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, yet state spending does not keep up with growth in population and inflation, let alone prepared 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), are little more than an extension of many parts of previous spending, leaving roughly $50 billion on the table. But it’s not easily spent: the Texas constitution limits the amount of increase over the previous biennium’s budget. Some policymakers claim that means that most of the record surplus should be left unspent; others say the limit can be worked around to deal with unmet needs.
CTD supports tapping into the surplus to address years of neglect and pressing crises in disability services. We encourage advocates to be aware of the constitutional barrier, but not to let it deter or disrupt advocacy. The pandemic was not the sole cause of today’s crises, but it did expose problems that had been developing for many years.
The Latest
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.
CTD advocates for a base wage of $15 in 2024 and $17 in 2025 of the budget bill at a cost of $2.6 billion in general revenue funds. Offsets from lower hospital and nursing homes costs, plus increased state sales tax revenue bring the net cost under $2 billion. The federal government would match this with $4 billion in new money.
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.
CTD supports funding to reduce the Medicaid waiver interest lists by 15,000 service slots, with a commitment to prioritize ongoing real reductions. This must be in conjunction with the raise in community attendant wages. Without a raise, Texas Medicaid cannot serve its existing consumers.
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 due to budget constraints.
Now that the huge barrier of including the benefit into statute is achieved, advocacy moves to securing the funding. 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 (set aside for this specific purpose by the Legislature). HHSC has identified that amount as $15 million per year in general revenue funding. CTD supports $30 million in general revenue funding for this important benefit.
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.
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.
Advocacy
Our Priorities
- Attendant Wages
- Criminal Justice
- Healthcare Costs
- Increase the Number of Texans with Health Insurance
- Oral and Dental Care
- School Safety, Discipline, & Mental Health Supports
- Special Education & Schools
- State Budget & Appropriations
- Voting
- Youth Justice
