During the 83rd Legislative Session, the Legislature passed Senate Bill 1, the Fiscal Year (FY) 2014–2015 biennial budget. The budget includes $94.6 billion in General Revenue (GR) and $197 billion in All Funds. Combined with the supplemental appropriation, the $94.6 billion GR budget is an increase of less than 8% compared to 2012–13 GR spending. However, after adjusting for population and inflation, the GR for 2014–2015 is 8.4% below the levels in the 2010–2011 budget. For people with disabilities, the budget funds many of the requested health and human services exceptional items to restore or expand services. Below is a summary of how select health and human services programs were addressed in the budget.
Department of Aging and Disability Services
Medicaid Waiver Programs
The Department of Aging and Disability Services (DADS) requested funding to provide services to 20% of the people waiting on the Home and Community-based Services (HCS) and Community Living Assistance and Support Services (CLASS) interest lists who are likely eligible for services. DADS also requested funding to increase services by 10% over August 2013 caseload levels for the other waivers. As of April 30, 2013, there were 105,032 unduplicated people waiting on interest lists.
Below is how the budget addressed Medicaid waiver programs that allow people with disabilities to receive services at home or in the community instead of institutional settings:
- HCS: DADS requested funds to enroll 5,566 people; the budget funded 1,324 enrollments
CLASS: DADS requested funds to enroll 3,056 people; the budget funded 712 enrollments
Texas Home Living (TxHmL): DADS requested funds to enroll 574 people; the budget funded 3,000 enrollments
Community Based Alternatives (CBA): DADS requested funds to enroll 982 people; the budget funded 100 enrollments
STAR+PLUS: DADS requested funds to enroll 1,116 people; the budget funded 490 enrollments
Medically Dependent Children Program (MDCP): DADS requested funds to enroll 238 people; the budget funded 120 enrollments
Deaf Blind with Multiple Disabilities Program (DBMD): DADS requested funds to enroll 16 people; the budget funded 100 enrollments
In total, DADS requested funds to enroll 11,548 people in Medicaid waiver programs and the budget funded 5,846 enrollments.
The budget fully funds the DADS request for diversions and transitions from institutions into community waiver programs. New this session were HCS services for people with intellectual and developmental disabilities (IDD) to transition from nursing facilities and Child Protective Services group homes.
The $28.1 million for Promoting Independence will be used to:
- Transition 400 people from large and medium Intermediate Care Facilities (ICFs) into HCS services
Transition 192 children aging out of foster care into HCS services
Provide HCS services to 300 people in crisis to prevent State Supported Living Center (SSLC) placement
Provide CBA services to 100 people in crisis to prevent nursing home placement
Provide HCS services to 360 people with IDD in nursing homes
Provide HCS services to 25 kids living in Child Protective Services group homes
Community First Choice
The budget includes a new basic attendant and habilitation service for 11,902 people with IDD that would be delivered by managed care organizations (insurance companies). The new service will be available to people with a functional need who are also eligible for Medicaid.
Department of Assistive and Rehabilitative Services
The Department of Assistive and Rehabilitative Services’ (DARS) requested funds for exceptional items, which are priorities the agency considered of importance in addition to the base budget.
- DARS requested $10.8 million in GR to maintain current Early Childhood Intervention (ECI) services; the budget funded $10.8 million in GR
DARS requested $4.8 million in GR to expand autism services to unserved areas; the budget funded $2.4 million in GR
DARS requested $2 million in GR to expand Independent Living Centers (ILCs); the budget did not provide funding in GR to expand ILCs
DARS requested $1.3 million in GR for access to interpreter services for the deaf; the budget funded $700,000 in GR
DARS requested $840,000 in GR for deaf and hard of hearing resource specialists; the budget funded $200,000 in GR
DARS requested $11.8 million in GR for Comprehensive Rehabilitation Services (CRS) for 206 people; the budget funded $5.9 million in GR
Early Childhood Intervention
The ECI program provides services to eligible children with developmental delays that assist them to gain skills or improve development. The ECI request was fully funded to address the increase in the average cost of services that occurred as a result of a decision made during the 82nd legislative session to narrow eligibility. The budget also includes a rider that makes $63 million of the total ECI appropriation contingent on a requirement that families earning above 400% of the federal poverty level pay 100% of the cost of ECI services. That means that a family of four earning more than $94,200 would be required to pay approximately $400 per month for ECI services.
The DARS Autism Program provides intensive, evidence-based treatment to children ages 3–8 with a diagnosis of autism spectrum disorder. The budget funds $2.4 million to establish two additional autism service locations and makes the funding contingent upon a plan to provide services more efficiently to more children.
Comprehensive Rehabilitation Services
Individuals with a traumatic brain injury or spinal cord injury can receive post-acute rehabilitative services in the CRS program. The budget includes added funding to provide CRS services to an additional 103 people.
Independent Living Centers
The Legislature did not fund the DARS request for $2 million for three new ILCs, primarily because no evidence was presented to support the request. Instead, a rider was added to require DARS to report on the actual and projected numbers of recipients served by each center and the types of services provided. The rider also requires DARS to make recommendations to improve the measurement, collection, and reporting of outcome data related to the centers.
Deaf and Hard of Hearing Services
The Legislature funded about 42% of the DARS combined requests for (A) access to interpreter services for the deaf and (B) deaf and hard of hearing resource specialists.
Department of State Health Services
Children with Special Health Care Needs
The Children with Special Health Care Needs (CSHCN) program covers services for children across the state who have extraordinary medical needs, disabilities, and chronic health conditions. The program pays for medical care, family support services, and related services not otherwise covered. The budget includes an additional $6.6 million.
Mental Health Funding
The budget includes over $150 million to address mental health (MH). This includes funds to eliminate the adult and children’s waiting lists for MH services. Below is the amount of funding the budget will provide for MH workgroup initiatives:
- $1.6 million for a public MH awareness campaign
$5 million for school-based training for teachers and staff in prevention and early identification of MH
$25 million for crisis services
$20 million to expand community MH for 6,242 adults and 286 children
$24.4 million for statewide expansion of the Youth Empowerment Service waiver
$25 million for collaborative public-private partnerships
$17 million to expand local MH authorities to serve people who are underserved
$6 million to expand NorthSTAR to serve people who are underserved
$4 million to fund MH services for veterans
$20 million for 1915i Home and Community-Based Services including rental assistance
$2.1 million for 10 beds in private residential treatment centers for youth at risk for parental relinquishment of custody to the Department of Family and Protective Services
Health and Human Services Enterprise
Acquired Brain Injury
The budget provides $2.1 million to the Office of Acquired Brain Injury and to increase services and supports for people with an acquired brain injury.
In this budget, 121,000 attendants will receive wage increases. The lowest wages will be raised to $7.50 per hour in FY 2014 and to $7.86 per hour in FY 2015. The $88.7 million GR appropriation to increase wages also includes $20 million for provider rate enhancement. The original request was for $176 million for a 50 cent per hour across the board wage increase.
Texas Department of Housing and Community Affairs
For FY 2014–2015, $3.8 million of the $11.8 million appropriated to the Housing Trust Fund will be used to fund the Amy Young Barrier Removal Program. This funding will be available to fund architectural accessibility modifications in individual homes or rental units.