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Summary: Recent legislation provided for the creation of health care funding districts to support the local health care safety nets in certain counties along the Texas-Mexico border. SB 1623 would expand the number of counties able to create a health care funding district. Current law allows counties to create these districts only if they have more than 500,000 people and are adjacent to two or more counties with 50,000 or more people. SB 1623 would extend this ability to counties with 350,000 people adjacent to one county with more than 50,000 people, and counties with less than 300,000 people that contain one or more municipalities with more than 200,000 people. SB 1623 would also move the date at which any district created under this chapter has to be abolished to December 2016.
These districts are operated by commissions that, in order to levy a tax or spend any money, have to obtain majority approval from voters.
SB 1623 would require each district to create a local provider participation fund that cannot be comingled with other county funds and can be used for various health care expenditures, including for intergovernmental transfers from the district to the state to draw down Medicaid funds, indigent health care, and administrative expenses. The fund would be comprised of any “mandatory fees,” taken by a district (SB 1623 replaces any mention of the word “tax,” with mandatory fee), refunds received from the Health and Human Services Commission for intergovernmental transfers, and any earnings the fund experiences.
Analysis: We are neutral on SB 1623. On one hand, it expands government by expanding the number of counties that will be eligible to create these districts, which have the power to levy “mandatory fees.” Still, these counties would choose whether or not to create a district, and any potential fee would have to be approved by a majority of voters, as well as any expenditure. Because voters have the ability, through elections, to give their input on mandatory fees and expenditures, this legislation puts decision making at a more appropriate level of government.