Skip navigation
Glenn Hegar
Texas Comptroller of Public Accounts
Glenn Hegar
Texas Comptroller of Public Accounts
Glenn Hegar
Texas Comptroller of Public Accounts

Budget Drivers: The Forces Driving State SpendingArticle II: Health and Human Services

Cost drivers — rising population, caseloads and medical costs

For the 2018-19 biennium, Article II received $33.5 billion in GRR appropriations and $43.8 billion in federal funding; total All-Funds appropriations were $78.9 billion, including about $1.6 billion in other revenue from interagency contracts, rebates and other payments. The state’s Health and Human Services Commission, which administers Medicaid in Texas, received the largest share of both GRR appropriations ($28.7 billion or 86 percent) and federal funds ($40.9 billion or 93 percent) for the 2018-19 biennium.

Medicaid is the costliest Article II program by far, receiving $61.8 billion in All Funds for the biennium, or 78 percent of the total.

From fiscal 1996 through 2019, both GRR and All-Funds appropriations for Article II more than tripled, rising at an average annual growth rate of 5.2 percent (Exhibit 7). The rise reflects both the growth and the aging of the Texas population, the rising cost of prescription drugs and the prevalence of chronic disease such as diabetes, cancer and Alzheimer’s disease.

EXHIBIT 7: ARTICLE II APPROPRIATIONS VS. MEDICAL COST INDEX AND PERSONAL INCOME,
FISCAL 1996-2019 (1996=100)

Exhibit 7: Article II Appropriations vs. Medical Cost Index and Personal Income, Fiscal 1996-2019 (1996=100)
Fiscal Year General Revenue-Related Funds Index All Funds Index Medical Cost Index Personal Income Index
1996 100.0 100.0 100.0 100.0
1997 104.6 104.5 98.8 108.6
1998 100.4 102.6 95.2 118.7
1999 102.1 104.2 103.6 125.7
2000 106.2 110.1 98.5 136.5
2001 114.3 112.4 106.1 146.4
2002 132.3 142.3 124.0 148.9
2003 125.5 139.2 150.3 153.4
2004 147.8 161.0 165.7 159.3
2005 148.2 167.7 175.0 172.1
2006 167.7 193.0 182.8 189.5
2007 165.9 194.9 185.4 202.3
2008 215.9 225.1 193.2 223.6
2009 183.1 198.8 208.0 217.4
2010 236.8 261.2 233.7 221.6
2011 245.0 242.4 256.1 242.3
2012 262.9 260.3 272.0 260.1
2013 280.6 279.0 278.1 270.9
2014 285.8 293.2 292.4 285.9
2015 303.3 306.4 327.5 301.9
2016 315.2 310.4 341.9 304.3
2017 342.8 336.4 351.9 310.2
2018 332.8 322.6 361.3 323.1*
2019 320.5 319.1 372.9 340.7*

* Estimated

Sources: Bureau of Labor Statistics, IHS Markit, Legislative Budget Board and Texas Comptroller of Public Accounts


Note, however, that appropriations rose more slowly than either the medical cost index (5.9 percent annually) or personal income (5.5 percent annually). This indicates that Texas’ Medicaid program may be comparatively cost-efficient due to relatively tight eligibility requirements, low reimbursement rates and the state’s increased use of managed-care service models.



HB855 Browser Statement

In 2015, the Texas Legislature passed House Bill 855, which requires state agencies to publish a list of the three most commonly used Web browsers on their websites. The Texas Comptroller’s most commonly used Web browsers are Google Chrome, Microsoft Internet Explorer and Apple Safari.

We support: