LEGISLATIVE BUDGET BOARD
                              Austin, Texas
                                     
                    FISCAL NOTE, 77th Regular Session
  
                              April 9, 2001
  
  
          TO:  Honorable Mike Moncrief, Chair, Senate Committee on
               Health & Human Services
  
        FROM:  John Keel, Director, Legislative Budget Board
  
       IN RE:  SB34  by Zaffirini (Relating to providing dental services
               to certain recipients of medical assistance.), Committee
               Report 1st House, Substituted
  
**************************************************************************
*  Estimated Two-year Net Impact to General Revenue Related Funds for    *
*  SB34, Committee Report 1st House, Substituted:  negative impact of    *
*  $(10,154,232) 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.                                                             *
**************************************************************************
  
General Revenue-Related Funds, Five-Year Impact:
  
          ****************************************************
          *  Fiscal Year  Probable Net Positive/(Negative)   *
          *               Impact to General Revenue Related  *
          *                             Funds                *
          *       2002                         $(5,053,835)  *
          *       2003                          (5,100,397)  *
          *       2004                          (5,101,675)  *
          *       2005                          (5,101,675)  *
          *       2006                          (5,101,675)  *
          ****************************************************
  
All Funds, Five-Year Impact:
  
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*Fiscal  Probable Savings/(Cost) from GR   Probable Savings/(Cost) from   *
* Year          Match for Medicaid           Federal Funds - Federal      *
*                      0758                            0555               *
*  2002                      $(5,053,835)                    $(7,644,242) *
*  2003                       (5,100,397)                     (7,676,148) *
*  2004                       (5,101,675)                     (7,674,871) *
*  2005                       (5,101,675)                     (7,674,871) *
*  2006                       (5,101,675)                     (7,674,871) *
***************************************************************************
  
Fiscal Analysis
  
The bill would require the Department of Human Services (DHS) to provide
certain dental services annually to a resident of a nursing facility who
is a Medicaid recipient.  Services would include a dental examination, a
prophylaxis, and a diagnostic dental x-ray.

The bill would require the Health and Human Services Commission (HHSC) to
conduct a study regarding the need for and cost of expanding dental
services.
  
  
Methodology
  
1.  The Medicaid nursing home population is assumed to be 64,568 in FY
2002 and 64,967 in subsequent years.  All of the population would receive
an annual exam.  Only clients with teeth (estimated to be 73%) would
receive dental cleaning and x-rays.

2.  Estimated costs include $50 for a dental exam, $90 for a cleaning,
and $150 for an x-ray.

3.  It is estimated that 1.62% of Medicaid nursing home clients already
receive limited dental care through "incurred medical expenses."  The
monthly cost of this care is estimated to be $146.80.  This expense has
been subtracted from the cost of care required by the bill.

4.  The net cost is estimated to total $12,698,077 in FY 2002,
$12,776,545 in each subsequent year.  It is assumed that federal funds
would provide for 60.2% of the expense in FY 2002, 60.08% in FY 2003, and
60.07% in each subsequent year.  General Revenue would provide for the
remaining expense.

5.  Dental exams could identify dental problems.  Potentially, treatment
for such problems would be allowable Medicaid expenses.  These related
costs have not been estimated.

6.  The HHSC has indicated a study regarding the need for and cost of
expanding dental services could be absorbed within existing funding
levels.
  
  
Local Government Impact
  
No fiscal implication to units of local government is anticipated.
  
  
Source Agencies:   529   Health and Human Services Commission, 501
                   Texas Department of Health, 324   Texas Department of
                   Human Services
LBB Staff:         JK, HD, PP