed to send the personal needs allowance directly to a resident who receives Supplemental Security Income (SSI). The bill stipulates that this increase does not apply to a resident who is participating in a medical assistance waiver program administered by the commission.

If signed into law, the bill would take effect on Sept. 1, 2023. However, if changing the law requires a federal waiver or authorization, the state may delay implementation until approval is granted.

Background Information:

Residents of various long-term care facilities receive a personal needs allowance of $60 per month. This is generally used to purchase personal goods and services that are not provided by the facilities or Medicaid, such as toiletries, shoes, clothing, haircuts, or even cell phones and corresponding data. The allowance is deducted from the regular care payments to the facilities and funded by both state and federal dollars.

The rate of the allowance is set by the executive commissioner of HHSC, but the minimum rate is set by law and total funding is decided by the Legislature. The minimum allowance has not been raised since 2007 when legislation increased it from $45 per month to $60 per month. Cumulative inflation since 2007 is estimated to be over 43%.

Statement from the bill author, Rep. Senfronia Thompson:


tcdd staff

Statement from the bill author, Rep. Senfronia Thompson:

tcdd staff
We never think about the cost of a hairbrush, a bottle of shampoo, or a comb. We just take those things for granted because we have them available. But [facility residents] sometimes need to buy those things, and they need those dollars to make those purchases.”

Where is the bill in the process?

On Nov. 14, 2022, HB 54 was pre-filed for the 88th regular session. Since committee assignments have yet to be named, the bill is waiting to be referred.

Who supports the bill and why?

The following comments were taken from a March 30, 2021, public hearing on a bill similar to HB 54:

  • Long-Term Care Ombudsman: Alexa Schoeman, the deputy state ombudsman with the Long-Term Care Ombudsman Program, an independent office within the Texas HHSC, testified in support of the bill. She referenced the isolation that many of us felt during COVID-19 lockdowns, stating, “we know that residents with cell phones and minutes were able to stay better connected with their loved ones through the pandemic. They could reach out on their own schedules as long as they had the minutes. I think a lot of us would be surprised at how few nursing facilities offer their residents free Wi-Fi, so data is something they have to pay for using their personal needs allowance.” Schoeman continued, “[this increase] may not sound like a lot to many people, but it would make a tremendous difference in the lives of nursing facility residents.”
  • Family Member: Marlene Cohen, testifying on behalf of herself, provided these remarks: “Long-term care residents on Medicaid consistently face a shortfall with the just $60 in the personal allowance. This leaves them to prioritize their purchases and wait until the next month or longer for essential items.” She continued, “One of my family members was a long-term care resident and on Medicaid. While she had family members who were able to help with small gifts of necessities, it put the person in an awkward position by having to ask for specific items. Many residents didn’t have family who could help. By supporting [this bill] and increasing the personal needs allowance … the lives of vulnerable long-term care residents across the state will be improved.”


The following groups also registered their support for the 2021 legislation but provided no testimony: Texas Medical Association, Texas Catholic Conference of Bishops, Every Texan, The Arc of Texas, AARP, Methodist Healthcare Ministries, and Texas Association of Health Plans.

The following comments were taken from a March 12, 2019, public hearing on another bill similar to HB 54:

  • TSHL: Sherry Hubbard, representing the Texas Silver-Haired Legislature, spoke in favor of the bill. She referred to the monthly allotment as a “personal dignity allowance” and mentioned that her statewide organization ranked this issue among their top five priorities — out of nearly 50 in total — for that session. Hubbard noted, “the current allowance has lost its ability to meet the needs of the Medicaid residents in nursing homes as the purchasing power has declined over this time. But [due to] the escalating cost of the items, … they’re finding it difficult to make ends meet, and they are relying upon vigilant and compassionate legislators to recognize and address their plight in keeping up with the rising costs of personal items and services.”

Who opposes the bill and why?

No opposition was registered at the 2019 and 2021 hearings on similar bills.

How much will the bill cost?

In 2021, the Legislative Budget Board (PDF) found that the bill similar to HB 54 would have a cost of $9,955,737 over the course of the biennium, and would require ongoing expenditures of around $5 million per year moving forward. However, HB 54 provides for a larger per-month increase, so overall costs are anticipated to be somewhat higher than that of the 2021 legislation.

Is there a Senate companion to the bill?

No identical bill has been filed in the Senate.

Share this bill:

TCDD has created a Bill of the Week one-pager for HB 54 (PDF). This is a simplified explanation of the bill that you can share with your representative and personal network.

Stay informed:

For the latest information about where HB 54 is in the process, follow the bill on the Texas Legislature Online. To receive future legislative updates from TCDD, subscribe to TCDD eNews or follow us on TwitterFacebookLinkedIn, or Instagram.



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