State Budget & Appropriations
5.5 minute read
Our Position
Texans need prosperous, safe, and healthy communities that promote growth and opportunity. Excellent public schools, quality health care, safe roads, environmental protection, and other crucial services require strong public investments. But state spending does not keep up with growth in population and inflation, let alone prepare our state for the challenges of the future (not to mention the present).
As the 2023 Legislature convened, State Comptroller Glenn Hegar released a mind-boggling revenue estimate of $188 billion available. The early budget bills from the House and Senate, known as HB 1 (Bonnen) and SB 1 (Huffman), were little more than an extension of many parts of previous spending, leaving roughly $50 billion on the table.
CTD was among the many voices calling on the Legislature to tap into the surplus to address years of neglect and pressing crises in disability services. Unfortunately, but perhaps unsurprisingly, they did not. While lawmakers made the largest increase they ever have to attendant wages (from $8.11 per hour to $10.60 per hour), they passed on the opportunity to set an actual competitive wage. They also funded miniscule increases for private duty nurses, Medicaid interest list reduction, and Early Childhood Intervention (ECI). They rejected Medicaid expansion and access to dental care for adults with disabilities in Medicaid.
The Latest
April 17, 2023: The Dallas Morning News reports on the Senate's budget, SB 1 paid subscription required
January 9, 2023: The Texas Tribune looks at the record breaking budget estimate
Background
In every area of our work, it is clear that lawmakers' budgetary decisions can empower and help all Texans, including Texans with disabilities—or hurt them. That's why CTD always priorities the State Budget and Appropriations in our advocacy work. While securing funding is often an uphill battle, CTD has built a track record of success: over the past twelve years, we have calculated that CTD has led or significantly contributed to legislative efforts that have added over $4 billion in state budget appropriations to programs and services that support Texans with disabilities and seniors.
Across our priorities, CTD favors policies that support long-term sustainability and prosperity while benefitting Texans with disabilities of all ages. As individuals, basic principles of money management tell us that it’s smarter to plan up-front investments and prevent expensive, avoidable crisis situations. The same is true for the state. Here are a few of CTD’s policy positions that build on this foundation:
Community attendant wages
People who need help with activities of daily living to stay in their own home benefit from reliable community attendants, but the $8.11 wage set by the Legislature is very low and not competitive, causing a workforce collapse. A raise in the wage will result in better health for Medicaid beneficiaries, fewer acute care costs, fewer ER visits and hospitalizations, and less unnecessary institutionalization. All of these costs are paid for by the public and far more expensive than a fair wage for community attendants.
While CTD advocated for a base wage of $15, the Legislature set it at $10.60 per hour, an expense of $2 billion this biennium and another $2 billion carried forward in the next biennium's budget.
Also of note, the Legislature funded a pitiful 2% wage increase for private duty nurses, another group serving Texans with disabilities that is long overdue for a real raise.
More about Community Attendants
Medicaid waiver interest lists
With 156,000+ unduplicated individuals as of December 2022, Texas has the nation’s largest and longest waitlist to receive services under a Medicaid waiver program. But the number of people waiting is the wrong number for a true analysis: not everyone waiting is eligible for waiver services. Some say this means the interest list problem is overblown, but nothing could be further from the truth.
A better measure is the years of wait to access services. A Texan entering waiver services today would have placed their name on the list an incredible 16 years ago. Every person accessing waiver services before that individual will have been eligible, and that’s why it’s misleading to say eliminating ineligible listers will impact the years of wait. Looking at it another way: Texans entering the waiver today faced a 16-year wait back in 2007. On average, a Texan joining the list at #156,000 today will be looking at a wait of at least 27 years before reaching the top of the list at the State’s current rate.
Even a 10% reduction of the list each year would be an improvement, but the 2023 Legislature funded less than a 1% per year reduction.
Access to oral and dental care
In 2021, CTD built on our substantial progress from 2017 and 2019 on Medicaid reimbursement for dental services provided to adults with disabilities. In the 87th Legislative session, language about a preventative benefit landed in legislation that passed, but the Texas Health & Human Services Commission (HHSC) has not yet implemented the program.
Though independent analysis showed the state would save more money through reduced ER visits, hospitalizations, and acute care, HHSC contends an initial budget number must be appropriated. We worked to secure the funding in 2023, but the Legislature rejected a rider to fund access to dental care for those who have zero benefits.
More about Access to Oral Healthcare
Increase the number of insured Texans
To borrow the words of Rep. John Bucy, "Medicaid expansion is the biggest tool we have to save lives and help people access needed healthcare." If Texas accepted Medicaid expansion, currently uninsured Texans would have access to health care, the federal government would provide several billion dollars to the state coffers, and an estimated 300,000+ jobs would be created.
The Legislature did not even hold a hearing on a Medicaid expansion bill in 2023. However, with strong leadership from the Cover Texas Now coalition and Sick of It TX campaign, it did expand postpartum coverage for mothers—from 2 months postpartum to a full year.
Special education
It’s simply accepted that public education leads to citizens better able to be good learners, workers, entrepreneurs, neighbors, and taxpayers. The same is true for kids with disabilities. A strong Early Childhood Education program for kids 0 - 3 is pennies on the dollar with a huge return on investment.
Access to medical cannabis
Props to the Legislature for permitting then expanding access to medical cannabis. Consequently, hemp (derived from the same plant) has been legalized and is largely unregulated. The result has been that numerous consumers left regulated medical cannabis for cheaper, unregulated hemp products. Legislators should recognize this change in environment and reform the medical cannabis laws with a goal to drive consumers to safer, more regulated, and more effective products in the Texas Compassionate Use Program (TCUP). This should be a source of state revenues and new jobs, as demonstrated in multiple states.
