LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 77th Regular Session
March 30, 2001
TO: Honorable Patricia Gray, Chair, House Committee on Public
Health
FROM: John Keel, Director, Legislative Budget Board
IN RE: HB1422 by Oliveira (Relating to the provision of medical
assistance to certain legal immigrants.), Committee
Report 1st House, Substituted
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* The Estimated Two-year Net Impact to General Revenue Related *
* Fundsfor HB1422, Committee Report 1st House, Substituted: *
* Scenario 1 would have a negative impact of $(2,306,766), and *
* Scenario 2 would have a negative impact of $(2,931,215), through *
* the biennium ending August 31, 2003. *
* *
* 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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All Funds, Five-Year Impact:
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*Fiscal Probable Probable Probable *
* Year Savings/(Cost) from Savings/(Cost) from Savings/(Cost) from *
* GR Match for Federal Funds - Tobacco Settlement *
* Medicaid Federal Receipts *
* 0758 0555 5040 *
* 2002 $(683,766) $(1,034,240) $157,088 *
* 2003 (2,261,662) (3,403,824) 481,574 *
* 2004 (3,611,187) (5,432,607) 722,361 *
* 2005 (4,958,749) (7,459,856) 963,148 *
* 2006 (6,306,311) (9,487,105) 1,203,935 *
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Scenario 1, above, assumes implementation of section 1 (a) of the bill
only. Scenario 2, below, assumes implementation of Section 1 (a) and (b)
of the bill. It is anticipated that Section 1 (b) would have to be
authorized by federal law.
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*Fiscal Probable Probable Probable *
* Year Savings/(Cost) from Savings/(Cost) from Savings/(Cost) from *
* GR Match for Federal Funds - Tobacco Settlement *
* Medicaid Federal Receipts *
* 0758 0555 5040 *
* 2002 $(1,293,218) $(1,648,228) $157,088 *
* 2003 (2,276,659) (3,426,395) 481,574 *
* 2004 (3,634,919) (5,468,309) 722,361 *
* 2005 (4,991,203) (7,508,679) 963,148 *
* 2006 (6,347,487) (9,549,049) 1,203,935 *
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Technology Impact
Section 1 (b) of the bill would have a technology impact on the
Department of Human Services (DHS). Details are reflected below.
Fiscal Analysis
Section 1 (a) of the bill would direct the state Medicaid program to
provide medical assistance to aliens who entered the United States on or
after August 22, 1996, and who have resided in the United States for a
period of five years. This would increase the average monthly number of
recipients in the Medicaid program and decrease the average monthly
number of recipients in the State Immigrant Health Insurance Program
(SIHIP). Costs and savings related to implementing this portion of the
bill are reflected in Scenario 1.
Section 1 (b) would direct the state Medicaid program to provide
pregnancy-related medical assistance to the maximum extent permitted by
federal law to a person who is pregnant and is a lawfully present alien,
regardless of the date on which the person entered the United States. It
is anticipated Section 1 (b) would require a waiver from federal law.
Scenario 2 assumes such a waiver would be granted. Programming changes
within the automation system maintained by DHS would be required under
Scenario 2. Costs related to both sections of the bill are reflected in
Scenario 2.
Both scenarios assume an implementation date of January 2002. Fiscal
impacts have been adjusted accordingly.
Methodology
Scenario 1
1. An increase is assumed in the average monthly number of Medicaid
recipients served by the Department of Health (TDH) totaling 491 in FY
2002, 1,620 in FY 2003, 2,586 in FY 2004, 3,551 in FY 2005, and 4,516 in
FY 2006. The average monthly cost per recipient (weighted for all client
groups) for premiums and ancillary services is assumed to total $291.35
per client--the estimated cost for FY 2001. Cost and utilization levels
are assumed to remain constant. The federal share of costs is assumed to
be 60.20% in FY 2002, 60.08% in FY 2003, and 60.07% in subsequent years.
2. It is assumed the Health and Human Services Commission (HHSC), which
administers SIHIP, would experience a savings as certain SIHIP recipients
transfer to the Medicaid program. Specifically, a reduction is assumed
in the average monthly number of SIHIP recipients totaling 121 in FY
2002, 370 in FY 2003, 554 in FY 2004, 739 in FY 2005, and 924 in FY 2006.
The average monthly savings per recipient is assumed to total $108.58.
Savings would accrue to tobacco settlement receipts (General Revenue).
Scenario 2: Assumes all costs under Scenario 1, plus the following:
1. It is assumed the following number of women would receive prenatal
care through a Medicaid waiver operated by TDH: 49 in FY 2002, 83 in FY
2003, 132 in FY 2004, 181 in FY 2005, and 229 in FY 2006. (It is assumed
these women would already be eligible for delivery services through the
Medicaid emergency care (cost-reimbursed) program.)
2. It is assumed prenatal services would total $450 per woman per
pregnancy. The federal share of costs is assumed to be 60.20% in FY 2002,
60.08% in FY 2003, and 60.07% in subsequent years.
3. DHS would implement changes in the automated eligibility system to
track newly eligible clients. It is estimated the effort would require
10,920 programming hours at a cost of $110 per hour, resulting in a one
time cost totaling $1,201,200. The federal share of costs is assumed
to be 50 percent.
Local Government Impact
No significant fiscal implication to units of local government is
anticipated.
Source Agencies: 324 Texas Department of Human Services, 501 Texas
Department of Health, 529 Health and Human Services
Commission
LBB Staff: JK, HD, PP