Attendant Wages

As in past sessions, one of our top priorities for 2023 was raising community attendant wages. The attendant workforce is crucial to keeping Texans with disabilities and older adults healthy and in their own homes. But recruitment and retention of these workers is at high risk due to an extremely low base wage, no benefits, increasing demand, and alternative employers paying much higher wages.

We had started out asking for a base wage of $15 per hour. When the state budget went to conference committee, it looked like we might get $11. At the end of the day, though, the Legislature put the base wage of community attendants at $10.60 per hour.

We are disappointed, to say the least, this is woefully inadequate. But we've been in this fight a long time and we're not going to call it quits now. We are encouraged that the budget conference committee took the Senate's methodology of raising the wage, which amounts to $2 billion into the pockets of attendants this biennium and another $2 billion carried forward in the next biennium's budget. This will put us in a stronger position to push for a competitive wage next session.

Even thought $10.60 per hour is not nearly enough, it's the biggest increase the Legislature has ever given attendants by far. And that's not nothing.

Criminal Justice

In 2021, CTD made major strides into the area of criminal justice. This is critical work because it is well documented that people with disabilities are over represented in the criminal justice system, as well as more likely to be victimized while in the system and receive less access to supportive services.

Many of the bills we worked on this session hit snags or ran out of time before they could make it to passage: increasing the use of medically recommended parole, accessible and equitable educational and reentry programming, establishing a Family Liaison position at county jails, the reinstatement of Pell Grants for incarcerated students, and others. Here, too, we are disappointed that so much promising change did not come to pass.

However, we had a few wins that will absolutely improve outcomes for incarcerated Texans with disabilities:

• We supported a bill that will reform the dehumanizing—and completely inaccessible—conditions of medical transport for women in the Texas Department of Criminal Justice (TDCJ), also known as medical chain.
• During the pandemic, virtual visitation was necessarily the only option for inmates to see their loved ones. But TDCJ continued to prefer virtual over in-person visitation, even when restrictions were lifted and even when accessibility was questionable. We helped to pass a bill that guarantees, when possible, the right of in-person visitation to a person housed at a TDCJ facility.

Healthcare Cost & Consumer Protections

Access to the right medication at the right time is best decided between a consumer and their doctor. This session, we were pleased to pass a number of measures to remove barriers and protect consumers:

• limiting the use of copay accumulators. When a consumer receives copay assistance, a copay accumulator prevents those funds from counting toward their annual deductible or other out-of-pocket requirements. This makes it harder for consumers to meet their deductible or maximum, resulting in higher out-of-pocket costs. After 3 sessions, a ban on copay accumulators finally passed.
• preventing commercial insurance from requiring a pre-authorization before every infusion for people with auto-immune disease. People who need infusions generally stay on them for long periods of time, and this bill will remove an administrative burden.
• preserving a single Medicaid formulary. A formulary is a list of prescription medications covered by an insurer, in this case, Medicaid. Medicaid health plans in Texas currently all use the same formulary, but that was scheduled to be broken up into to as many as 19 separate Medicaid formularies. All those drug lists would be very complicated for consumer choice. Fortunately, a bill to continue a single formulary passed.

Increase the Number of Texans with Health Insurance

Texas' rate and number of uninsured citizens continues to be the highest in the nation—and it's growing. Texans with disabilities currently not eligible for coverage would gain it with Medicaid expansion, which is why we have been members of the Cover Texas Now coalition and Sick of It TX campaign, both who advocate for health insurance expansion. While the Legislature did not even give a Medicaid expansion bill a hearing, they did expand postpartum coverage for mothers—from 2 months postpartum to a full year.

Medical Cannabis

CTD continued our role as the leading consumer advocate for better access to medical cannabis in 2023. We worked hard on a bill that would have dramatically increased patient access AND corrected a major harmful flaw in Texas statute created in 2021 (at that time, the Legislature legalized hemp, a member of the cannabis family. Patients under a physician's direction in the highly-regulated medical cannabis program left in droves for unregulated, cheaper hemp products). While the bill made it through the House, it stalled in the Senate and died.

Oral and Dental Care

CTD is the lead advocate supporting legislation relating to Medicaid reimbursement for dental services provided to adults with disabilities. After several sessions of incremental progress, language about a preventative benefit passed in 2021. However, the Texas Health & Human Services Commission (HHSC) has not yet implemented the program. Even though the benefit is in statute, and we worked to secure the funding, the Legislature rejected a rider to fund access to dental care for those who have zero benefits.

School Discipline & Mental Health Supports

Over the last few years, CTD and our partners have noted an alarming uptick in news articles and reports about students with disabilities being violently, and even lethally, disciplined in public schools across the state. Right out of the gate this session, CTD helped to organize a powerful press conference on harmful student restraint in schools (view the recording, closed captioned in English and Spanish) to educate lawmakers about the dangers of such practices—and policy solutions to end them.

It wasn't for nothing—the Legislature passed No Kids in Cuffs, a measure to ban certain types of physical restraint, handcuffs, and the use of chemical irritants on students under 11 years old.

Special Education & Schools

In addition to advocating for student safety in schools, CTD fought hard against public school vouchers, which would take money away from public schools and present a host of potential problems for students with disabilities. CTD joined an army of opponents to vouchers, who managed to fend off voucher legislature during the regular session. However, there will almost certainly be a special session on this issue in the fall. Stay tuned.

State Budget & Appropriations

As the 2023 Legislature convened, State Comptroller Glenn Hegar released a mind-boggling revenue estimate of $188 billion. The early budget bills from the House and Senate were little more than an extension of many parts of previous spending, leaving roughly $50 billion on the table. CTD was among the many voices calling on the Legislature to tap into the surplus to address years of neglect and pressing crises in disability services. Unfortunately, but perhaps unsurprisingly, they did not. Among the items we were watching in the state budget:

• community attendant wages did see an increase, but legislators could have given a much more meaningful raise.
• funding for waiver slots for less than a 1% per year reduction of the Medicaid interest list.
• a pitiful 2% wage increase for private duty nurses, another group serving Texans with disabilities that is long overdue for a real raise.
• a minimal increase for Early Childhood Intervention (ECI).

Voting Access

CTD focused on two major and successful advances in voting:

• the creation of an accessible mail-in ballot voting system, allowing voters with certain disabilities to cast a truly private ballot, while fully complying with absentee voting regulations.
• improvements in polling place accessibility, including codifying priority access in lines for voters with disabilities, practices for effective curbside voting, better on-site signage, and online information.

Youth Justice

Like their counterparts in the adult system, many Texas youth in under the care of the Texas Juvenile Justice Department (TJJD) have a mental health diagnosis or an intellectual and / or developmental disability (ID / DD). Both federal and state investigations in recent years have revealed that state facilities are sites of multiple forms of abuse and inadequate mental health support, and may violate the Individuals with Disabilities Education Act (IDEA) rights of the youth in their care. In support of the Finish the 5 Campaign, CTD called upon the state to close the remaining 5 state secure juvenile detention facilities in Texas and redirect resources to community-based support that would better serve these individuals. While a bill to do so gained some traction, it failed to make it to the finish line.

Looking ahead

We'll be putting out our full Legislative Report this summer, with much more detail. In the meantime, between special sessions and interim advocacy, there will be plenty to do! Stay tuned for interim Raise Your Voice! Zoom calls, virtual advocacy trainings, and action alerts.

Coming up, at CTD

Thank you to our 2023 General Sponsor

Thank you to our 2023 Raise Your Voice! sponsors

Having trouble viewing this email? View it in your web browser.

If you have received this message in error, our apologies! Update your preferences or unsubscribe below.