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: HB2558 by Maxey (Relating to a program providing
services to certain children with special health care
needs.), As Introduced
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* Estimated Two-year Net Impact to General Revenue Related Funds for *
* HB2558, As Introduced: negative impact of $(61,857,858) 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. *
**************************************************************************
General Revenue-Related Funds, Five-Year Impact:
****************************************************
* Fiscal Year Probable Net Positive/(Negative) *
* Impact to General Revenue Related *
* Funds *
* 2000 $(30,747,476) *
* 2001 (31,110,382) *
* 2002 (31,387,666) *
* 2003 (31,387,666) *
* 2004 (31,387,666) *
****************************************************
All Funds, Five-Year Impact:
*****************************************************
* Fiscal Year Probable Savings/(Cost) from *
* General Revenue Fund *
* 0001 *
* 2000 $(30,747,476) *
* 2001 (31,110,382) *
* 2002 (31,387,666) *
* 2003 (31,387,666) *
* 2004 (31,387,666) *
*****************************************************
Fiscal Analysis
The bill would modify the Chronically Ill and Disabled Children's Program
(CIDC) and rename the program as the Children with Special Health Care
Needs (CSHCN) program.
The bill would eliminate diagnosis-specific medical eligibility criteria
and replace it with a functional definition of a child with special
needs. A child would be a person younger than 21. The bill would
eliminate the assets test for financial eligibility and remove persons
over the age of 21 with cystic fibrosis from eligibility for program
services. The bill would require the Department of Health to develop
and implement a health benefits plan to provide coverage for children
eligible for the CSHCN program and children not eligible for assistance
under Medicaid or the Children's Health Insurance Program. In addition,
the bill would require the department to provide "other family support
services" for children eligible for the CSHCN program. The bill would
allow the department to establish a waiting list if necessary for the
program to remain within budgetary limitations.
Methodology
According to the Department of Health, there would be no fiscal
implications in association with the implementation of the provisions of
this bill because the department assumes a Children's Health Insurance
Program will be implemented for children 0 through 10 with family income
up to 200 percent of the federal poverty level and for children ages 11
through 18 with family income up to 150 percent of the federal poverty
level that would cover the needs of children with special health care
needs.
The numbers in the table above are based on the following assumptions:
1. The new definition of Children with Special Health Care Needs is
assumed to encompass 1.3 percent of the population of children. The
current CIDC financial eligibility threshold is 200 percent of the
federal poverty level. This office has no data available at this time on
the total number of uninsured children through age 21 in families with
incomes less than 200 percent of the federal poverty level. The
estimates above assume, based on extrapolations of data produced by the
Legislative Council, that children through age 18 in families with
incomes above Medicaid eligibility levels and below two hundred percent
of poverty would be as follows: 490,901 in 2000, 496,695 in 2001,
501,122 in 2002 and subsequent years. Multiplying this figure by 1.3
percent provides the estimated number of new CSHCN clients.
2. Participation in the program is assumed to be fifty percent of the
potential eligible clients calculated above. The estimated cost to
provide a comprehensive health benefits package for a special needs child
is assumed to be $716 per month.
3. Other family support services are assumed to be utilized by five
percent of the participating CSHCN clients. For those clients, the
average monthly expenditure in the Medically Dependent Children's Program
($1,750), which provides family support services, is assumed to be a
proxy estimate for the average monthly cost of "other family support
services."
To the extent that a Children's Health Insurance Program, Phase 2, is
implemented and CSHCN receive services through CHIP, the above costs
would be reduced.
There would be some reduced costs in association with denying benefits to
persons over the age of 21 with cystic fibrosis who are currently
eligible for the CIDC program but data are not available to estimate
this amount.
Local Government Impact
No fiscal implication to units of local government is anticipated.
Source Agencies:
LBB Staff: JK, TP, KF