81st Legislature

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81st Legislature

• January 2009 Sneak Preview

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Sneak Preview 81st Legislature

• Aerial overview of the upcoming 81st Legislature
• Key health care issues
• Other factors that will affect discussion
• Ground rules of talk

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Budget

• Health care policy to a large degree will be
  driven by State Budget
• Forecast looks clear to partly cloudy with dark
  storm clouds on the horizon.

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Budget

• Projected surplus from the FY08-09 biennium of
  about 5 billion in the general revenue fund and
  6.8 billion in the Rainy Day Fund . 
• 3 billion is already dedicated to property tax
  relief
• Revenue increase for the FY10-11 biennium is
  slowing dramatically (have you seen your 401k
  lately?)
• Unknown supplemental appropriation needed for
  Hurricane Ike, Medicaid, community colleges, TDCJ
  and ???

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Budget Drivers

• Public Ed- money for enrollment growth,
  facilities, teacher pay incentives, textbooks,
  increase in per capita formulas, help with
  utility and gasoline costs.
• Higher Ed- enrollment growth, special items,
  Tuition Revenue Bonds, financial aid programs
• TRS and ERS- money for health care cost increases
  for teachers and state employees, annuity
  increases for retirees, issues of actuarial
  soundness of retirement funds
• Criminal Justice-increased operating costs for
  prisons, TYC, probation and parole programs

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Budget Drivers

• Transportation-no toll roads, then must leave
  more of Highway Fund (Fund 6) money at TXDOT for
  construction and maintenance of roads greater
  demand for general revenue funding at DPS
• Debt Service-costs of new general obligation and
  cancer bonds approved by voters.
• Pressure to further reduce property taxes and/or
  appraisal reform reexamine the business tax to
  lower the rates
• Economic Development -  Enterprise Fund and
  Emerging Technology Fund to stimulate business
  growth.

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Medicaid

• Any Texas health care overview has to start with
  Medicaid
• It's not the 800 lb Gorilla, it's the whole zoo.

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Medicaid Factors

• Frew settlement continued ramifications
• Increasing costs and caseload growth in program
• Provider rates

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Medicaid Horizon

• SB 10 from 2007 and Reform Waiver
• Increased scrutiny on medical errors and so
  called "never" events
• Growing desire for electronic records
  capabilities for efficiency better quality care

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Indigent Care Uninsured

• As the health care issue debate has raged for 20
  years, the pressures are starting to boil
• County indigent care
• Impact of Hurricane Ike
• Success of case management in Bexar County give
  greater support and flexibility to counties

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Indigent Care Uninsured

• RWJ Coverage Institute grant facilitating Texas
  effort that has been collaborated among executive
  and legislative leadership
• Discussion of reinsurance effort to bring lower
  cost plan to small businesses
• Could see combined efforts with Health
  Opportunity Pool

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Related issues

• Convenience care clinics
• Stand alone ER's
• Expanded scope of practice for nurse
  practitioners and PA's

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Mental Health

• State hospitals still overloaded
• Continue crisis redesign effort and rollout
• Priority within workforce and FREW discussions
• Issues in Foster Care

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Trauma

• The word trauma and Texas Legislature seem to fit
  together
• Fully expend funds from DRP account
• Focus on strengthening network with real time
  monitoring and rural structures
• Matching some of funds within Medicaid

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Other Factors

• HHSC new budget 4 billion in hole
• Rising costs and trends
• New Congress
• FMAP national economy vs TX economy

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Competing Factors

• Ike Recovery
• CPS and Foster Care
• Long Term Care issues -- quality measures on
  nursing homes
• ICF services reform state schools
• Interest List reduction
• Cancer Research and Prevention Institute - 300
  million

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Opportunities for FQHC's

• You are part of the Answer

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Opportunities for FQHC's

• Continuation and improvement of incubator fund
  need data to show impact
• Be a part of Medicaid Reform answer
• Vital role in improving children's access related
  to FREW
• Use loan forgiveness dollars to help clinics
  recruit providers
• Encourage connection with Family Practice
  Residency Programs

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• Thank you.
• Reid Charles says
• bye bye!

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81st Legislature

• Coming to Austin
• January 13, 2009