Texas Health and Human Services Commission (HHSC) is the Medicaid single state agency and will have oversight responsibility for this grant. HHSC is the umbrella organization over four other state agencies whose commissioners directly report to the HHSC Executive Commissioner, including the Department of Aging and Disability Services (DADS) and the Department of State Health Services (DSHS).

The HHSC Executive Commissioner has delegated lead operational responsibility for this project to DADS. The project director will be an employee of HHSC assigned to work in the DADS Promoting Independence Unit. The State Medicaid Director at HHSC will also provide oversight of the project. The project director will work with the HHSC State Medicaid Office, DSHS, HHSC Office of Program Coordination for Children and Youth, DADS’ divisions that operate the current MFP and Promoting Independence initiatives, and the Texas Department of Housing and Community Affairs. DADS will interface with eligible beneficiaries and ensure the provision of services. See Appendix F for specific agency and unit based organizational charts.

MPF Grant Organizational Chart
  • HHSC Executive Commissioner
    • DADS Commissioner
      • Assistant Commissioner Provider Services
        • Provider Services Key Staff
      • Deputy Commissioner
        • Quality Assurance Key Project Staff
      • Chief Operations Officer
        • Information Technology Key Staff
      • Promoting Independence Unit
        • Project Director
      • Assistant Commissioner Access and Intake
    • DSHS Commissioner
      • Assistant Commissioner Mental Health and Substance Abuse
        • Mental Health and Substance Abuse Key Staff
    • Assistant Commissioner Medicaid/CHIP

Key Staff

Many employees of these DADS divisions currently contribute to the overall MFP and Promoting Independence initiatives. Resumes for key staff are provided in the Appendix. There will be two dedicated staff to the demonstration program. These are the project director and the manager of the Promoting Independence Initiative. The project director will dedicate 100 percent of his or her time to this project. The manager of the Promoting Independence Initiative, Marc Gold, will dedicate 50 percent of his time to managing the project director and providing overall leadership. Other critical staff include the following:  The chief liaison with the State Medicaid Director’s Office will be Larry Swift, policy analyst, who will dedicate five percent of his time to ensure coordination and State Medicaid Office oversight. Dena Stoner, Senior Policy Advisor to the Assistant Commissioner for Mental Health and Substance Abuse Services will dedicate five percent of her time to ensure coordination of behavioral health supports. Larry North, as the Section Director, Institutional Services, DADS Provider Services division, will dedicate five percent of his time for working with facility closures. Jeff Kaufmann, as DADS Grants Coordinator under the Deputy Director, will dedicate five percent of his time assisting the Project Director with overall grant management. Many other DADS and HHSC staff that oversee current operation of waivers and programs will continue in their current roles and contribute less than five percent as in-kind support to this grant.   DADS will continue its current contracts with relocation specialists to assist individuals with transitioning from nursing facilities to the community.

Budget Narrative

Appendix G provides detailed charts on the budget. Over the five- year span of the grant request, Texas will expend an estimated $179.5 million (all funds) to transition 2,616 persons. $54.9 million in general revenue dollars will be matched by $17.8 million in enhanced federal match and $106.7 million in regular federal match.

Medicaid Administrative Costs

Table 3 shows the costs that will be matched at the administrative cost rate. Texas is requesting approximately $2.6 million in administrative matching funds for a total state and federal expenditure of $5.2 million. This will fund: one new position as the project director; pre-transition services for persons leaving nursing facilities; and relocation services needed by individuals transitioning from nursing facilities.

Table 3 - Medicaid Administrative Budget by State Fiscal Year
Method Of Finance: FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 Cumulative Total
Federal Match (FMAP) $71,700 $628,357 $628,357 $628,357 $628,357 $2,585,128
Enhanced Match (EFMAP) 0 0 0 0 0 0
State $71,701 $628,356 $628,356 $628,356 $628,356 $2,585,125
TOTALS $143,401 $1,256,713 $1,256,713 $1,256,713 $1,256,713 $5,170,253

 

Qualified HCB Services

 

Tables 4 – 6 show the breakout of costs by target population for 1915(c) waiver services.

Nursing facilities - Texas estimates transitioning 1,400 (350 annually at an average cost of $1,452 per person, per month including CBA and STAR+PLUS) total persons from nursing facilities in state fiscal years 2008 through 2011. Texas will use FY 2007 to develop the operational protocol and will not transition individuals during this fiscal year. Projected cost of providing services is $49.7 million at regular federal match, $30.3 million from Medicaid at regular federal match, with $4.2 million at the enhanced match.

Table 4 - Individuals Transitioning From Nursing Facilities by State Fiscal Year
Method Of Finance: FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 Cumulative Total
Federal-FMAP   $2,001,880 $5,713,976 $9,426,073 $13,138,169 $30,280,098
Federal Grant-EFMAP   $643,285 $1,192,847 $1,192,847 $1,192,847 $4,221,826
State   $643,614 $2,480,356 $4,866,660 $7,252,964 $15,243,595
TOTALS 0 $3,288,780 $9,387,180 $15,485,580 $21,583,980 $49,745,520

Closure of Community-Operated Intermediate Care Facilities - Texas proposes to spend approximately $32 million total with $19.5 million at regular federal match and $3.5 million in enhanced match. Texas estimates transitioning 400 persons (approximately 133 annually at $4,443 per person, per month) from community-operated ICFs/MR from FYs 2009 - 2011. Texas will use FY 2007 to develop the operational protocol and FY 2008 to put in place the mechanisms needed for successful transitions.

 

Table 5 - Closure of Community-Operated Intermediate Care Facilities by State Fiscal Year
Method Of Finance: FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 Cumulative Total
Federal-FMAP     $2,177,086 $6,493,394 $10,812,407 $19,482,887
Federal Grant-EFMAP     $699,586 $1,387,005 $1,387,005 $3,473,596
State     $699,943 $2,787,244 $5,563,702 $9,050,889
TOTALS 0 0 $3,576,615 $10,667,643 $17,763,114 $32,007,372

Promoting Independence Program - Texas proposes to transition 816 persons (120 from 14-plus bed community operated ICFs/MR and 84 from State Mental Retardation Facilities annually at an average cost of $4,468 per person, per month) from FY 2008-2011. The total 5 year projected expense is $89.3 million all funds with $54.4 from Medicaid at regular match and enhanced match at $7.6 million.

Table 6 - Promoting Independence Program by State Fiscal Year
Method Of Finance: FY 2008 FY 2009 FY 2010 FY 2011 Cumulative Total
Federal-FMAP $3,606,285 $10,264,041 $16,921,797 $23,579,553 $54,371,676
Federal Grant-EFMAP $1,158,846 $2,139,407 $2,139,407 $2,139,407 $7,577,067
State $1,159,437 $4,458,784 $8,738,692 $13,018,600 $27,375,513
TOTALS $5,924,568 $16,862,232 $27,799,896 $38,737,560 $89,324,256

 

HCB Demonstration and Supplemental Demonstration Services

 

Texas plans to use enhanced match funds as part of the demonstration for person with behavioral health conditions. Services will include: Cognitive Adaptive Training (CAT) at $750,000 per year, environmental supports at $30,000 per year, training and technical assistance at $4,500 per year, substance abuse counseling at $15,000 (individual) and $4,800 (group) per year. Texas does not plan to use supplemental demonstration services.

Table7 - HCB Demonstration Services by State Fiscal Year
Method Of Finance: FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 Cumulative Total
Federal-FMAP           0
Federal Grant-EFMAP   $643,440 $643,440 $643,440 $643,440 $2,573,760
State   $160,860 $160,860 $160,860 $160,860 $643,440
TOTALS 0 $804,300 $804,300 $804,300 $804,300 $3,217,200

 

 

Updated: May 1, 2015