Senate Committee on Health and Human Services Report to the 78th Legislature November 15, 2002 Please direct questions and comments to: Senator Mike Moncrief, Chairman Senate Committee on Health and Human Services P.O. Box 12068 Austin, Texas 78711 512/463-0360 Interim Report prepared by: Patricia A. Becker Committee Director/General Counsel Karen Hilton Policy Analyst Jennifer Sims Policy Analyst Lisa Barton Policy Analyst David Quin Policy Analyst Scott Caffey Committee Clerk ____________________________________________________________ Copies of this report were distributed in compliance with the State Depository Law and are available for public use through the Texas State Depository Program at the Texas State Library and other state depository libraries. Acknowledgments The Senate Committee on Health and Human Services would like to express its appreciation to the following for their contributions during the interim and in the writing of this report: Texas Health and Human Services Commission Texas Department of Health Texas Department of Human Services Texas Department of Mental Health and Mental Retardation Texas Department of Protective and Regulatory Services Texas Rehabilitation Commission Texas Workforce Commission Texas Commission on Alcohol and Drug Abuse Texas Council on Offenders with Mental Illness Texas Department on Aging Texas Education Agency Texas Juvenile Probation Commission Texas Youth Commission Texas State Board of Dental Examiners Texas State Board of Medical Examiners Texas State Board of Nurse Examiners Texas State Board of Pharmacy Texas State Board of Pediatric Medical Examiners Texas State Board of Veterinary Medical Examiners Patsy Spaw, Secretary of the Senate Rebecca Gregg, Senate Committee Coordinator Carleton Turner, Senate Sergeant-at-Arms Sharon Scarborough and the members of her staff, Senate Media Senate Publications and Printing Texas Legislative Council This report was made possible by the leadership of the Committee members and the contribution of key staff: Robert Garza, Eduardo Haggard, Rebecca Hairgrove, Ashley Keene, Amy Lindley, Rhonda Myron, J.P. Urrabazo, Andrea Varnell, Carissa Waida, Darren Whitehurst, Stacy Gaston, Monty Wynn, and, Senator Mike Moncrief’s staff under the direction of Chief of Staff, Gina Martin. The Committee also appreciates the numerous stakeholders for their involvement in this report, especially those who provided testimony to the Committee during the public hearing process. Senate Committee on Health and Human Services Interim Report Table of Contents Executive Summary ....................................................i Charge 1: Mental Health Interim Charge 1 .....................................................1.1 Mental Health .......................................................1.1 Mental Health and Children ............................................1.2 Background ...................................................1.2 Definitions ...............................................1.3 Prevalence ..............................................1.4 Risk Factors .............................................1.5 Prevention ....................................................1.6 Early intervention .........................................1.6 School-Based Mental Health Programs ........................1.8 Texas Children’s Mental Health Services ............................1.9 The Department of Mental Health and Mental Retardation ..........1.9 History ............................................1.9 Prevalence Rates vs. Services Provided .................1.10 Program Services ..................................1.10 Priority population ...................................1.11 Funding ..........................................1.12 Health and Human Services Commission ......................1.13 Protective and Regulatory Services ..........................1.13 Texas Juvenile Probation Commission ........................1.14 Texas Youth Commission ..................................1.15 Texas Council on Offenders with Mental Impairments ............1.16 Early Childhood Intervention ................................1.17 Texas Education Agency ..................................1.18 Texas Commission on Alcohol and Drug Abuse .................1.18 Texas Department of Health ................................1.19 Symptoms of System Weakness ..................................1.20 Relinquishment of Custody .................................1.20 Juvenile Justice ..........................................1.23 Promising Practices ............................................1.24 System of Care ..........................................1.24 System of Care in Other States .............................1.27 Texas Coordination Efforts ......................................1.28 Community Resource Coordination Groups ....................1.28 Texas Integrated Funding Initiative ...........................1.30 Additional Mental Health Funding Streams ..........................1.33 Medicaid ...............................................1.33 Children's Health Insurance Program .........................1.35 Commercial Insurance ....................................1.37 Parity ............................................1.38 Conclusion ...................................................1.39 Recommendations .............................................1.40 Mental Health Delivery System .........................................1.48 Background ..................................................1.48 Texas Mental Health History ................................1.48 Current Structure of the Mental Health System .......................1.50 Prevalence vs. Priority Population ............................1.50 Community Based Services ................................1.51 State Operated Facilities ...................................1.53 Related Pilots and Studies .......................................1.54 House Bill 2377 ..........................................1.54 House Bill 1734 ..........................................1.56 NorthSTAR .............................................1.56 Mental Health System Task Force ...........................1.59 Public Mental Health Systems in Other States ..................1.64 Indigent Mental Health and Benefit Design .....................1.66 Conclusion ...................................................1.68 Recommendations .............................................1.69 Allocation Formula ..................................................1.73 Background ..................................................1.73 Service Waiting List .......................................1.74 Previous Efforts to Resolve This Issue .............................1.76 Conclusion ...................................................1.77 Recommendation ..............................................1.79 Acronyms .........................................................1.80 Endnotes .........................................................1.82 Interim Charge 2: Welfare Reauthorization Interim Charge 2 .....................................................2.1 Welfare Reform .....................................................2.1 Background ...................................................2.1 Eligibility ................................................2.2 Texas Eligibility Workers ..............................2.3 TIERS Implementation ...............................2.4 Work Requirements .......................................2.4 TANF Funding ............................................2.6 Funding in Texas ..........................................2.7 Federal Welfare Reauthorization Activities ...........................2.9 Work-Related Requirements .................................2.9 Supporting Working Families ...............................2.10 Marriage and Child Support Provisions ........................2.11 Additional Reauthorization Provisions .........................2.11 Barriers to Self Sufficiency .......................................2.12 Hardest to Serve .........................................2.12 Housing ................................................2.13 Sanctions ..............................................2.13 Job Retention and Employment Advancement ..................2.14 Immigrants .............................................2.15 Conclusion ...................................................2.16 Recommendations .............................................2.17 Child Care .........................................................2.28 Background ..................................................2.28 Texas Child Care System ..................................2.29 Funding for Child Care ....................................2.30 Eligibility Criteria .........................................2.33 Child Care Access ........................................2.33 Quality Child Care ........................................2.36 Child Care Reauthorization ......................................2.38 Conclusion ...................................................2.40 Recommendations .............................................2.41 Food Stamps ......................................................2.47 Background ..................................................2.47 Food Stamp Caseloads ....................................2.49 Current Caseload Increases ................................2.53 Food Stamp Reauthorization .....................................2.54 Mandated Changes to the Food Stamp Program ................2.55 Partial Restoration of Benefits to Immigrants .............2.55