Texas health budget proposal would eliminate autism program funding

Texas health officials have outlined a $335 million reduction plan inside one of the largest agency budgets in state government, proposing trims or eliminations across dozens of health and human services programs while leaving facility-based services untouched. 

The Health and Human Services Commission’s (HHSC) base request for 2028-29 totals about $100.6 billion in all funds, an amount equal to about a third of the entire $338 billion state budget approved for 2026-27. 

The scope of HHSC is vast, a result of the state’s 2003 consolidation of 12 health and human services agencies under one umbrella. Today, HHSC administers Medicaid, the Children’s Health Insurance Program, SNAP and other major safety-net programs; operates 10 state psychiatric hospitals and 13 State Supported Living Centers; and licenses and regulates health care and child care facilities and providers, according to the agency’s legislative appropriations request. 

State leaders directed agencies this summer to reduce their base requests by 3 percent. For HHSC, that meant identifying about $335 million in reductions from General Revenue and General Revenue-Dedicated funds. Medicaid and CHIP were exempted from the reduction exercise, and HHSC says it protected key core functions, including direct care services in state hospitals and State Supported Living Centers, eligibility operations and regulatory oversight. 

The proposal is still early in the budget process, even if agency requests typically reflect some level of coordination with state budget writers. Lawmakers will decide what reductions, restorations or new funding make it into the final state budget. That leaves room for negotiations over whether programs proposed for elimination, including the autism program, are ultimately restored. 

Parents of children with autism have been especially concerned because the proposal would eliminate state funding for direct therapy services outside of Medicaid, according to recent reporting by the Texas Tribune. The state’s non-Medicaid autism program provides focused applied behavior analysis services through contracted providers. HHSC’s budget documents show the program received $13.7 million in General Revenue for the current biennium, with no funding requested for 2028-29. 

The autism program is one piece of a larger client-service reduction package. HHSC’s summary identifies $205.5 million in General Revenue reductions to client services, the largest category in the plan. Other proposed eliminations include the Pediatric Tele-connectivity Resources Program, Long Term Youth and Family Support, Healthy Texas Women navigator services, Healthy Texas Women cost-reimbursement contracts, the Nutrition Incentives Program and the Statewide Youth Services Network. 

Other client-service programs would be reduced rather than eliminated. Those include Texas Home Visiting, Texas Nurse Family Partnership, Healthy Outcomes through Prevention and Early Support, Family and Youth Success, Community Youth Development, Healthy Community Collaboratives, Mental Health First Aid, Multi-Assistance Centers and rural hospital telepsychiatry consultations. 

The balance of the $335 million reduction plan would come from program administration, other administration, regulatory cost recovery and historical or projected lapses. HHSC’s summary identifies $19.6 million in reductions to program administration, $28.3 million to other administration, $21.1 million in regulatory cost recovery and $56.3 million in lapse reductions. The agency says the lapse reductions are not expected to directly affect services because they come from areas where funds have historically gone unused or where spending is projected to fall below appropriated levels. 

HHSC laid out its rationale in a document titled “2028-29 Biennium 3 Percent Reductions,” which explains how the agency identified reductions for its legislative appropriations request. In that reduction summary, HHSC says its “most basic funding priority is to preserve funding directly serving clients over amounts associated with the administration of those services.” The agency says that when client-service reductions could not be avoided, it considered demand, utilization, effects on health and safety and whether other funding sources were available. 

At a Sept. 17 HHSC Executive Council meeting, Chief Financial Operations Officer Trey Wood said the agency took a “strategic approach” to the 3 percent exercise. HHSC says it looked first for reductions in historical lapses, administrative functions and regulatory programs where fee increases could offset state funding losses. 

The agency’s legislative appropriations request also frames the reductions against several other budget pressures. HHSC says recent federal changes to SNAP could expose Texas to up to $2 billion in additional costs over the 2028-29 biennium, depending on the state’s payment error rate. Executive Commissioner Stephanie Muth wrote in the budget request that reducing the SNAP error rate has been her top priority because improvements in accuracy could reduce the state’s exposure to those costs. 

One area HHSC did not reduce is facility-based services. The reduction summary says the agency took no reductions to facility-based services, including state hospitals and State Supported Living Centers. 

That distinction comes as Texas continues a multi-year state hospital construction program. Since 2017, lawmakers have invested more than $2.5 billion to replace, renovate and expand state hospitals, including new hospitals in Houston, Dallas, Lubbock and Amarillo, according to HHSC. 

In June, HHSC and UT Southwestern cut the ribbon on the Texas Behavioral Health Center in Dallas, a 292-bed psychiatric hospital operated by UT Southwestern Medical Center. HHSC also lists major projects under construction in Terrell, Wichita Falls, Amarillo, Lubbock, Harlingen and San Antonio. 

The hospital expansion comes amid pressure to add inpatient psychiatric capacity, including forensic beds for people found incompetent to stand trial. In July, a federal judge ordered HHSC to admit detainees committed for competency restoration within 21 days within four years, after finding that people were waiting in jail because the state lacked sufficient capacity. 

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