Human Services Texas House of Representatives Interim Report 2000
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HOUSE COMMITTEE ON HUMAN SERVICES TEXAS HOUSE OF REPRESENTATIVES INTERIM REPORT 2000 A REPORT TO THE HOUSE OF REPRESENTATIVES 77TH TEXAS LEGISLATURE ELLIOTT NAISHTAT CHAIRMAN COMMITTEE CLERK MIKE LUCAS Committee On HUMAN SERVICES December 5, 2000 Elliott Naishtat P.O. Box 2910 Chairman Austin, Texas 78768-2910 The Honorable James E. "Pete" Laney Speaker, Texas House of Representatives Members of the Texas House of Representatives Texas State Capitol, Rm. 2W.13 Austin, Texas 78701 Dear Mr. Speaker and Fellow Members: The Committee on Human Services of the Seventy-Sixth Legislature hereby submits its interim report including recommendations for consideration by the Seventy-Seventh Legislature. Respectfully submitted, Elliott Naishtat, Chairman Glen Maxey Rick Noriega Norma Chavez Barry Telford Wayne Christian Vicki Truitt John Davis Arlene Wohlgemuth Glen Maxey Vice-Chairman Members: Norma Chavez, Wayne Christian, John Davis, Rick Noriega, Barry Telford, Vicki Truitt and Arlene Wohlgemuth TABLE OF CONTENTS INTRODUCTION .............................................................5 INTERIM STUDY CHARGES ....................................................6 CHARGE 1 ...................................................................7 Introduction .......................................................7 Challenges Created by the Expiration of the TANF Waiver ....................8 Two-Parent Participation Rate . 9 Exemptions from Work Requirements ..............................9 Time Limits ................................................11 Allowable Work Activities .....................................11 Conclusions About the Challenges of Waiver Expiration ...............13 Child Care .......................................................13 Transitional Supports ...............................................15 Effective Case Management ..........................................16 Up-Front Needs Assessment ...................................16 Family Violence .............................................16 Sanction Policies ............................................17 The Employment Retention and Advancement Project - A Texas Innovation ......17 Conclusion .......................................................18 Recommendations .................................................19 CHARGE 2 ..................................................................23 Introduction ......................................................23 Factors Affecting Nursing Home Financial Status ..........................24 Medicare Rates and the Medicare Payment System ..................24 Increased Fraud and Overpayment Detection ......................26 Medicaid Reimbursement Rates .................................27 Liability Insurance Cost Increases ................................29 Increased State Regulatory Action and Civil Litigation ................32 Other Influencing Factors ......................................34 State Policies and Resources for Dealing with the Crisis .....................35 Impact on Residents ................................................37 Recommendations .................................................39 Discussion of “Insurance Reform” Recommendations .................42 CHARGE 3 ..................................................................43 Introduction ......................................................43 Background on Long-Term Care Trends and Community-Based Services ........44 L.C. and E.W. v. Olmstead Supreme Court Ruling ........................46 Guidance from the Federal Government .................................48 Background on the Governor’s Executive Order and the Promoting Independence Plan ................................................51 Overview of Initial Promoting Independence Plan ..........................52 Agencies’ Proposed Identification and Assessment Efforts .............54 Identified Issues and Barriers .........................................56 Closing Comments .................................................57 Recommendations .................................................60 CHARGE 4 ..................................................................63 Introduction ......................................................63 Issues Related to Public Assistance Enrollment and Re-Certification ............64 Client Diversion .............................................64 The Link Between TANF Cash Assistance, Medicaid and Food Stamps ...65 Staff Turnover and Workload Increases at DHS Local Offices ..........66 Fraud and Error Control .......................................66 Confusion Related to Legal Immigrant Policies ......................67 Administrative Burdens .......................................68 Suggestions about the Process of Obtaining Benefits ..................69 Uninsured Children .................................................70 Legal Immigrants’ Eligibility for Public Assistance ..........................71 Conclusion .......................................................72 Recommendations .................................................73 ENDNOTES .................................................................78 ATTACHMENT - ADDITIONAL LETTER FROM MEMBERS INTRODUCTION At the beginning of the 75th Legislature, the Honorable James E. “Pete” Laney, Speaker of the Texas House of Representatives, appointed nine members to the House Committee on Human Services. The committee membership included the following: Elliott Naishtat, Chairman; Glen Maxey, Vice-Chairman; Norma Chavez; Wayne Christian; John Davis; Rick Noriega; Barry Telford; Vicki Truitt; and Arlene Wohlgemuth. During the interim, the committee was assigned four charges by the Speaker: 1) Study issues created by the transition of the TANF Program to federal law when the state’s waiver expires in 2002. Include a review of the final TANF regulations and how other states use TANF funds outside the traditional cash assistance program. Consider policies to improve outcomes for people leaving welfare. 2) Study issues surrounding the financial difficulties experienced by some nursing home companies, including the reasons for bankruptcies and closures, state policies and resources for dealing with them, and impacts on residents. 3) Assess the state’s responsibilities and policies regarding supports for individuals with disabilities in community-based settings. 4) Study the current public assistance eligibility, application and review processes, and other Department of Human Services’ client communications to ensure that clients are getting the supports necessary to make a successful transition to self-sufficiency. The committee has completed its hearings and research and has filed its report. The committee wishes to express appreciation to all the people who contributed to the development of this report. Thanks to the speakers and citizens who provided testimony at hearings, to the leadership and staff of the Texas Health and Human Services Commission, Texas Department of Human Services, Texas Department of Mental Health and Mental Retardation, Texas Department of Protective and Regulatory Services, Texas Department of Insurance, Office of Public Insurance Counsel, Texas Workforce Commission, Office of the Attorney General, Texas Department on Aging, Legislative Budget Board, the Promoting Independence Advisory Board, Local Workforce Development Boards, and to the staff of the Texas House of Representatives for their time and efforts on behalf of the committee. 5 HOUSE COMMITTEE ON HUMAN SERVICES INTERIM STUDY CHARGES CHARGE Study issues created by the transition of the TANF Program to federal law when the state’s waiver expires in 2002. Include a review of the final TANF regulations and how other states use TANF funds outside the traditional cash assistance program. Consider policies to improve outcomes for people leaving welfare. CHARGE Study the issues surrounding the financial difficulties experienced by some nursing home companies, including the reasons for bankruptcies and closures, state policies and resources for dealing with them, and impacts on residents. CHARGE Assess the state’s responsibilities and policies regarding supports for individuals with disabilities in community-based settings. CHARGE Study the current public assistance eligibility, application and review processes, and other Department of Human Services’ client communications to ensure that clients are getting the supports necessary to make a successful transition to self-sufficiency. 6 CHARGE 1: Study issues created by the transition of the TANF Program to federal law when the state's waiver expires in 2002. Include a review of the final TANF regulations and how other states use TANF funds outside the traditional cash assistance program. Consider policies to improve outcomes for people leaving welfare. Introduction In 1995, the 74th Texas Legislature passed House Bill 1863, and welfare reform was initiated in Texas. The legislation made cash assistance a time-limited benefit, and recipients were required to work or prepare for the workplace. House Bill 1863 was similar, in many ways, to provisions in the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), the federal welfare reform measure which was passed by Congress in August of 1996. Both contain time limits, an emphasis on personal responsibility and mandatory work requirements. In other ways, however, HB 1863 differs from federal welfare reform. For instance, there are no lifetime limits on assistance in the Texas legislation as there are in