e-Texas e-Texassmaller smarter faster governmentDecember, 2000
Carole Keeton Rylander
Texas Comptroller of Public Accounts

Recommendations of the Texas Comptroller

Chapter 8: Health and Human Services

Health Care and Human Services


Health and Human Services (HHS) spending in Texas has skyrocketed in recent years. Medicaid spending, driven by the eligible population, federal requirements, and health care costs is the fastest-growing element of these expenditures and has shot up by 248 percent over the last decade. Yet despite enormous increases in state funding for these services, some key indicators of progress—such as the number of Texas residents without health insurance—demonstrate that we still have challenges to meet.

Given that HHS costs are expected to continue to rise for the foreseeable future, the state must inevitably face a fundamental choice: should we continue devoting an ever-greater share of the state budget to health and human services, at the expense of other vital needs such as education and transportation? Or can we transform the way we deliver health and human services in ways that will provide basic services without breaking the bank?

We believe the second option is a desirable and achievable goal that can be met by enhancing the use of technology in the health and human service area and adopting the following strategies and recommendations.

Reduce the Number of Uninsured Texans

Absent fundamental changes in policy and the health care market, the uninsured population in Texas and throughout America is expected to grow. Those without insurance need an alternative to expensive emergency room care.

One approach is to free the existing health care market from needless constraints and inequities, ensure information is freely available, and allow consumers to make their own choices. To reduce the number of uninsured Texans, the state should work to change federal law to allow the health care market to work more efficiently, change state law to allow the health care market to operate more efficiently, and use technology to remove state obstacles to Medicaid enrollment for uninsured Medicaid–eligible children.

Improve Children's Health Services

To further improve children’s health care, the state should fund the expansion of the Seniors and Volunteers Program for Childhood Immunizations (SVCI), a public-private partnership formed to reach more children among areas and population groups that have low immunization rates. SVCI does outreach in hospitals, educating new mothers, enrolls and monitors children in their first year of life, and provides transportation and other services. Telemedicine can expand access to chronically ill and disabled children in remote, rural areas of Texas. Technology and disease state management (DSM) - tailor-made, customized health services for people with chronic diseases, can reduce the cost of frequent trips to the emergency room made by children suffering from asthma and improve the quality of their care. The state should provide more comprehensive health care services by refinancing the cost of health care for children with serious medical problems.

Reduce Costs and Improve Services by Customizing Services

A fundamental assumption behind modern government is that all persons—all “clients”—should be treated the same. Once groups are characterized—as disabled, single mothers, mentally retarded, poor, or elderly—they receive treatment deemed appropriate for that group, with little or no consideration for their unique circumstances. This cookie-cutter approach results in waste and, worse, ineffectiveness in programs that have a major impact on many people’s lives. Yet the personalization trend now sweeping across the consumer market is precisely about being able to treat people differently, according to their own needs and preferences.

Many people needing state services are confused by the structure of state government and unable to determine which agency could provide the particular assistance they need. Texas should expand TexasOnline to provide a single point of entry for citizens seeking health and human services. Texas should provide options other than nursing home care to the frail elderly seeking long-term care so that they can remain in their own homes.

Texas should take full advantage of the flexibility that it has with the new federal welfare reform law to provide employment-related services to all welfare recipients before they exhaust their five-year lifetime limit for receiving federal assistance. Texas should restructure its Temporary Assistance for Needy Families (TANF) program by providing additional alternatives to the monthly cash grant that eligible families currently receive and by customizing financial assistance and services according to their individual needs.

Make Better Use of the State’s Bargaining Power as a Major Purchaser of Health and Human Services

As the payer of last resort for the Medicaid population and low-income Texans with major high-cost illnesses, the state should make every effort to be a prudent purchaser of health and human services. Texas should examine the practices of other states and the private sector to find more efficient and cost-effective ways of purchasing medical goods and services.

Health services and prescription drugs are purchased separately by more than a dozen different Texas agencies. Texas may be able to negotiate better prices by combining agency purchases instead of allowing each agency to strike its own bargains.

Other ways the state could reduce drug costs would be to allow seniors to purchase drugs at Medicaid prices, reduce costs of the Medicaid Vendor Drug program and change the way the state purchases prescription drugs in the prison system.

e-Texas is an initiative of Carole Keeton Rylander, Texas Comptroller of Public Accounts
Post Office Box 13528, Capitol Station
Austin, Texas

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