Stand-out health care-related Texas budget riders

The Texas budget contains a number of health care-related budget riders that are worth keeping an eye on. These contingent appropriations direct how funds will be collected and spent during the interim and, in some cases, are used as policy amendments.

Riders passed in previous legislative sessions are often included in the introduced version of current session appropriations. During the House and Senate Appropriations deliberations, these riders have the potential to be altered; so, some riders are amendments and some are the same as in previous appropriations.


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Here are some stand-out riders from 2020-2021 appropriations:

The Texas Managed Care program received attention this legislative session. An important rider, found on page 28 of the Article II Riders document,, provides additional accountability for the managed care program.

It requires the Office of the Inspector General to report certain information in an effort to reduce fraud, waste, and abuse in Medicaid managed care. The rider directs that the OIG, in collaboration with managed care, evaluate the strategies and mechanisms currently in place to prevent abuse, waste, and cost avoidance. OIG is required to present a report on the findings to the Legislative Budget Board by March 1, 2020.

Community-based Care Payments, found on pages 5 to 9 of the document, amends Senate Rider 29 to include language that allows for notification when additional funding is needed for some of the programs included in community-based care.

A new way of providing foster care, community-based care brings a community-based approach to providing care for children, youth, and families. Created during the 2017 legislative session, the program provides additional access to foster care programs through a Single Source Continuum Contractor. This rider allocates specific funding for foster care payments, CPS Direct Delivery staff payments, network care costs, startup costs, annual resource transfer costs, and General Fund appropriations.   

Another budget rider, maternal mortality and morbidity, is found on page 15 of the document. It also amends Senate Rider 29 to remove contingency language, and it provides additional language directing the Department of State Health Services and the Maternal Mortality and Morbidity Task Force to collect data on postpartum depression and maternity care.

A major focus of the Legislature, maternal mortality rates in the state have become increasingly high. The rider allocates funding and additional FTEs to implement a series of new programs and fund research opportunities across the state. The programs create maternal safety initiatives, and create models and pilot programs.

A total of $1 million General Fund dollars is allocated to increasing public awareness. The information will be collected from state health agencies.

The Adult Safety Net (ASN) rider, found on page 17, amends House Rider 71 to direct the Department of State Health Services to provide a set of limitations on adult safety net vaccinations to immunize Medicare-D patients.

The ASN program provides publically purchased vaccines at no cost to patients enrolled in the program. The goal of the program is to increase the rate of vaccination in the state to uninsured Texans. The rider grants local health departments the ability to provide immunizations to Medicare-D patients whose insurance will not cover the vaccine. It also requires that these immunizations will not be provided if additional funding is required, or if providing Medicare-D patients will reduce the number of vaccinations provided to uninsured Texans.

Another rider amendment addresses hospital payments and changes the language to conform with with funding decisions made during budget considerations. Found on page 24, the rider directs funding over the next fiscal year.

Some of the key parts of this rider direct funding for rural hospitals, outpatient reimbursement rates, outpatient services, safety-net hospitals, and trauma care.

The rider also directs HHSC to develop new methodology for add-on payments that target safety-net hospitals and those that treat a high percentage of the state’s Medicaid, low-income, and uninsured patients. And, it directs HHSC to ensure that no single hospital receives reimbursement beyond its specified limit, and defines a series of terms for additional clarification.

In each of these riders, the requirements, and funding allocated to each program will be rolled out during the 2020-2021 fiscal year. It is likely that changes to many of the programs mentioned herein will be visible as a result.