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85th Legislature invests in behavioral health and physician workforce

Special to Medical Journal – Houston BY TED SHAW, President/CEO, Texas Hospital Association

On Memorial Day, the 85th Legislature came to a close. At the time of this writing, the specter of a special session lingers as lawmakers have unfinished business, at least according to Lieutenant Governor Dan Patrick. But, assuming Governor Abbott does not call a special session, lawmakers go back to their home districts, and state agencies begin the rulemaking process to implement new laws.

For Texas hospitals, the legislative session covered a wide range of issues. There were more healthcare-related bills filed during the 85th Legislature than in any other previous session. The Texas Hospital Association tracked more than 1,000 bills. These were bills that would change how we care for patients, serve our communities, and run our businesses. Some we supported; many we did not.

The state budget for 2018-19 – how much the state will spend and on what – was one of the more challenging items. Despite Texas’ wide tax base and diversified economy, the recent drop in oil prices brought a loss of tax revenue and about $10 billion less for budget writers to appropriate for state operations and programs.

With these tight financial circumstances, it is particularly notable, therefore, that lawmakers in the 85th Legislature put some significant resources in two key areas: graduate medical education and behavioral health care.

Texas long has had too few physicians to meet the health care needs of its growing population. Statewide, there is a severe shortage of primary care physicians, as well as specialists in a number of disciplines, including pediatrics and geriatrics. The number of psychiatrists and other behavioral health care professionals is insufficient to serve all Texans living with mental health or substance use issues.

One of the most effective ways to increase the number of physicians in the state is to increase the number of physicians who train here. In 2015, lawmakers appropriated funds to increase the number of graduate medical education training opportunities in Texas. Lawmakers in the 85th Legislature continued this tradition by appropriating $90 million for health-related institutions to continue the same level of state funding for current graduate medical education programs and added funding for new GME programs at The University of Texas Austin and The University of Texas Rio Grande Valley.

In addition, to expand GME training opportunities, the state budget provides $97 million in all funds – an increase of $44 million over the prior biennium. These funds may be used for:

GME planning and partnership grants to hospitals, medical schools and community based ambulatory patient care centers; new or existing GME programs to increase the number of first-year residency positions; unfilled first-year residency positions; and grants to GME programs that received a similar grant in 2015.

On the behavioral health front, legislators built on the work done by the Select Committee on Mental Health during the interim. That committee identified multiple areas of needed improvement for the state’s behavioral health care system. And lawmakers responded.

The 85th Legislature appropriated more than $7.5 billion for behavioral health including $3.6 billion for Medicaid and CHIP behavioral health services. Of the $4 billion appropriated for non-Medicaid behavioral health services, $63 million will be used to address the current and projected waitlists for community mental health services for adults and children, and $366 million will be used for construction and repairs at state hospitals and other inpatient mental health facilities.

Although not part of the budget decisions, legislators also took steps to increase the number of providers available to treat Texans with substance use issues. Licensed chemical dependency counselors now will be eligible for educational loan repayment assistance as other behavioral health professionals currently are through the Loan Repayment Program for Mental Health Professionals. To be eligible for financial assistance, LCDCs must serve indigent and low-income populations.

Finally, the Texas Department of Insurance will have more authority to fully enforce the existing mental health parity law so that Texans with depression, for example, will be treated the same, in terms of benefits or provider access, as someone with a physical health condition such as diabetes or congestive heart failure.

Budgets and laws always are about choices and priorities. In its choices, the Texas Legislature demonstrated its commitment to making Texas a healthier place to live and work.