House Appropriations Article for 2022-2023

 To: Subcommittee Chair Giovanni Capriglione and members of the Subcommittee 

Date: March 1, 2021 

Re: Article II appropriations for 2022-2023 

From: Every Texan (formerly CPPP), Anne Dunkelberg, Associate Director 

Every Texan (formerly Center for Public Policy Priorities) appreciates the opportunity to provide written testimony to the Subcommittee regarding Article II appropriations for 2022-2023. The Benedictine Sisters of Boerne, Texas, founded Every Texan in 1985 to advance public policy solutions for expanding access to health care. For today’s hearing, we share this summary document, and we will distribute an extended version of these recommendations to the subcommittee shortly. 

Complete Projections of FFCRA federal funds increase impact are needed. Slide #12 of the HHSC presentation (“COVID-19 Fiscal Impact,” full committee 2/23/2020) shows a gain of $3.1 billion in federal Medicaid funds (no date frame provided), offset by about $1 billion in costs due to maintaining Medicaid coverage for all enrollees, a federal requirement until the end of the PHE. National experts estimate Texas will gain $6.5 billion in excess FMAP through December 2021; Federal officials informed states the PHE will be extended until then at minimum. However, LBB slide 12 indicates the FFCRA enhanced FMAP is only “guaranteed through June 30, 2021” and states—without supporting details or indicating how far in the future this will happen—that “eventually” the costs of retaining enrollment will exceed the state GR savings. HHSC Slide #6 “Key Budget Drivers” (from the full committee hearing 2/23) assumes the PHE ends June 2021, again indicating that full and updated revenue change estimates are needed. 

With such a large amount of additional federal revenue expected, lawmakers will need good estimates from LBB and HHSC to guide decisions. Key questions include: (1) How much additional federal Medicaid funding has Texas received so far; (2) how much will the projected total of additional funding be through the end of SFY 2021; and (2) how many additional federal Medicaid dollars will Texas get from September 2021 through December 2021; and (3) detailed data on the actual and projected offsetting costs of maintaining enrollment. 

Importance of Planning for end of FFCRA enhanced federal Medicaid funding. Given the billions of federal dollars that will be used in lieu of GR to maintain education and HHS in 2022-23, state budget-writers should carefully track and document all the federal aid that that is replacing state tax dollars – especially aid in the form of temporary increases in the Medicaid match rate and education stabilization funds. This will prevent any surprises for legislators returning in 2023 about the amount of General Revenue that will be needed to avoid current services cuts after federal economic stimulus aid is no longer available. 

Full Information and transparency about non-GR matching funds for Medicaid. Slide #2 in the HHSC presentation (HAC full committee hearing 2/23) shows 19.1% of HHS Spending in the current biennium going to off-budget supplemental payments. With such a significant role of off-budget Texas Medicaid spending and increasing reliance on local tax dollars and LPPFs to fund the non-federal share of Texas Medicaid, we recommend that the committee request full details on the sources and uses of all on-budget and off-budget Medicaid spending that relies on non-GR funds, both currently and as it would change under HHSC’s current Medicaid “directed payment” proposals in the future. 

Downward children’s Medicaid enrollment from 2017 to February 2020. Per HHSC enrollment data, from December 2017 to February 2020, combined Medicaid-CHIP child enrollment dropped by over 237,000 children, while Texas’ uninsured rate for children increased (and, as is also true for adults, is the highest number and percentage of uninsured in the U.S.). 

Correct Texas policies that are suppressing children’s Medicaid and CHIP enrollment. Two Texas policy changes would materially help reverse Texas’ downward uninsured child trend, and will require modest funding: 2 

(1) 12-month continuous eligibility for children’s Medicaid would eliminate inaccurate mid-year processes that HHSC reports terminate 65,000 children annually; and (2) revitalization and updating of HHSC outreach and informing about the eligibility of U.S. citizen children and lawfully present children for Medicaid and CHIP. 

Don’t cut eligibility staff during pandemic and economic downturn. 5% cuts required by state leadership included a substantial reduction in authorized eligibility staff which remains in the filed GAA bills. HHSC’s summary assumes reduced or delayed hiring for approximately 741.6 Eligibility Operations positions, and acknowledges the risk of longer eligibility determination waits. Per the LBB, 2022-23 budget recommendations reflect this in a decrease of $35.2 million in General Revenue ($48.7 million in All Funds) from the 2020-21 biennium for eligibility determination and related functions. 

Even with the Medicaid enrollment freeze in place, new Medicaid applications must be processed, along with renewals for current clients. SNAP enrollment has been increasing as you would expect due to high unemployment; January 2021 SNAP enrollment of 3.6 million Texans is over 270,000 above January 2020, and at peak in September 2020, was up nearly 700,000 to just over 4 million Texans. 

Medicaid expansion, via State plan Amendment or 1115 waiver. Multiple Texas experts have provided estimates confirming that covering adults under 138% federal poverty income will be cost neutral to the state budget, and beneficial to local taxpayers, hospitals, and families struggling to build economic security. In addition, Congress is considering legislation that would boost Texas’ Medicaid match rate 

Additional Priority issues. Every Texan strongly supports increased wages for Personal Attendants who help tens of thousands of Texas seniors and people with disabilities remain at home and out of nursing homes, but who are paid less than most fast-food or big box store workers. We also endorse full funding for Early Childhood Intervention (ECI), to insure every Texas child with a developmental delay gets prompt intervention services that can dramatically improve their health and intellectual development, which is better for Texas in every way. 

Thank you. Questions may be submitted by email or text to Anne Dunkelberg, Associate Director, at; or 512 627 5528.

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