State Health Officials Walk Back Cuts to Health Services
The changes to the budget proposal come after lawmakers and advocates protested the previous plan would hurt vulnerable Texans.
Texas officials walk back $15 million proposed cuts to women’s and children's health services
"Texas officials walk back $15 million proposed cuts to women’s and children's health services" was first published by The Texas Tribune, a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.
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State health officials walked back a plan to cut $15 million in funding from health and safety net programs, including services that offer low-income Texans access to birth control and cancer screenings, and support families of young children with disabilities or developmental delays.
They are instead looking at other belt-tightening measures this year to find savings — and continuing to focus cuts on the agency’s administrative budget — under a revised proposal released Monday.
The latest proposal — part of a state-mandated budget reduction to weather the coronavirus pandemic — comes after lawmakers and advocates warned the previous plan would hurt vulnerable Texans and criticized top state officials for propelling the process without formal input from the Legislature.
The new plan says the Texas Health and Human Services Commission received “feedback” from numerous stakeholders and found “alternative savings opportunities.” The agency also has more “financial certainty” after the close of the fiscal year two weeks ago, the budget proposal said.
Gov. Greg Abbott, Lt. Gov. Dan Patrick and outgoing House Speaker Dennis Bonnen asked state agencies in May to reduce their budgets by 5% as the coronavirus battered parts of the economy and left Texas with a projected deficit of $4.6 billion. Several state agencies responding to the virus and its economic fallout were exempted from the mandate, as were critical programs like child protective services and much of the health commission’s two-year budget, which includes about $29 billion in state funds.
Bonnen said a public hearing will be held to discuss the cuts, though money has already dried up for at least one program — a mobile unit for stroke patients whose director said funding was supposed to arrive Sept. 1 for the next fiscal year.
“The legislative budget board is statutorily required to hold a public hearing for the purpose of discussing interim cuts before they are finalized," the speaker said in a statement. "The House will follow the proper process and notice requirements so the public can be heard.”
Texas’ Republican leadership asked the health commission to come up with cuts worth about $133 million in state funds. Most of the commission’s proposals have focused on reducing administrative costs, shrinking its workforce and letting unspent funds lapse.
But in the initial plan, officials also suggested direct cuts to women's health and other programs, worth about 11% of the total reductions. Advocates and lawmakers feared the loss of funding could lessen oversight of child care facilities, make it more difficult to sign families up for health insurance or food benefits and reduce access for low- and middle-income women seeking contraception, postpartum treatment or checks for diabetes, breast and cervical cancer, and sexually transmitted infections.
A proposed cut of $3.8 million from women’s health programs would have left fewer Texans receiving birth control or cancer screenings, a budget document obtained by The Texas Tribune said.
State Reps. Sarah Davis, R-Houston, and Donna Howard, D-Austin, said the cuts to women’s health were not financially prudent, given the programs saved Texas an estimated $20 million in the 2019 fiscal year by averting births with contraception and family planning.
They also criticized the agency’s decision to leave intact a robustly funded program that discourages women from having abortions,and offers new parents financial counseling, social service referrals and children’s items like car seats.
State Sen. Jane Nelson, R-Flower Mound, responding on Twitter to a Tribune report, said the health commission should “go back to the drawing board” to preserve funding for women’s health, and that it would remain at an “all-time high” as long as she chaired the powerful finance committee.
Health commission spokesperson Christine Mann did not immediately respond to a request for comment on the new plan, but has said that agency is “deeply committed to ensuring budget reductions have minimal impact on the Texans we serve every day.”
“We’re equally mindful of the financial responsibility we have to Texas taxpayers as we face the economic challenges brought on by this pandemic,” she has said.
The agency’s latest plan assumes the $15 million previously cut from programs can now be almost entirely absorbed by funds left unspent at the end of each fiscal year.
Reductions to other services — like administration and regulatory oversight — could still affect low-income Texans. Shrinking the agency’s workforce that reviews applications for assistance programs could delay services and risk the state running afoul of federal guidelines that require needy Texans to be quickly enrolled, for example. A summary of the agency’s initial proposal conceded that some hiring freezes “would have a significant impact on the agency’s mission.”
In all, the agency proposed cutting about $54 million from its administrative budget, including regulatory oversight and benefits enrollment. The remaining $76 million would come from funds left unspent this fiscal year.
“This plan is not final and will evolve over time,” the new proposal says.
Stephanie Rubin, chief executive of the advocacy group Texans Care for Children, called the updated proposal a "step in the right direction," but said the administrative cuts could still have negative consequences for children and families.
“In particular, we’re concerned about proposed cuts that would create delays for kids who need to sign up for Medicaid insurance so they can see a doctor and proposed cuts that could threaten kids’ safety in child care or foster care," she said in an email. "We encourage the Governor, Lt. Governor, Speaker of the House, and other legislative leaders to take cuts for kids and families off the table for this year and next session.”
Kami Geoffray, CEO of Every Body Texas, said she was "heartened" by the revised plan but called for more transparency.
"Confusion over funding availability threatens the stability of the family planning safety... we urge HHSC to engage stakeholders early and often to ensure that the real-world impacts of policy and funding decisions are incorporated into agency analysis," said Geoffray, whose organization supports women’s health providers that contract with the state.
A Bonnen spokesperson did not immediately respond to questions about the format and timing of a public hearing on the cuts.
This article originally appeared in The Texas Tribune at https://www.texastribune.org/2020/09/15/texas-funding-women-health/.
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Federal Judge may Hold Texas Responsible for not Meeting Foster Care Reforms
Federal Judge Janis Jack hammered state child welfare officials during a two-day hearing over what she called failures to improve Texas' foster care system.
Federal judge says she will again hold Texas in contempt of court for failing to meet foster care reforms
"Federal judge says she will again hold Texas in contempt of court for failing to meet foster care reforms" was first published by The Texas Tribune, a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.
U.S. District Judge Janis Jack said Friday she will once again hold Texas health and human services officials in contempt of court, a punishment that may come with hefty fines, for failing to make progress toward foster care reforms she ordered to be implemented last year.
Jack indicated she would give the state about a month to make improvements before deciding whether to assess fines of up to several thousand dollars per day.
If finalized, the contempt finding would mark the second time in 10 months that Jack has punished state officials for being out of compliance with her demands, which are the culmination of a decade-long class-action lawsuit that brought the state under federal court supervision. Her announcement followed a two-day hearing, held by video conference, in which she frequently chided some of Texas’ top child welfare bureaucrats.
At times, she interrupted Paul Yetter, the Houston-based attorney representing more than 10,000 long-term foster children in Texas, to emphatically agree with his assertions that the foster care system “continues to hurt and endanger children.”
“I actually am stunned by the noncompliance of the state,” Jack said, “but I keep being stunned every time we have one of these hearings.”
The hearing focused on more than a dozen of Jack’s orders, which required state officials to beef up oversight of residential facilities that house kids, improve the timeliness of state investigations into abuse and neglect in foster homes and build software to alert caregivers and caseworkers about instances of child-on-child sexual aggression. Jack also urged state officials at the hearing to improve communication between two separate state agencies: one that oversees children in foster care, and one that licenses homes and facilities that house large numbers of foster children.
Throughout the hearing, Jack echoed concerns raised by two-court appointed monitors in a 363-page report released in June that detailed “substantial threats to children’s safety,” particularly in large, privately-run foster homes.
“The State’s oversight of children’s placements is in numerous instances lethargic and ineffective,” the monitors wrote. “Operations with long, troubled histories of standards violations and child abuse allegations remain open and are permitted to care for vulnerable children, some of whom are then hurt. The prevalence of physical restraints and injuries to children in some facilities is simply shocking, as are the numerous instances where DFPS staff document that the agency does not know where children are placed.”
Jack said she agreed with the monitors’ findings and accused state officials of dragging their feet on making meaningful changes. In particular, she took issue with Jean Shaw, the associate commissioner for child care regulation at the Texas Health and Human Services Commission, for not coming down harder on residential operations with long histories of regulatory violations.
Texas foster care officials testified Thursday that they had recently stopped placing children in one facility where monitors identified problems. A Texas Department of Family and Protective Services official testified that the agency was terminating its contract this week with Prairie Harbor, a Houston-area residential treatment center where a teen died in February from a pulmonary embolism associated with a blood clot in her leg.
The home has yet to have its license pulled, though state officials indicated that was a possibility.
Jack berated Shaw for allowing the home to remain open for months after the teen’s death and for recently approving a variance that allowed the home to marginally reduce the number of staff supervising children. Shaw said the agency had approved the variance at Prairie Harbor, and similar variances at other foster facilities, because of private operators’ difficulties fully staffing during the coronavirus pandemic.
At one point, Jack told Shaw, “I don’t think you’re thinking at all.” At another, Yetter asked Shaw if she realized that granting the variance had placed children at Prairie Harbor at risk.
“I don’t realize that,” Shaw said.
Jack cut her off. “That’s the problem, Mr. Yetter,” the judge said, addressing the children’s attorney. “That’s the problem.”
In a statement after the hearing, Katie Olse, the chief executive of the trade group Texas Alliance of Child and Family Services, which represents foster home administrators, said that “Texas’ children must be at the center of this process” and that private groups have been “heroically serving children coming from terrible circumstances.”
“The community-based organizations serving these children take problems in Texas’ foster care system very seriously, and this legal process has no doubt brought attention to specific issues that need to be addressed,” Olse said. “It’s clear that better alignment between state agencies would improve care for vulnerable children. We also need to be sure that all available resources are flowing to help the young people who need them.”
During the two-day hearing, state officials described their efforts as a work in progress and resisted the sweeping terms Jack used to criticize the system they oversee. But given the opportunity, they declined to name any perceived inaccuracies in the court-appointed monitors’ report, which detailed 11 recent child deaths.
At one point, Texas Department of Family and Protective Services Commissioner Jaime Masters told the judge, “Your Honor, I’m concerned by what I’m hearing as well.”
In a recent legal filing, lawyers from the Texas Attorney General’s Office, which is defending child welfare officials in the case, wrote that they had “taken tremendous strides” to comply with Jack’s order. The arguments made by the children’s attorneys, they wrote, paint “an incomplete picture” of the state’s efforts.
In November 2019, Jack held the state in contempt of court after a similarly fiery hearing for failing to comply with her orders, at the time focusing on a requirement that large foster homes have 24-hour, awake supervision. Based on initial information from the monitors, she said then she no longer found the state’s child welfare agency “to be credible in any way.”
She fined the state $150,000 at the time.
This article originally appeared in The Texas Tribune at https://www.texastribune.org/2020/09/04/texas-foster-care-lawsuit-judge-hearing-contempt/.
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