| TO: | Honorable Patrick M. Rose, Chair, House Committee on Human Services |
| FROM: | John S. O'Brien, Director, Legislative Budget Board |
| IN RE: | HB892 by Villarreal (Relating to the Women's Health Program.), As Introduced |
| Fiscal Year | Probable Net Positive/(Negative) Impact to General Revenue Related Funds |
|---|---|
| 2010 | ($2,247,323) |
| 2011 | ($1,415,898) |
| 2012 | ($2,022,209) |
| 2013 | ($171,708) |
| 2014 | ($72,305) |
| Fiscal Year | Probable (Cost) from GR Match For Medicaid 758 |
Probable Savings from GR Match For Medicaid 758 |
Probable (Cost) from Federal Funds 555 |
Probable Savings from Federal Funds 555 |
|---|---|---|---|---|
| 2010 | ($2,247,323) | $0 | ($8,316,351) | $0 |
| 2011 | ($3,146,979) | $1,731,081 | ($12,450,334) | $2,484,898 |
| 2012 | ($4,686,640) | $2,664,431 | ($17,816,351) | $3,827,847 |
| 2013 | ($4,743,288) | $4,571,580 | ($18,530,265) | $6,567,748 |
| 2014 | ($4,918,135) | $4,845,830 | ($19,399,971) | $6,961,749 |
| Fiscal Year | Change in Number of State Employees from FY 2009 |
|---|---|
| 2010 | 49.8 |
| 2011 | 74.8 |
| 2012 | 124.6 |
| 2013 | 128.3 |
| 2014 | 132.1 |
Section 1: The bill would modify the Human Resources code with respect to the Women's Health Program. The bill would require Medicaid to provide adequate resources to increase outreach to maximize enrollment and continuous utilization by potentially eligible women in the Women’s Health Program. The bill would require that services designed to reduce unintended pregnancies and lower rates of sexually transmitted disease be maintained at a level at least equal to September 1, 2009.
The bill would require Medicaid to assist women to establish eligibility for the Women’s Health Program as soon as eligibility for other Medicaid coverage terminates after the birth of a child.
This would require Medicaid to modify administrative procedures to provide continuous eligibility when transitioning from Medicaid to the Women’s Health Program. The bill would establish provisions related to physician liability.
Section 2: The bill would add a new section to the Human Resources code titled “Women’s Health Program Outreach Pilot Program.” This section would require the Health and Human Services Commission (HHSC), in conjunction with a health plan and hospital in Bexar County, to develop an outreach pilot program to assist women in enrolling in the Women’s Health Program. The bill would require HHSC to report to the legislature on the costs and benefits of establishing a statewide outreach program, problems encountered in the pilot and recommended solutions. This section would expire September 1, 2011.
The bill would take effect September 1, 2009.
The fiscal impact of Section 1 stems from the requirement to provide outreach and to provide continuous enrollment when recipients transition from Medicaid to the Women's Health Program (WHP). Savings are anticipated in the Medicaid program due to recipients receiving WHP services. The fiscal impact of Section 2 results from implementation of the outreach pilot program.
The average monthly cost of the WHP is estimated to be $13.45 in fiscal year 2010, rising to $14.27 in fiscal year 2014. The estimated cost of client services would be $7.6 million in fiscal year 2010, $11.6 million in fiscal year 2011, $16.4 million in fiscal year 2012, $17.2 million in fiscal year 2013, and $18.1 million in fiscal year 2014. The federal matching rate for the WHP is assumed to be 90 percent. Contracted costs for eligibility support, document processing, postage, and correspondence are estimated to be $0.5 million in fiscal year 2010, $0.8 million in fiscal year 2011, $1.1 million in fiscal year 2012, $1.1 million in fiscal year 2013, and $1.2 million in fiscal year 2014.
HHSC estimates a need for more staffing to address the requirement of continuous eligibility. The estimated costs of the full-time equivalents in the table above is $2.1 million in fiscal year 2010, $2.9 million in fiscal year 2011, $4.9 million in fiscal year 2012, $4.8 million in fiscal year 2013, and $4.9 million in fiscal year 2014. The staffing is assumed to increase relative to the WHP caseload. All administrative and staffing costs are assumed to be matched with federal funds at 50 percent.
According to HHSC, savings are anticipated from lower costs in Medicaid related to the spacing of pregnancies, which would result in fewer prenatal, delivery and newborn costs in Medicaid. However, the savings estimate differs from that of the original WHP. The savings in this cost estimate assume a lower fertility rate of Medicaid recipients who have just given birth, based on data from the existing WHP program, than the fertility rate of women in the original WHP. While the general population fertility rate is between 7 and 8 percent, the rate assumed for the WHP expansion population described here is less than one percent. The agency indicates that this is because women who have given birth recently are much less likely to get pregnant again within one year. This would suggest a smaller opportunity for savings. Savings are not anticipated until fiscal year 2011. The savings are estimated to be $4.2 million in fiscal year 2011, $6.5 million in fiscal year 2012, $11.1 million in fiscal year 2013, and $11.8 million in fiscal year 2014. The federal matching rate is approximately 60 percent.
Section 2: HHSC estimates the cost of the pilot program to be $150,000 in fiscal year 2010 and $150,000 in fiscal year 2011. The pilot would expire on September 1, 2011.
| Source Agencies: | 529 Health and Human Services Commission, 537 State Health Services, Department of
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| LBB Staff: | JOB, CL, PP, MB
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