MEDICAID FUNDED LONG-TERM
SERVICES AND SUPPORTS FOR
PEOPLE WITH DISABILITIES
Colleen Hor ton
Hogg
Foundation for
Mental Health
The University
of Texas at
Austin
July, 2010
WHAT I WAS ASKED TO DO…
 Explain Medicaid funding for long term ser vices and suppor t.
 Talk about all t he waiver programs of fered t hrough DADS and DSHS
including:





Eligibility requirements (eligibility)
How to sign up
Services available
Funding amounts
Where to get information
 Include information a bout t he consumer directed ser vices options.
 Provide information on ot her long term ser vices and suppor ts
 Talk about t he waiting lists.
 Talk about how folks can impact c hange during t he session.
MEDICAID
( M U C H O F T H E I N FO R M AT I O N I N T H I S P R E S E N TAT I O N TA K E N
D I R E C T LY F R O M T H E DA D S W E B S I T E )
 History
 Entitlement program established in Texas in 1967 to provide health care
to certain low income individuals; Title XIX of Social Security Act (1965)
 Purpose – to provide health coverage to:




Low-income families, children & related caretakers
Pregnant women
Elderly
People with disabilities
 Eligibility
 Individuals receiving TANF and SSI
 Individuals receiving waiver services
 Individuals meeting income and disability criteria
 Emergency Medicaid Services
PEOPLE WITH
DISABILITIES
30 % or the
Medicaid
Population
58% of
Medicaid
Costs
MEDICAID STATE PLAN
THE STATE’S CONTRACT WITH THE FEDS
 Entitlement (no waiting list)
 Mandatory Services
 Optional Services
 Mandatory populations
 Optional Populations
 Texas Medicaid and CHIP in Perspective 2009 http://www.hhsc.state.tx.us/medicaid/reports/PB7/PinkBook
TOC.html
MANDATORY SERVICES
 EPSDT-Texas Health
Steps
 Inpatient/Outpatient
hospital care
 Physician services
 Nurse midwife
services
 Nurse practitioner
 FQHCs
 Lab & xrays
 Prenatal care
 Family planning
services
 Skilled nursing
 Children’s vaccines
 Nursing facility care
 Home health care
 Rural Health Clinics
 Nurse practitioners
 Home health care
 Rural health clinics
OPTIONAL SERVICES
 Durable medical equip.
 PT, OT, Speech
 Personal care services
 Dental services
 ICFMR
 IMDs (under 21, over 65)
 Private duty nursing (under
21)
 RX drugs (3 per mo.)
 Unlimited RX in nursing
facilities, ICFMR, managed
care
 Birthing center
 Renal dialysis
 Rehabilitation (chronic
mental illness, physical,
development)
 Targeted case management
 Medical transportation
 Optometry
 Podiatry
 Emergency hospital
services
 Licensed professional
counselor (LPC)
POPULATIONS COVERED
 TANF recipients
 Families based on age, income, and assets
 Newborns up to 1 2 months whose mother is Medicaid cer tified at the
time of child’s bir th
 The majority of children in foster care
 Some adopted children
 Non-disabled, non -pregnant adults over age 65 w/ income below the
TANF limit
 Children under 19 and pregnant women over the income limit but have
significant medical bills (Medically needy/spend down)
 SSI recipients (aged, blind and disabled)
OPTIONAL POPULATIONS
 Individuals receiving Primary Home Care services (up to 300%
of SSI income limit)
 Individuals receiving waiver services
 Childless adults (not covered in Texas)
CHILDREN IN MEDICAID
Some things are dif ferent for kids:
 All medically necessary services
 Texas Health Steps – Early and Periodic Screening, Diagnosis,
and Treatment
 Comprehensive Care Program
 Personal Care Services
 Voluntary participation in managed care ( Star+Plus)
NUTS AND BOLTS
 How do I apply for Medicaid?
 By phone – call 211 (connects callers with information on health and human
services)
 On-line
 In person
 Texas Medicaid and Healthcare Par tnership (TMHP) contracts with state
to provide Medicaid administration, reimbursement ser vices, claims,
prior authorization
 Texas Medicaid and CHIP in Per spective 2009 http://www.hhsc.state.tx.us/medicaid/repor ts/PB7/PinkBookTOC.html
 Frew v. Hawkins (1996) – Texas HealthSteps
 Alber to, N. – Private duty nur sing and per sonal care ser vices
CHIP
CHILDREN’S HEALTH INSURANCE PLAN
 Eligibility
 Under 19 years of age
 Children in families with low incomes and assets
 Services
 12 months of health care coverage
 Cost Sharing
 Enrollment fees are $50 or less per family
 co-pays typically $3 -$5
HOW TO ENROLL IN CHIP
 If you would like to request an application or check the status
of your application, call 1 -877-543-7669.
 You may also go online to www.chipmedicaid.com and print
an application.
 Fax or mail completed applications to the Texas ACCESS
Alliance at:
P.O. Box 14200
Midland, TX 79711
FAX: 1-877-542-5951
M A X I MUM M ONTH LY I N C OME L I M I T S
FO R H E A LTH C A RE C OVE RAG E P ROG RA MS FOR C H I LDREN
Source: HHSC Financial Services, 2007 Medicaid Expenditures,
Medicaid for
Medicaid for
Medicaid for
Children Under Children Ages 1 Children Ages 6
Age 1
to 5
through 18
CHIP
Medicaid for
Youth
Transitioning out
of Foster Care
Family Size
1
$1,670
$1,201
$903
$1,805
$3,610
2
$2,247
$1,615
$1,215
$2,429
$4,857
3
$2,823
$2,030
$1,526
$3,052
$6,104
4
$3,400
$2,444
$1,838
$3,675
$7,350
5
$3,976
$2,859
$2,150
$4,299
$8,597
6
$4,553
$3,273
$2,461
$4,922
$9,844
7
$5,130
$3,688
$2,773
$5,545
$11,090
8
$5,706
$4,102
$3,085
$6,169
$12,337
For each
additional
person, add:
$577
$415
$312
$624
$1,247
 STAR
 Managed care – acute care
 STAR+Plus
 Managed care – acute care and long
term services and supports
 PCCM (Primary Care Case Mgt.)
 Primarily in rural areas
 Northstar
 Behavioral health managed care
 Dallas/Ft. Worth
 IDD Pilot – current study
MANAGED
CARE
COMMUNIT Y SAFET Y NET SERVICES
39 MHMR COMMUNIT Y CENTERS
 MRA




Service coordination
Respite
Employment services
Flexible services
 LMHA




Children’s mental health services
Adult mental health services
Crisis services
State hospitals
 Will allow parents of children with
disabilities in families with income up to
300% of federal poverty limit, to buy into
the state Medicaid Program
 SB 187 - Authorizing legislation/SB 1 –
appropriation (Senator Deuell and Rep.
Lucio)
 Development - underway
 Implementation ???
A program at risk.
MEDICAID
BUY-IN
FOR
CHILDREN
MEDICAID 1915(C) WAIVERS
 State/Federally funded
 Community -based long term services and supports
 State must submit a waiver application to CMS
 Texas has too many waivers! Nine dif ferent (1915(c) waivers
with dif ferent administrative units and rules, service arrays,
rates, monitoring requirements, billing guidelines, etc.
 Developed to provide alternatives to institutionalization
 Waive certain Medicaid rules (e.g. state -wideness)
 1915(c) waivers “waive off” of some institutional setting (e.g. nursing
facility, state school, ICFMR)
TEXAS 1915(C) WAIVER PROGRAMS









Community Living Assistance and Support Services (CLASS)
Home and Community -based Services (HCS)
Medically Dependent Children’s Program (MDCP)
Deaf-Blind with Multiple Disabilities (DBMD)
Community Based Alternatives (CBA)
Consolidated waiver (CWP)
Youth Empowerment Services (YES)
Texas Home Living (TxHmL)
STAR+PLUS
Federal requirement – waiver programs must be cost neutral in
the aggregate.
WAIVER INTEREST LISTS
August,
2009
# on
interest
list
March,
2010
# on
interest
list
CLASS
HCS
MDCP
DBMD
CBA
27,674
42,360
14,347
79
34,050
30,363
43,385
17,052
262
35,278
Managed Total
Care
5,633
124,143
5,743
132,083*
(Unduplicated
102,647)
TIME ON THE INTEREST LIST/MARCH 2010
H T T P : / / W W W. DA D S . S TAT E . T X . U S / S E R V I C E S / I N T E R E S T L I S T /
Interest
List
CBA
ICM
STAR+
CLASS
DBMD** MDCP
HCS
0-1 years
18,979
1,358
4,274
6,909
222
5,464
9,296
1-2 Years
14,847
12
48
6,268
34
4,662
7,934
2-3 years
1,452
2
30
5,458
6
3,917
6,444
3-4 years
N/A
2
17
4,241
N/A
3,009
5,097
4-5 years
N/A
N/A
N/A
2,607
N/A
N/A
3,899
5-6 years
N/A
N/A
N/A
2,561
N/A
N/A
3,268
6-7 years
N/A
N/A
N/A
2,320
N/A
N/A
3,222
7-8 years
N/A
N/A
N/A
N/A
N/A
N/A
2,935
8-9 years
N/A
N/A
N/A
N/A
N/A
N/A
1,290
9+ years
N/A
N/A
N/A
N/A
N/A
N/A
N/A
CLASS provides home- and
community-based services
to people with related
conditions as a costeffective alternative to
placement in an
intermediate care facility
for persons with intellectual
disabilities or a related
condition (ICF-MR/RC).
CLASS
Community
Living
Assistance
suppor ts and
Ser vices
CLASS ELIGIBILIT Y REQUIREMENTS
 Disability/functional





Related conditions (not primary diagnosis of intellectual disabilities)
Must meet level of care needed for ICFMR eligibility
Must have a need for habilitation
Assessment conducted by direct service agency nursing staff
Must be diagnosed before the age of 21 years
 Financial




300% for the federal poverty level; $2,000 countable assets
Based on child’s income, not family income
Determined by HHSC Medicaid enrollment division, not DADS
Service plan may not exceed 200% of cost of care in ICFMR
SERVICES AVAILABLE IN CLASS
 Adaptive aids
 Case management
 Habilitation
 Minor home
modifications
 Nursing services
 OT, PT, Speech
 Psychological
Services
 Behavioral supports
 Respite care
 Specialized therapies
 Medical supplies
 Support family
services
HOW TO APPLY FOR CLASS WAIVER
SERVICES
 Call toll-free - 1-877-438-5658 to have a person placed on the
interest list.
 Be prepared to provide Social Security and Medicaid numbers,
type of disability, age of the onset of the disability, date of
birth, address and telephone number of the person to be
placed on the interest list.
 Need to confirm annually that you want to remain on the
waiting list.
 Assessment to determine eligibility is not done until services
are of fered (slot is available).
UTILIZATION REVIEW/INCREASED COSTS
 Amount of services/budget based on plan of care.
 CLASS waiver costs have increased 25% since 2006.
 Cost cap for CLASS is approximately $57,000
 DADS utilization review unit looking closely at those plans of
care that exceed a certain threshold ;
 Children - ($43,000) (3/2010)
 Adults - $57,368
HCS provides individualized
services and supports to
persons with intellectual
disabilities who are living
with their family, in their
own home or in other
community settings, such
as small group homes.
HCS
Home and
Community
-based
Services
HCS ELIGIBILIT Y
 Disability




Must have an intellectual disability with IQ of 70 or below, or
Have a related condition with an IQ of 75 or less
Must meet the level of care criteria for an ICFMR
Assessment and service coordination done by local MHMR Center
staff
 Financial
 300% of the SSI income limits; no more than $2000 in countable
assets
 Based on child’s income, not family income
 Determined by HHSC Medicaid enrollment division, not DADS
 Service plan may not exceed 200% of cost of care in an ICFMR
SERVICES AVAILABLE IN HCS
 Service Coordination
 Adaptive aids
 Minor home
modifications
 Counseling and
therapies
 Speech, OT, PT
 Audiology
 Dietary
 psychological
 Nursing
 Dental treatment
 Respite
 Supported employment
 Day habilitation
 Residential Services
 Supported home living
 Foster/companion care
 Supervised home living
HOW TO APPLY FOR HCS WAIVER
SERVICES
 Apply for services by
 Contacting you local mental retardation authority (MRA)
 MRA website: http://www.dads.state.tx.us/contract/mra.cfm
or call 211 .
 Be prepared to provide Social Security and Medicaid numbers,
type of disability, age of the onset of the disability, date of
birth, address and telephone number of the person to be
placed on the interest list.
 Need to confirm annually that you want to remain on the
waiting list. If your local MRA doesn’t contact you, call them!
UTILIZATION REVIEW/INCREASED
COSTS/WAITING LIST
 Amount of services based on assessed Level of Need (LON)
 Number of individuals waiting for HCS services = 43,385
(3/2010)
 Current waiting time = about 9 years (3/2010)
 Service coordination now conducted by local MRA (MHMR
community center)
 Cost caps vary by level of need.
MDCP provides services to
support families caring for
children and young adults
who are medically dependent
and to encourage deinstitutionalization of
children in nursing facilities.
MDCP
Medically
Dependent
Children’s
Program
MDCP ELIGIBILIT Y
 Disability
 Must meet medical criteria for nursing facility admission
 Must be under the age of 21 years
 Must meet disability criteria for social security or Medicaid benefits
 Financial Eligibility
 300% SSI income limits; no more than $2,000 in countable assets
 Based on child’s income, not family’s
SERVICES AVAILABLE IN MDCP
 Respite
 Adjunct support services
 Adaptive aids
 Minor home modifications
 Transition services
HOW TO APPLY FOR MDCP SERVICES
 Call 1-877-438-5658 to have the child's or young adult's
name placed on the MDCP interest list.
 Be prepared to provide Social Security and Medicaid numbers,
type of disability, age of the onset of the disability, date of
birth, address and telephone number of the person to be
placed on the interest list.
 Need to confirm annually that you want to remain on the
waiting list. If your local MRA doesn’t contact you, call them!
UTILIZATION REVIEW/WAITING LIST
 Service coordination/case management is
performed by DADS regional MDCP staff (nurse
and/or social worker)
 Cost cap is 50% of cost of nursing facility care
(wrap-around Comprehensive Care Program
services)
 Number of children waiting = 17,052 (3/2010)
 Current waiting time = 3-4 years (3/2010)
DB/MD waiver provides home
and community-based
services to people who are
deaf-blind with multiple
disabilities as a cost-effective
alternative to institutional
placement. The program
focuses on increasing
opportunities for consumers
to communicate and interact
with their environment.
DBMD
Deaf/Blind
Multiple
Disabilities
ELIGIBILIT Y FOR DBMD
Disability/Functional
 Meet ICFMR or related conditions care criteria. Have deaf blindness with a third disability resulting in a need for one or
more services.
Financial
 Must meet Medicaid eligibility.
 Have an individual plan of care that does not exceed specific
limits.
SERVICES AVAILABLE IN DBMD
Adaptive aids
Medical supplies
Assisted living *
Behavior support
Case managements
Chore Provider
Employment
assistance
Minor home mods
Habilitation
Intervener
Nursing services
OT, PT, Speech
Orientation &
mobility
RX
Respite care
Supported
employment
Transition assitance
HOW TO APPLY FOR DBMD WAIVER
SERVICES
 Call 1-877-438-5658 and ask for the DB-MD waiver
representative.
UTILIZATION REVIEW/WAITING LIST
 Fewer “slots” and number served than other waivers
 Provides services similar to other waivers and some services
specific to those experiencing multiple disabilities.
 Number on waiting list = 262 (3/2010)
 Current wait = 2-3 years (3/2010)
CBA
This program provides
home-and communitybased services to people
who are elderly and to
adults with disabilities as a
cost-effective alternative to
living in a nursing home.
Community
Based
Alternatives
ELIGIBILIT Y FOR CBA
Disability/functional
 be at risk of entering a nursing facility,
 be 21 or older
 Must meet medical necessity for Medicaid nursing home care
Financial
 Meet Medicaid income eligibility requirements (300% SSI) and
have no more than $2,000 in countable assets
 Cost of plan of care may not exceed 200% of the cost of care
in a nursing facility
SERVICES AVAILABLE IN CBA
 Adaptive aids
 Medical supplies
 Adult foster care
 Assisted living
 Emergency response
services
 Home delivered meals
 Minor home mods
 Nursing services
 OT, PT, Speech
 Personal assistance
services
 Respite care services
 Dental services
 Unlimited RX
 Transition assistance
services
HOW TO APPLY FOR CBA SERVICES
 Call your local Department of Aging and Disability Services
Of fice.
 DADS local of fices can be found at:
http://dads.state.tx.us/contact/combined/cfm
 Call 211
UTILIZATION REVIEW/WAITING LIST
 Case management performed by DADS regional staf f.
 Eligible individuals living in STAR+Plus areas must receive
their services through STAR+Plus and are not able to obtain
services on fee-for-service basis.
 Number on waiting list = 35,278 (3/2010)
 Current anticipated wait = 2 -3 years (3/2010)
The Consolidated Waiver
Program provides home and
community-based services
to people who are eligible
for care in a nursing facility
or intermediate care facility
for persons with intellectual
disabilities or a related
condition (ICF/MR-RC).
CWP
Consolidated
waiver
program
CWP ELIGIBILIT Y
 No age limit
 Must currently be on an interest list in Bexar County for one of the
following programs:





Community Based Alternatives
Community Living Assistance and Support Services
Deaf-Blind with Multiple Disabilities
Medically Dependent Children
Home and Community -based Services
 Must have a ser vice plan developed by a DADS and the par ticipant
using the per son -directed planning process.
 Must meet specific institutional level of care criteria for an ICF -MR/RC,
or
 Must meet medical necessity determination for nur sing facility
ser vices.
SERVICES AVAILABLE IN CWP
 Adaptive aids
 Medical supplies
 Assisted living /residential
care
 Audiology
 Behavior communications
specialist
 Dental
 Dietary
 Nursing services
 Orientation and mobility
 Personal assistance svcs.
 RX
 Psychological services
 Respite care










Emergency response system
Family surrogate svcs.
Habilitation
Home delivered meals
Independent advocate
Minor home modifications
Social work
OT, PT, speech/language
Transportation
Transition assistance svcs.
HOW TO APPLY FOR CWP SERVICES
 Contact local Department of Aging and Disability Services
of fice.
 DADS local of fices can be found at:
http://dads.state.tx.us/contact/combined/cfm
 When names “comes up” on one of the other waiting lists in
Bexar County, and there is an open slot in CWP, individuals
have the option to choose between the standard waiver or the
consolidated waiver program
FOOD FOR THOUGHT…
 Waiver services should not be considered an “all you can eat
menu.”
 Every child should have access to the services they truly need,
but those children and families fortunate enough to be
receiving waiver services also have a responsibility. It’s not a
contest of whoever gets the most, wins.
 With tens of thousands waiting for services, every extra dollar
used af fects how long all the children on the waiting list will
have to wait.
YES
Allows more flexibility in
the funding of intensive
community-based services
and supports for children
with serious emotional
disturbances (SED) and
their families.
Youth
Empowerment
Ser vices
YES WAIVER PILOT
Pilot Project approved by CMS
 Achieves cost neutrality by waiving off of state hospitals
 Access through MHMR centers in Bexar and Travis counties
 Intended to expand to other parts of Texas if successful
 Provides intensive mental/behavioral health services in the
community
 Intended to prevent hospitalization/residential treatment
 Pilot in Travis and Bexar counties only
 Administered by DSHS
YES WAIVER ELIGIBILIT Y
Disability/Functional
 Be between the ages of 3 -18 years;
 Reside in Travis or Bexar County;
 Reside in a non-institutional setting with the child or adolescent’s
Legally Authorized Representative (LAR); or in the child or
adolescent’s own home or apartment, if legally emancipated;
 Choose, or have the LAR choose, the waiver program services as an
alternative to care in an inpatient psychiatric facility;
 Meet Department State Health Services (DSHS) clinical criteria
(including, but not limited to risk of self -harm, risk of severe
disruptive or aggressive behavior, family resources, and risk of
challenging school behavior); and
 There must be a reasonable expectation that, without Waiver
services, the child or adolescent would qualify for inpatient care
under the Texas Medicaid inpatient psychiatric admission guidelines
YES WAIVER ELIGIBILIT Y CONT’D.
Financial
 Must be eligible for Medicaid, under a Medicaid Eligibility
Group included in the approved waiver; parental income is not
counted in financial eligibility;
SERVICES AVAILABLE IN YES WAIVER
Respite
Community living
supports
Family supports
Transitional services
Adaptive aids
Minor home mods
Professional
services
Supportive familybased alternatives
Non-medical
transportation
Paraprofessional
services
HOW TO APPLY FOR SERVICES
Travis County -ATCIC’s YES Waiver Interest List Message Line at
512-804-3191 ,or
e-mail YES@atcic.org. ATCIC maintains an interest
list for individuals interested in receiving YES
waiver services
Bexar County – Center for Health Care
Services, (210) 731-1300
YES
 Allows more flexibility in the funding of intensive
community-based services and supports for children
with serious emotional disturbances (SED) and their
families.
 The waiver is designed to reduce Medicaid
psychiatric hospital expenses for children with SED
by providing community -based services.
Waiver “lite”
TXHML
This program provides
selected essential services
and supports to people with
mental retardation who live
in their family homes or
their own homes.
Texas
Home
Living
TXHML WAIVER ELIGIBILIT Y
Disability/Functional
 No age limit.
 Have a determination of mental retardation made in
accordance with state law or have been diagnosed by a
physician as having a related condition.
 Not be assigned a pervasive plus level of need (LON 9).
 Live in their own home or with their family.
Financial
 Must meet Medicaid eligibility
 Only waiver that considers the family income instead of only
the child’s income; many children eligible for HCS are not
eligible for TxHmL
 Have a plan of care that does not exceed the specific program
annual cost limit of $12,000
TXHML WAIVER SERVICES
Adaptive aids
Minor home mods
Specialized
therapies
Behavioral support
Dental treatment
Nursing
Respite
Day Habilitation
Employment
assistance
Supported
employment
Community support
TEXAS HOME LIVING WAIVER
 Does not have a separate waiting list
 HCS waiting list used when slots are available
 If TxHmL is accepted, individual’s name remains on HCS
waiting list
 Only waiver that allows all services to be consumer directed
 Early Childhood Intervention
 School services
 DARS employment services
 In-Home and Family Support (DADS)
 Children with Special Health Care
Needs (DSHS)
 Community MHMR services
 Social Security
OTHER
NONWAIVER
SERVICES /
PROGRAMS
Requires waiver from CMS
Provides all waiver services
available in CBA with the
option to offer more
Provider rates are
negotiated with the health
plan, not mandated by state
STAR+
PLUS
STAR+PLUS ENTITLEMENT
 Those who are SSI eligible in the STAR+Plus regions
have an entitlement to long term services and
supports (CBA services).
 Those who have income between SSI and 300% of
SSI do not have an entitlement and must be placed
on the waiting list.
 Number waiting for services = 5,743 (3/2010)
 Consumer directed services is not
a service; it’s a way of delivering
services
 Three options for service delivery
 CDS is one mechanism available
to enhance opportunities for selfdetermination/direction
 All waivers have some services
that can be provided through the
CDS options
 Not all waiver services can be
provided through CDS
SERVICE
DELIVERY
OPTIONS
THREE T YPES OF SERVICE DELIVERY
 Agency Model




Agency is responsible for arranging for provision of services
Agency is responsible for recruitment, hiring, training, monitoring
Individual has little say with respect to who provides their care
Direct care workers are employees (or contractors ) of the agency
 Service Responsibility Options Model (SRO)
 Agency is the employer of record, but client participates in the hiring
of attendants and respite providers
 Consumer Directed Services Model (CDS)
 Individual receiving the services is the employer of record
 Client is responsible for recruitment, hiring, training, supervising
attendants, respite providers, therapists, nurses
T YPES OF SERVICES THAT CAN BE
CONSUMER DIRECTED








Habilitation
Respite
Intervener
Supported home living
Adjunct support services
Personal assistance services
Professional therapies
Nursing
Note: not all services listed above can be consumer directed in
all the waivers. Check with your case manager/service
coordinator.
 Allows an individual residing in a
nursing facility to transition to
community services.
 An attempt to end the institutional
bias in the H&HS system.
 Only available to individuals
residing in nursing facilities.
 Not available for individuals in
ICFsMR or state schools (state
supported living centers).
 Voluntary closure is not the same
as money-follows-the-person.
MONEY
FOLLOWS
THE
PERSON
 13 facilities, 4,200 residents at
$150,000 per year, per resident
 Olmstead – least restrictive setting
STATE
SUPPORTED
LIVING
CENTERS
 Promoting Independence Advisory
Committee
 Community Living Options
Information Process (CLOIP)
 No MFP only target population slots
 Children in State Schools Workgroup
 DOJ Investigation
Formerly
called
State
Schools
 Projected $18 billion deficit
 5% cuts being implemented
 Additional 10% must be identified
 Only two ways to cover the deficit – raise
more revenue or cut spending
 “Everything is on the table except raising
taxes”
 May provide opportunities for major
changes
 Items previously “of f the table” are now on
 Mental health services may be hit harder
than others (limited federal match)
THE 82 ND
LEGISLATURE
IF THERE EVER WAS A TIME OR NEED
FOR ADVOCACY…IT IS NOW!
 $18 Billion deficit
 Lots of competition for the limited resources
 Possibility of major systems changes
 Get connected with other parents and advocates
 Become informed on the issues
 Begin crafting your message(s)
 Visit you legislators during the interim
 Make a plan
BEGIN YOUR ADVOCACY
 Write down three things you’ll do this summer to begin your
advocacy ef forts. (e.g., make an appointment to meet your
legislators, contact advocacy organization, etc.)
 Become familiar with this website”
 www.capitol.state.tx.us
Government was never meant to be a spectator sport.
Barbara Jordon
RESOURCES
 Information about the Medicaid waivers
http://www.dads.state.tx.us/providers/waiver_comparisons
 Texas Medicaid and CHIP in Perspective 2009 http://www.hhsc.state.tx.us/medicaid/reports/PB7/PinkBook
TOC.html
 Imagine Enterprises
http://www.imagineenterprises.com/
 Texas Legislature on Line
http://www.capitol.state.tx.us
If you need more information feel free
to contact me at:
colleen.horton@austin.utexas.edu
THE
END 