Tuesday, Dec. 4
10:00 – 11:30 AM
IBC Bank Community Room
2817 E. Cesar Chavez

David Evans, Integral Care chief executive officer and Dr. Matt Snapp, Integral Care board chair provided a brief welcome before the forum began. Lee Johnson, Texas Council of Community Centers deputy director moderated the forum.

The Texas Council of Community Centers and The Texas Conference of Urban Counties endorse legislative policies such as the 1115 Medicaid Transformation Waiver, Medicaid expansion, the proposed redesign of behavioral health Medicaid Rehabilitation and IDD service systems and increased Medicaid provider rates.

Lee Johnson: The Texas Council of Community Centers is comprised of 35 community centers in 290 counties and provides an organization through which Community Centers can work together as a public system serving Texans with mental illness, intellectual developmental disabilities, and chemical dependency. It is our pleasure to have with us Texas House of Representatives delegates Donna Howard, who is well versed in behavioral health and areas of public health and Eddie Rodriguez.

General Platform:

• Support agency base appropriations, exceptional items and policy decisions.
• Explore, monitor and promote options to expand access to essential community-based services for people with intellectual and developmental disabilities, serious mental illness and substance use disorders. 
• Promote rates necessary to deliver quality care across intellectual disability, mental health and substance use disorder services.

To view Integral Care’s Legislative Session Guiding Principles, click here.

To view Texas Council of Community Centers Legislative Priorities, click here. 

Johnson: How can organizations advocate for Medicaid Expansion?

Rep. Howard: This is one of the bigger issues we will be considering. Leadership is not in support and does not want to participate. I'm concerend with follow through, but that doesn't mean we won't work on it. Texas has the largest uninsured rate in the nation and Medicaid Expansion could tremendously assist many more Texans. Certainly our budgeting has relied on a certain percent of folks not taking advantage of something they are eligible for. We have invested so little in Texas and the Federal Government is providing funding at 100 percent for the first three years and 90 percent thereafter. Not taking advantage of this would be fiscally irresponsible. The “get the most bang for the buck” theory typically decreases services.

Rep. Rodriguez: I completely agree. Half the membership of the upcoming legislature will be freshman. The Republicans push the anti-services rhetoric, but don’t consider what it will mean for constituents. Advocacy is important to talk to the leadership about its impact to constituents.

Johnson: Representative Burnam filed a bill that will allow counties to file for Medicaid Expansion on their own, what would that mean for counties?

Rep. Rodriguez:  Medicaid Expansion should be statewide because everyone is in need for increased services. Ideally statewide is best.

Johnson: Let’s shift to 1115 Transformation Waiver. How can advocates convey the values and approach to best practices to legislators?

Rep. Rodriguez:  Generally speaking 1115 is a positive thing. It is a small amount of money from local and state and big investment at the federal level. The problem is it is a moving target and not solidified. Advocates can talk about the savings and strong track record of preventative care. In the long run, people are healthier and we are also saving money in the immediate future.

Rep. Howard: Both sides know we could deliver healthcare better than we currently do. But how do we deal with it? More colleagues care about fiscal impact, but bigger picture is better outcomes and that should be part of the equation. If we take more federal money, the state will invest less and money is shifted. Eventually holes are left for states if the federal government doesn't invest again. Having a deficient then becomes the new normal. The vast majority of legislators try to stay on top of it, but don't understand everything going on and that is where advocates come in.

Rep. Rodriguez: We’ve had budget cuts for at least the last 10 years and population has boomed. Legislators look at numbers, not people. Advocates need to present the face of people represented by the outcomes of these cuts.

Johnson: How can advocates break through all the issues that come across your desk to ensure the best possible outcome?

Rep. Howard: Make sure you give real life stories about how people are impacted in their particular community. This can be very powerful. Also, get to know our staff.

Rep. Rodriguez: Knowing staff is important.                                                 

Johnson: Considerations for using the State Budget rainy day fund?

Rep. Howard: There are so many moving parts. Stated constitution requires we use personal growth budget board to raise the base budget. Based on the predicted by the State Comptrollers office the most we can raise our budget is 10.71 percent. Leadership is betting on a lower percentage, somewhere around eight percent. We are limited in what we can raise.  Supplemental bills can only go as high as our current spending cap. 

Rep. Rodriguez: It depends on what is considered a rainy day? The way particular taxes are going up all over the state because republicans are not doing the job. We have to find balance. 

Question and Answer Period

Question: Byzantine Regulations are too rigid and we are losing many nurses. What considerations for changing the scope of practice in education of nurses to ensure we keep the nurses employed in Texas to provide the services for Medicaid Expansion and the 1115 Waiver?

Rep. Howard: Perryman report is a good resource for information. I agree that the regulations are stringent and need to be reworked.

Rep. Rodriguez: We are closer to the goal to provide more nurses and access to care.

Question: Please provide more information on Senate Bill 57’s budget for providers.

David Evans: Managed care redesign has limited language in the current bill. Managed care solution calls for a pilot of two community centers and two private companies to enroll everyone.

Johnson: From what I understand, the timelines in SB 57 are pretty far out in the future. Individuals and families may have opportunity for input.

Question: Privatization is used as a way of attaining cost containment. Who is keeping track of administration overhead cost outsourced to private companies?

Rep. Howard: Outsourcing is an issue. We don't have a good mechanism for accountability. We need to pay attention to oversight and transparency.

Comment: About outcomes, peer services work. It’s less expensive than crisis services. Expanding certified recovery should be the expected outcome.

Comment: State Supported Living Centers need to go away. It’s much cheaper to provide services to those in the community. 

David Evans concluded the forum by saying, “We've just scratched the surface of a complexity of issues and what ways these issues will impact service, balance of privatization, managed care and Medicaid Expansion.  I’ll close on votes matter and elections matter. Thank you for your attendance here today.”