LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 77th Regular Session February 28, 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.), As Introduced ************************************************************************** * The Estimated Two-year Net Impact to General Revenue Related Funds * * for HB1422, As Introduced: Scenario 1 would have a negative * * impact of $(2,945,428), and Scenario 2 a negative impact of * * $(3,569,877) 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. * ************************************************************************** All Funds, Five-Year Impact: *************************************************************************** *Fiscal Probable Savings/(Cost) from GR Probable Savings/(Cost) from * * Year Match for Medicaid Federal Funds - Federal * * 0758 0555 * * 2002 $(683,766) $(1,034,240) * * 2003 (2,261,662) (3,403,824) * * 2004 (3,611,187) (5,432,607) * * 2005 (4,958,749) (7,459,856) * * 2006 (6,306,311) (9,487,105) * *************************************************************************** Scenario 1, above, assumes implementation of Section 1 (a) of the bill only. Scenario 2, below, assumes implementation of the provisions of Section 1 (a) and (b) of the bill. It is anticipated Section 1 (b) would have to be authorized by federal law. *************************************************************************** *Fiscal Probable Savings/(Cost) from GR Probable Savings/(Cost) from * * Year Match for Medicaid Federal Funds - Federal * * 0758 0555 * * 2002 $(1,293,218) $(1,648,228) * * 2003 (2,276,659) (3,426,395) * * 2004 (3,634,919) (5,468,309) * * 2005 (4,991,203) (7,508,679) * * 2006 (6,347,487) (9,549,049) * *************************************************************************** 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 number of Medicaid recipients per month. Costs related to implementing this portion of the bill are reflected in Scenario 1. Section 1 (b) would direct the state Medicaid program to provide medical assistance in the form of prenatal care, child delivery care, and obstetrical care related to prenatal care and child delivery care to a person who is pregnant and ineligible for medical assistance solely because of having resided in the United states for less than five years. It is anticipated Section 1 (b) would require a waiver from federal law. Scenario 2 assumes such a waiver would be granted. Additional 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 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. 2. The average monthly cost for premiums and related services is assumed to total $291.35 per client. This is the weighted average cost for all client groups. No annual increase in costs is assumed. The federal share of costs is assumed to be 60.2 percent in FY 2002, 60.08 percent in FY 2003, and 60.07 percent in subsequent years. 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 that prenatal services would total $450 per women per pregnancy. The federal share of costs is assumed to be 60.2 percent in FY 2002, 60.08 percent in FY 2003, and 60.07 percent 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: 529 Health and Human Services Commission, 324 Texas Department of Human Services, 501 Texas Department of Health LBB Staff: JK, HD, PP