LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 76th Regular Session
March 30, 1999
TO: Honorable Patricia Gray, Chair, House Committee on Public
Health
FROM: John Keel, Director, Legislative Budget Board
IN RE: HB1398 by Coleman (Relating to indigent health care.),
As Introduced
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* Estimated Two-year Net Impact to General Revenue Related Funds for *
* HB1398, As Introduced: negative impact of $(124,933,300) through *
* the biennium ending August 31, 2001. *
* *
* The bill would make no appropriation but could provide the legal *
* basis for an appropriation of funds to implement the provisions of *
* the bill. *
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General Revenue-Related Funds, Five-Year Impact:
****************************************************
* Fiscal Year Probable Net Positive/(Negative) *
* Impact to General Revenue Related *
* Funds *
* 2000 $(61,934,530) *
* 2001 (62,998,770) *
* 2002 (62,998,770) *
* 2003 (62,998,770) *
* 2004 (62,998,770) *
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All Funds, Five-Year Impact:
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*Fiscal Probable Probable Probable Change in *
* Year Savings/(Cost) Savings/(Cost) Revenue Number of State *
* from General from Local Gain/(Loss) Employees from *
* Revenue Fund from Local FY 1999 *
* 0001 *
* 2000 $(61,934,530) $(103,859,083) $61,683,889 6.0 *
* 2001 (62,998,770) (107,201,569) 62,710,214 9.0 *
* 2002 (62,998,770) (107,201,569) 62,710,214 9.0 *
* 2003 (62,998,770) (107,201,569) 62,710,214 9.0 *
* 2004 (62,998,770) (107,201,569) 62,710,214 9.0 *
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Fiscal Analysis
The bill would modify the County Indigent Health Care Program (CIHCP),
administered by the Department of Health. It is assumed that most of the
following would represent new expenditures for both the state and
counties.
1. The Department of Health assumes that a total of nine additional
Full-Time Equivalent positions and associated administrative costs would
be incurred in association with the implementation of the provisions of
this bill. First year staff and some costs have been reduced for a
phase-in period.
2. Section 61.006(f) would add eligibility for the CIHCP program for
persons entitled to federal Social Security Disability Income (SSDI) but
ineligible for Medicare during a federal waiting period.
3. Section 61.006(h) would be modified to expand the use of allowable
dental services.
4. Section 61.006(i) would be modified to expand the use of allowable
podiatric services.
5. Section 61.023(b) would be modified to allow the county to use less
restrictive standards of eligibility for services and credit expenditures
made on behalf of persons eligible under the less restrictive standards
toward state assistance.
6. Section 61.0286 would be added to allow counties to credit payments
for purchase of insurance premiums on behalf of eligible persons towards
state assistance.
7. Section 61.037 would be modified to lower the percentage of county
general revenue from ten to eight percent that a county must expend to
become eligible for state assistance.
8. Section 61.038(b) would increase the state matching ratio from 80 to
90 percent for payments made by the counties eligible for assistance for
health services for eligible persons.
9. Section 61.0395 would be added to require the department to
distribute assistance to a counties providing a significant amount of
tertiary care to eligible residents in a facility located outside of the
boundaries of the county.
10. Section 4.03 of the bill would create a trust fund, the Regional
Health Care Delivery System Trust Fund, with the Comptroller but outside
of the general funds of the state. The state could contribute money to
the fund at a matching rate higher than otherwise specified for CIHCP.
Methodology
1. Department of Health administrative costs are assumed to be $250,641
in the first year and $288,556 in subsequent years.
2. Department of Health analysis estimates the cost to the state to
provide health services for persons entitled to SSDI but ineligible for
Medicaid to be approximately $8.7 million in fiscal year 2000 and $9.2
million per year in subsequent years. Increased net costs to the
counties are estimated to be $16.2 million in fiscal year 2000 and $16.7
million in subsequent years, after including the amounts provided by the
state as matching funds.
3. Dental services are assumed to cost the state an additional $4.1
million per year. Net increased costs to the counties are assumed to be
$6.8 million per year.
4. Podiatric services are assumed to cost the state an additional $0.1
million per year; net increased costs to the counties are assumed to be
$0.2 million per year.
5. Allowance of the use of less restrictive eligibility standards was
calculated by the Department of Health assuming that the statewide
average percent of federal poverty level adopted by counties would be 25
percent. The impact of this provision to the state would be to increase
state costs by $15.6 million per year. The fiscal impact to counties,
assuming the same overall average percent of the federal poverty level,
would be $4.7 million per year.
6. Allowing counties to credit insurance payments on behalf of eligible
persons towards state assistance was calculated by the Department of
Health to be a $11.2 million cost in fiscal year 2000 and $11.8 million
per year in subsequent years, and an increased cost to counties of $36.0
million in fiscal year 2000 and $37.8 million in subsequent years.
7. Lowering the percentage of county general revenue from ten to eight
percent that a county must expend to become eligible for state assistance
is assumed to increase state expenditures by $11.3 million per year and
decrease county expenditures by the same amount.
8. Increasing the state matching ratio from 80 to 90 percent for
payments made by the counties eligible for assistance for health services
for eligible persons is assumed to increase state expenditures by $0.7
million per year and decrease county expenditures by the same amount.
9. It is assumed that a state matching pool for the department to
distribute assistance to a counties providing a significant amount of
tertiary care to eligible residents in a facility located outside of the
boundaries of the county would be $10 million per year. The counties
would receive a revenue gain of $10 million per year.
10. It is assumed that the Regional Health Care Delivery System Trust
Fund would be held within the Treasury but outside of the General
Revenue Fund. No increased state costs are assumed in association with
this provision as the state would be allowed but not required to
contribute money to the fund.
Local Government Impact
The estimated impact to units of local government is shown in the table
above. In general, the provisions of this bill would shift more
responsibility to the state to cover expenditures for health services
made at the county level.
Source Agencies:
LBB Staff: JK, TP, KF