LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 81ST LEGISLATIVE REGULAR SESSION March 18, 2009 TO: Honorable Patrick M. Rose, Chair, House Committee on Human Services FROM: John S. O'Brien, Director, Legislative Budget Board IN RE:HB676 by Eiland (Relating to eligibility for the child health plan.), As Introduced Estimated Two-year Net Impact to General Revenue Related Funds for HB676, As Introduced: a negative impact of ($112,697,136) through the biennium ending August 31, 2011. The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.
LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 81ST LEGISLATIVE REGULAR SESSION
March 18, 2009
TO: Honorable Patrick M. Rose, Chair, House Committee on Human Services FROM: John S. O'Brien, Director, Legislative Budget Board IN RE:HB676 by Eiland (Relating to eligibility for the child health plan.), As Introduced
TO: Honorable Patrick M. Rose, Chair, House Committee on Human Services
FROM: John S. O'Brien, Director, Legislative Budget Board
IN RE: HB676 by Eiland (Relating to eligibility for the child health plan.), As Introduced
Honorable Patrick M. Rose, Chair, House Committee on Human Services
Honorable Patrick M. Rose, Chair, House Committee on Human Services
John S. O'Brien, Director, Legislative Budget Board
John S. O'Brien, Director, Legislative Budget Board
HB676 by Eiland (Relating to eligibility for the child health plan.), As Introduced
HB676 by Eiland (Relating to eligibility for the child health plan.), As Introduced
Estimated Two-year Net Impact to General Revenue Related Funds for HB676, As Introduced: a negative impact of ($112,697,136) through the biennium ending August 31, 2011. The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.
Estimated Two-year Net Impact to General Revenue Related Funds for HB676, As Introduced: a negative impact of ($112,697,136) through the biennium ending August 31, 2011.
The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.
General Revenue-Related Funds, Five-Year Impact: Fiscal Year Probable Net Positive/(Negative) Impact to General Revenue Related Funds 2010 ($39,458,365) 2011 ($73,238,771) 2012 ($79,372,855) 2013 ($79,924,310) 2014 ($78,572,434)
2010 ($39,458,365)
2011 ($73,238,771)
2012 ($79,372,855)
2013 ($79,924,310)
2014 ($78,572,434)
All Funds, Five-Year Impact: Fiscal Year Probable (Cost) fromGeneral Revenue Fund1 Probable (Cost) fromGR Match For Title XXI8010 Probable (Cost) fromPremium Co-payments3643 Probable (Cost) fromExperience Rebates-CHIP8054 2010 ($3,431,597) ($36,026,768) ($4,205,340) ($2,068,506) 2011 ($6,421,211) ($66,817,560) ($5,661,675) ($3,871,122) 2012 ($6,962,797) ($72,410,058) ($6,172,140) ($4,197,240) 2013 ($7,015,710) ($72,908,600) ($6,410,370) ($4,229,315) 2014 ($6,902,102) ($71,670,332) ($6,521,595) ($4,161,057) Fiscal Year Probable (Cost) fromVendor Drug Rebates-CHIP8070 Probable (Cost) fromFederal Funds555 Probable Revenue Gain fromPremium Co-payments3643 Probable Revenue Gain fromExperience Rebates-CHIP8054 2010 ($2,222,945) ($99,432,975) $4,205,340 $2,068,506 2011 ($4,144,286) ($185,546,183) $5,661,675 $3,871,122 2012 ($4,491,853) ($201,181,218) $6,172,140 $4,197,240 2013 ($4,526,180) ($202,582,668) $6,410,370 $4,229,315 2014 ($4,453,130) ($199,160,378) $6,521,595 $4,161,057 Fiscal Year Probable Revenue Gain fromVendor Drug Rebates-CHIP8070 2010 $2,222,945 2011 $4,144,286 2012 $4,491,853 2013 $4,526,180 2014 $4,453,130
Fiscal Year Probable (Cost) fromGeneral Revenue Fund1 Probable (Cost) fromGR Match For Title XXI8010 Probable (Cost) fromPremium Co-payments3643 Probable (Cost) fromExperience Rebates-CHIP8054 2010 ($3,431,597) ($36,026,768) ($4,205,340) ($2,068,506) 2011 ($6,421,211) ($66,817,560) ($5,661,675) ($3,871,122) 2012 ($6,962,797) ($72,410,058) ($6,172,140) ($4,197,240) 2013 ($7,015,710) ($72,908,600) ($6,410,370) ($4,229,315) 2014 ($6,902,102) ($71,670,332) ($6,521,595) ($4,161,057)
2010 ($3,431,597) ($36,026,768) ($4,205,340) ($2,068,506)
2011 ($6,421,211) ($66,817,560) ($5,661,675) ($3,871,122)
2012 ($6,962,797) ($72,410,058) ($6,172,140) ($4,197,240)
2013 ($7,015,710) ($72,908,600) ($6,410,370) ($4,229,315)
2014 ($6,902,102) ($71,670,332) ($6,521,595) ($4,161,057)
Fiscal Year Probable (Cost) fromVendor Drug Rebates-CHIP8070 Probable (Cost) fromFederal Funds555 Probable Revenue Gain fromPremium Co-payments3643 Probable Revenue Gain fromExperience Rebates-CHIP8054 2010 ($2,222,945) ($99,432,975) $4,205,340 $2,068,506 2011 ($4,144,286) ($185,546,183) $5,661,675 $3,871,122 2012 ($4,491,853) ($201,181,218) $6,172,140 $4,197,240 2013 ($4,526,180) ($202,582,668) $6,410,370 $4,229,315 2014 ($4,453,130) ($199,160,378) $6,521,595 $4,161,057
2010 ($2,222,945) ($99,432,975) $4,205,340 $2,068,506
2011 ($4,144,286) ($185,546,183) $5,661,675 $3,871,122
2012 ($4,491,853) ($201,181,218) $6,172,140 $4,197,240
2013 ($4,526,180) ($202,582,668) $6,410,370 $4,229,315
2014 ($4,453,130) ($199,160,378) $6,521,595 $4,161,057
Fiscal Year Probable Revenue Gain fromVendor Drug Rebates-CHIP8070 2010 $2,222,945 2011 $4,144,286 2012 $4,491,853 2013 $4,526,180 2014 $4,453,130
2010 $2,222,945
2011 $4,144,286
2012 $4,491,853
2013 $4,526,180
2014 $4,453,130
Fiscal Analysis
Section 1 requires the Health and Human Services Commission (HHSC) to increase income eligibility for the Childrens Health Insurance Program (CHIP) from at or below 200 percent of the federal poverty level (FPL) to at or below 300 percent of FPL. It also increases the threshold at which an assets test may be established from 150 percent of FPL to 250 percent of FPL. Section 3 makes the new income eligibility level and assets test threshold applicable to determinations of eligibility made on or after the effective date of the bill, regardless of the date of application for coverage. Section 2 increases from 185 percent of FPL to 285 percent of FPL the threshold at which a review of income during the sixth month of enrollment is required. Section 4 makes the new threshold applicable to enrollees beginning on the effective date of the bill, regardless of the date the enrollment period began. Section 5 requires state agencies to request any federal waiver or authorization necessary to implement any provisions of the bill and authorizes them to delay implementation until the waivers or authorizations are granted.
Section 1 requires the Health and Human Services Commission (HHSC) to increase income eligibility for the Childrens Health Insurance Program (CHIP) from at or below 200 percent of the federal poverty level (FPL) to at or below 300 percent of FPL. It also increases the threshold at which an assets test may be established from 150 percent of FPL to 250 percent of FPL. Section 3 makes the new income eligibility level and assets test threshold applicable to determinations of eligibility made on or after the effective date of the bill, regardless of the date of application for coverage.
Section 2 increases from 185 percent of FPL to 285 percent of FPL the threshold at which a review of income during the sixth month of enrollment is required. Section 4 makes the new threshold applicable to enrollees beginning on the effective date of the bill, regardless of the date the enrollment period began.
Section 5 requires state agencies to request any federal waiver or authorization necessary to implement any provisions of the bill and authorizes them to delay implementation until the waivers or authorizations are granted.
Methodology
It is assumed that beginning September 1, 2009 clients between 200 and 300 percent of FPL will begin enrolling in CHIP. It is assumed that annual enrollment fees will be established in the amount of $65 for families between 200 and 250 percent of FPL and $85 for families between 250 and 300 percent FPL. It is assumed that beginning September 1, 2009, income reviews during the sixth month of enrollment will be done only for families with income above 285 percent of FPL and that the assets test will apply only to families with income above 250 percent FPL. All other costs and program policies are maintained at the level assumed for children at or below 200 percent of FPL. Federal law currently caps income eligibility for CHIP at 50 percentage points above the highest limit for children enrolled in Medicaid; in Texas this cap would be 235 percent of FPL. HHSC indicates that the state may be allowed to disregard income above 235 percent of FPL. It is assumed that federal matching funds will be available for children above 235 percent FPL, but if the state does not get approval to enroll children above 235 percent FPL additional General Revenue Funds would be required to fund them. It is estimated that increasing maximum income eligibility for the CHIP program and increasing the thresholds for income review and assets test would result in an additional 88,609 average monthly recipient months in fiscal year 2010; 165,828 in fiscal year 2011; 179,798 in fiscal year 2012; 181,172 in fiscal year 2013; and 178,248 in fiscal year 2014. The average cost per recipient month is estimated to be $129.69 in each fiscal year. The additional cost to the program from higher caseloads would be $137.9 million All Funds, including $45.2 million in General Revenue Funds, in fiscal year 2010; $258.1 million All Funds, including $82.8 million in General Revenue Funds, in fiscal year 2011; $279.8 million All Funds, including $89.8 million in General Revenue Funds, in fiscal year 2012; $282.0 million All Funds, including $90.6 million in General Revenue Funds, in fiscal year 2013; and $277.4 million All Funds, including $89.3 million in General Revenue Funds in fiscal year 2014. These General Revenue Funds amounts include expenditure of additional collections of Vendor Drug Rebates for CHIP, Experience Rebates, and Premium Copayments totaling $8.5 million in fiscal year 2010, $13.7 million in fiscal year 2011, $14.9 million in fiscal year 2012, $15.2 million in fiscal year 2013, and $15.1 million in fiscal year 2014. There would also be additional administrative expenditures associated with the expanded program estimated to be $9.5 million All Funds, including $2.7 million in General Revenue Funds, in fiscal year 2010; $14.4 million All Funds, including $4.1 million in General Revenue Funds, in fiscal year 2011; $15.6 million All Funds, including $4.5 million in General Revenue Funds, in fiscal year 2012; $15.7 million All Funds, including $4.5 million in General Revenue Funds, in fiscal year 2013; and $15.5 million All Funds, including $4.4 million in General Revenue Funds, in fiscal year 2014. These amounts include one-time costs for system changes and policy implementation and ongoing costs for eligibility and enrollment broker services and postage. The total cost of the bill is estimated to be $147.4 million All Funds, including $48.0 million in General Revenue Funds, in fiscal year 2010 rising to $292.9 million All Funds, including $93.7 million in General Revenue Funds, by fiscal year 2014. It is assumed that CHIP federal matching funds will be available; however, if the state exhausts its capped federal allotment, General Revenue Funds would be required in lieu of assumed Federal Funds.
It is assumed that beginning September 1, 2009 clients between 200 and 300 percent of FPL will begin enrolling in CHIP. It is assumed that annual enrollment fees will be established in the amount of $65 for families between 200 and 250 percent of FPL and $85 for families between 250 and 300 percent FPL. It is assumed that beginning September 1, 2009, income reviews during the sixth month of enrollment will be done only for families with income above 285 percent of FPL and that the assets test will apply only to families with income above 250 percent FPL. All other costs and program policies are maintained at the level assumed for children at or below 200 percent of FPL.
Federal law currently caps income eligibility for CHIP at 50 percentage points above the highest limit for children enrolled in Medicaid; in Texas this cap would be 235 percent of FPL. HHSC indicates that the state may be allowed to disregard income above 235 percent of FPL. It is assumed that federal matching funds will be available for children above 235 percent FPL, but if the state does not get approval to enroll children above 235 percent FPL additional General Revenue Funds would be required to fund them.
It is estimated that increasing maximum income eligibility for the CHIP program and increasing the thresholds for income review and assets test would result in an additional 88,609 average monthly recipient months in fiscal year 2010; 165,828 in fiscal year 2011; 179,798 in fiscal year 2012; 181,172 in fiscal year 2013; and 178,248 in fiscal year 2014. The average cost per recipient month is estimated to be $129.69 in each fiscal year. The additional cost to the program from higher caseloads would be $137.9 million All Funds, including $45.2 million in General Revenue Funds, in fiscal year 2010; $258.1 million All Funds, including $82.8 million in General Revenue Funds, in fiscal year 2011; $279.8 million All Funds, including $89.8 million in General Revenue Funds, in fiscal year 2012; $282.0 million All Funds, including $90.6 million in General Revenue Funds, in fiscal year 2013; and $277.4 million All Funds, including $89.3 million in General Revenue Funds in fiscal year 2014. These General Revenue Funds amounts include expenditure of additional collections of Vendor Drug Rebates for CHIP, Experience Rebates, and Premium Copayments totaling $8.5 million in fiscal year 2010, $13.7 million in fiscal year 2011, $14.9 million in fiscal year 2012, $15.2 million in fiscal year 2013, and $15.1 million in fiscal year 2014.
There would also be additional administrative expenditures associated with the expanded program estimated to be $9.5 million All Funds, including $2.7 million in General Revenue Funds, in fiscal year 2010; $14.4 million All Funds, including $4.1 million in General Revenue Funds, in fiscal year 2011; $15.6 million All Funds, including $4.5 million in General Revenue Funds, in fiscal year 2012; $15.7 million All Funds, including $4.5 million in General Revenue Funds, in fiscal year 2013; and $15.5 million All Funds, including $4.4 million in General Revenue Funds, in fiscal year 2014. These amounts include one-time costs for system changes and policy implementation and ongoing costs for eligibility and enrollment broker services and postage.
The total cost of the bill is estimated to be $147.4 million All Funds, including $48.0 million in General Revenue Funds, in fiscal year 2010 rising to $292.9 million All Funds, including $93.7 million in General Revenue Funds, by fiscal year 2014. It is assumed that CHIP federal matching funds will be available; however, if the state exhausts its capped federal allotment, General Revenue Funds would be required in lieu of assumed Federal Funds.
Technology
Technology costs included above total $1.0 million All Funds, including $0.3 million in General Revenue Funds, in fiscal year 2010 for one-time costs associated with system changes.
Technology costs included above total $1.0 million All Funds, including $0.3 million in General Revenue Funds, in fiscal year 2010 for one-time costs associated with system changes.
Local Government Impact
No fiscal implication to units of local government is anticipated.
Source Agencies: 529 Health and Human Services Commission
529 Health and Human Services Commission
LBB Staff: JOB, CL, PP, LR, JJ, SJ
JOB, CL, PP, LR, JJ, SJ