Texas Senate finance committee considers critical workforce needs and loss of federal funding in appropriation for health and human services
Top officials from the state’s health and human services agencies testified before the Texas Senate Committee on Finance (SCF) outlining their legislative appropriations requests for the 2024-2025 state budget, Senate Bill 1, on Friday.
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Appropriations in the budget bill for health and human services total $97.36 billion over the biennium, $41.5 billion of which would come from the general revenue. To address ongoing workforce shortages, SCF outlined a 10% increase to salaries across the board for state employees in its base budget, including special provisions for employee services and system support.
The state’s Legislative Budget Board (LBB) recommended lower total budgets for the Health and Services Commission (HHSC) and the Department of State Health Services (DSHS) in response to reductions in federal funding caused by the PHE unwinding.
Citing increased workforce spending and reduced federal funding, each health and human services agency outlined higher general revenue requests from the previous biennium for 2024-2025.
CMS informed state health officials in January of a temporary increase to federal matching assistance percentage (FMAP) starting in April that will be gradually phased out through the end of this year to assist in Medicaid redeterminations associated with the end of the PHE’s continuous coverage provision. The FMAP rate is expected to fall below the previous biennium’s levels starting in 2024.
Based on LBB projections, both the FMAP and the enhanced FMAP will drop from 61.07% and 72.74%, respectively, in 2023 to 60.13% and 72.09% in 2024. Rates will drop to 59.88% and 71.91% in 2025.
HHSC 2024-2025 request $88.6 billion
HHSC is requesting $88.6 billion in total funds, a 6.8% decrease from the previous biennium, with $35.9 billion coming from general revenue. HHSC Executive Commissioner Cecile Young outlined her agency’s workforce needs in testimony before the committee.
“We have over 37,000 employees and they are spread across the strait in our facilities and eligibility offices, many of them working on the front lines in the lower end of the pay scale,” Young said. “These increases will go a long way to helping them keep up with inflation and the cost of living.
Our agency also requires individuals with high levels of expertise to oversee complicated contracts and procurements to provide legal guidance and to perform rate setting and actuarial analysis and to manage IT systems. Our workforce needs are critical to our ability to meet the needs of Texans who rely on our service and to fulfill the work you have entrusted to us. I’d also like to note that many of our provider partners are experiencing the same workforce challenges and I look forward to working to address those as well with rate increases particularly for community attendance and others.”
Young said Medicaid redeterminations in April for the 5.9 million Texans benefiting from the continuous coverage provision pose an additional challenge, describing the processing as a “massive undertaking”.
HHSC has requested funding to hire more than 600 temporary employees to assist in the unwinding process. It projects up to 1.7 million people will lose their Medicaid coverage and caseloads will drop by 22% in 2024 and 8.7% in 2025.
DSHS 2024-2025 request: $2.13 billion
DSHS’s request of $2.13 billion over the next biennium, $896.9 million in general funds, marks a 72.4% decrease from the previous appropriation. Funding for the Texas Center for Infectious Disease (TCID) would equal $883 million per year while requested appropriations to address maternal mortality and morbidity stand at $3.5 million per year.
Speaking before the Senate committee, DSHS Commissioner, Dr. Jennifer Shuford outlined the department’s exceptional budget items and their objectives, which include addressing gaps in public health activities, emergency preparedness, and response statewide as well as supporting local health departments’ regional advisory councils.
“We’re also very grateful for additional funding to support the [state health services] workforce,” Shuford said. “With this funding, DSHS will be able to better retain and attract a trained workforce focused on providing core public health services across the state. With regards to workforce, we have one remaining request that addresses unique TCID—that’s our tuberculosis hospital down in San Antonio— and their staffing retention issues, because they’re a healthcare facility, that we can’t completely resolve on our own … DSHS is requesting nine items totaling $176 million in general revenue and $189 million dollars in all funds over the biennium to maintain and bolster public health across Texas.”
DFPS 2024-2025 request: $4.89 billion
In contrast, the total appropriation request for DFPS increased by 6.9% over last session, at $4.89 billion total. In its presentation, LBB recommended the increase to continue the work in expanding community-based care across regions of the state.
DFPS Commissioner Stephanie Muth, appointed by Gov. Greg Abbott in January, outlined several key priorities: stabilization of the workforce, increased capacity for foster placements, growth in kinship placements, rate modernization for foster care, and improved outcomes for children in the state’s care.
“So one of the things that struck me when I looked at the exceptional items that had already been submitted was we weren’t really addressing those behavioral health needs,” Muth said. “I do feel like as we’re working on these difficult placement issues, the answer is not just trying to build capacity in placements, it’s also preventing the need for those higher level capacity placements. I don’t think if we just focus on the supply that we’ll ever have enough supply. It’s also important to focus on how we can impact the demand side.”
Muth said HHSC’s top behavioral health specialist will be joining her department temporarily to assist in identifying and addressing any existing gaps in behavioral healthcare.