Texas HHS budget proposals: House vs. Senate

The Texas House of Representatives passed its $251.1 billion 2020-21 budget on a 145-2 vote at the end of March. On April 9, the Senate unanimously passed its $247.7 billion version of the budget.

The two proposals differ in their funding of Health and Human Services — the House allocates $87.6 billion, while the Senate allocates roughly $3 billion less, at $84.7 billion.

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Throughout the two plans, many efforts within HHS are funded at similar levels. In a few cases, the Senate funds services at a slightly higher level than the House — for example, the Senate puts about $18.3 million more than the House to community mental health services for adults.

The House proposal, though, more commonly funds services at a higher level than the Senate does — much of that $3 billion total difference comes into play in the capital budget for the Health and Human Services Commission.

Areas in the HHS budget where the House out-funds the Senate include:

Department of State Health Services

  • The House puts $8.7 million more than the Senate toward immunization efforts — both chambers include examining the latest flu vaccine as a use for the funding, but the House also adds making safety-net vaccines available to Medicare-D patients whose insurance doesn’t cover vaccines to its potential uses;
  • The House allocates $4.7 million more than the Senate to maternal and child health;
  • The House puts about $4.8 million more than the Senate toward upgrading lab information-management software; and
  • The House allocates $12 million to buy an emergency generator for Austin Laboratory, an expense that’s not included in the Senate’s budget.

Health and Human Services Commission

Under Medicaid client services:

  • The Senate puts $172.6 million less toward the aged and Medicare-related eligibility group and $900.3 million less toward the children eligibility group;
  • The House puts $34.6 million more toward intermediate care facilities for individuals with intellectual disabilities;
  • The House puts $379.2 million more toward home and community-based services;
  • The House allocates $24.3 million more than the Senate in funding the Texas Home Living waiver; and
  • The House puts $21.6 million more toward  the Program of All-Inclusive Care for the Elderly (PACE).

Under Medicaid and CHIP Support:

  • The House dedicates $69.3 million more than the Senate to Medicaid contracts and administration.

Under additional health-related services:

  • The House allocates $52.3 million more than the Senate to women’s health programs, while the Senate allocates $10 million more than the House to alternatives to abortion;
  • The House puts $59.7 million more toward early childhood intervention services than the Senate; and
  • The House allocates $50 million more to substance abuse prevention, intervention, and treatment, than the Senate.

For facilities:

  • The House puts $922.9 million more than the Senate, in 2020 alone, toward capital repairs and renovations; and
  • The House puts $26.2 million more than the Senate, over the biennium, into mental health state hospitals.

HHSC capital budget:

The House spends roughly $1 billion more than the Senate in its capital budget for the Health and Human Services Commission, with $656 million of that difference going toward the construction of state hospitals and other inpatient mental health facilities.

Another difference: The Senate specifically directs the Health and Human Services Commission to “develop and implement cost containment initiatives,” including increasing fraud, waste, and abuse prevention and detection, in order to save at least $350 million over the biennium.

A plan to implement those initiatives would be due December 1 of this year. In the House’s budget, a similar provision doesn’t set a specific savings goal.

The House refused to concur with the Senate’s amendments to the budget, and the bill is now in conference committee, as the chambers work toward a compromise.