State and Local Updates: Part 1

In Part 1 of this post, learn about state discussions on Medicaid, local goings on with the Felony Mental Health Court, and what happens When a Mind Changes.

Medicaid Matters

It is clear to any Capitol observer that Medicaid is on the forefront of the minds of Texas legislators, both Republicans and Democrats. To make sure it stays there, approximately 2,000 people gathered at the Capitol last Tuesday to show support for Medicaid expansion as laid out under the Affordable Care Act (ACA). For a summary of the rally, check out the post by Peter McGraw of the Hogg Foundation for Mental Health.

On Friday, the House Appropriations Committee heard testimony from experts and elected officials on Medicaid expansion. Health and Human Services Commissioner Kyle Janek made a presentation outlining what the expansion would look like in Texas.  Along with other provisions of the ACA, the Medicaid expansion would cut the current uninsured rate in half. In addition to the Legislative Budget Board’s earlier estimate that $50 million of state general revenue could draw down $4 billion of federal money in the next biennium, former chief revenue estimator Billy Hamilton stated that the expansion could free up an additional $1.2 billion of general revenue next biennium. Our very own Judge Ed Emmett also testified, sharing that Medicaid expansion has the potential to bring $975 million a year to Harris County. He reminded legislators that “poor people are going to continue to get sick and they’re going to continue to get care,” but the main issue is going to be who pays for it.  Currently, local taxpayers are largely footing that bill. He also urged them to recognize the immediate pay off of Medicaid expansion, while also cautioning “that it’s not just about dollars, it’s also about human potential.”  Well said, Judge!

Medicaid expansion holds significant potential for people with mental health and substance use disorders. The PCG Report estimated that 90% of current non-Medicaid eligible individuals receiving publicly funded mental health and substance abuse services would qualify if eligibility was expanded.

There’s no doubt that legislators will continue to weigh all options related to this matter, including a “Texas solution” that grants flexibility in the use of Medicaid dollars, potentially steering people into private health plans.  We’ll continue to monitor this throughout this session and beyond!

Felony Mental Health Court: A Year Later

Last week, the Harris County Felony Mental Health Court held a stakeholders meeting to give updates on the court since it started operating over a year ago.  Obviously, the court has seen a few major changes over the past few months, including two new judges.  Judges David Mendoza and Brock Thomas will run two dockets for individuals with mental illness and individuals with co-occurring mental health and substance use disorders, respectively.

Since its inception, the Court has received 159 referrals, with 64 current clients.  Over the past six years, these clients have cumulatively spent over 15,000 days in jail, incurring a cost of close to $900,000 in jail time alone. No doubt, the mental health court has the potential to help these folks maintain their treatment and break the cycle of incarceration.

Dr. Clete Snell of the University of Houston conducted a comprehensive review of the Court and had several recommendations for implementation, including:

  • Reviewing the original planning document for the court, which consisted of recommendations from criminal justice and mental health stakeholders. MHA played an integral role in the planning of the mental health court and hopes that some early recommendations, such as accepting certain violent offenders, will be considered;
  • Establishing a committee to identify additional funding for intensive treatment services. The lack of community mental health services has hampered the Court’s ability to provide alternatives to incarceration;
  • Implementing specific phases to mark participants’ progress. The report notes that phases can serve as a “powerful motivator” for participants; and
  • Individualizing sanctions for court infractions, while using jail as a penalty as a last resort.

Over all, the Court’s first year of operation was considered a great success.  The mental health community should continue to support the court and advocate for expansion opportunities whenever and wherever they arise.

When a Mind Changes

I am so very proud of a new MHA publication, “When a Mind Changes: Personal Stories About Mental Illness and Its Effect on Individuals, Families and Communities.” This booklet, which includes forewords by Harris County Judge Ed Emmett and Houston Mayor Annise Parker, tells real stories about real people in the Greater Houston area.

The stories of mental illness are as varied as we are. Take Elizabeth McIngvale, a young girl ravaged by a severe case of Obsessive Compulsive Disorder before she even turned 13. Or Dr. James McSwain, Principal of Lamar High School, who actually allowed his son to remain in the Harris County Jail so he could receive needed mental health treatment. Or Brenda Bouie, who lived in Hermann Park for 17 years, largely due to her battle with Schizophrenia.  Their words are powerful; their courage is inestimable. You’ll recognize fears, hopes, and dreams that you or someone you know may be dealing with right now.

I encourage you to get to know the people and the issues in this booklet. We hope it will promote a better understanding of mental illness and the need for services among the general public and, in particular, our elected officials.

If you would like hard copies of this booklet, please contact Traci Patterson at

That’s all for today. Stay tuned for more budget updates and bills tomorrow!


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