Return Control to Communities and IndividualsOver the past 30 years, too much government power has become concentrated in state and federal bureaucracies. And, as power has been taken from them,
our communities have been weakened. It is time to shift away from an Austin-knows-best mentality to one that puts more faith in Texas's diverse, multifaceted communities.
It is time to shift away from an Austin-knows-best mentality to one that puts more faith in Texas' diverse, multifaceted communities. Whenever possible, resources and responsibilities should be shifted to local communities, to the intricate networks of families, friends, schools, and businesses that are the real strengths of our democratic system. Local residents know their own problems and opportunities better than anyone else, and nine times out of 10, they can craft better solutions locally than programs created in Washington--or Austin.
1. Help Seniors Stay in their Homes
More than 65,000 Texans live in nursing homes. Many elderly Texans are forced to enter these facilities simply because they cannot afford adequate housing in their own communities; Medicaid will cover their expenses in nursing homes but not in their own homes. By some estimates, as many as 25 percent of all Texans in nursing homes could live in less restrictive environments.
A program that gives subsidies to low-income elderly Texans who live in apartments that provide service coordination and transportation would allow them to stay in their homes. Eligibility limits would ensure that the program assists only low-income seniors and that subsidies remain limited.
Action: Pilot a Facility-Based Rental Assistance program to be administered by the Texas Department of Human Services and Texas Department of Housing and Community Affairs to allow seniors to enjoy more productive lives while producing substantial savings in state and federal Medicaid spending. The average rent subsidy would be smaller than the average room and board charged by a nursing home. (See HOU 1, Volume II.)
2. Give People with Disabilities More Options
Advocates for people with disabilities say that to be truly independent, persons with disabilities should be responsible for as many aspects of their lives as possible.
At the moment, Texans with disabilities generally have little control over the service providers assigned to them. The state makes almost all of these decisions for them.
"Texas government has a one-size-fits-all
mentality and that must change."Carole Keeton Rylander
Action: The Health and Human Services Commission should create a voucher system allowing individuals with disabilities to select their own providers for services such as personal and technology assistance and durable medical equipment. Similar approaches have worked well in California, Pennsylvania, Missouri, Maine, and Virginia. (See HHS 4, Volume II.)
Turning Over Control in Workforce Development One recent success story is the state's reorganization of its previously chaotic and largely ineffective array of workforce development offices, which employed 9,000 state workers in 15 state agencies and operated about 30 individual programs. The 1995 Legislature restructured this bureaucracy into a single agency that offers customized training opportunities to all Texans through a network of local public/private partnerships called workforce development boards.
3. Shift Control of Child Welfare Programs to Community-Based Groups
The Texas Department of Protective and Regulatory Services (DPRS) provides foster care for children whose homes have become dangerous, and seeks permanent placements for children who cannot return home. Finding and arranging for adoptive homes, however, takes too long--an average of more than 16 months. The state's failure to act more swiftly has serious consequences for society as a whole. Children who reach the age of 18 in foster care are far more likely than their peers to live a life of crime, welfare dependency, and homelessness.
Action: Direct the Department of Protective and Regulatory Services (DPRS) to expand its use of community-based private adoption agencies to speed up adoptions and related processes such as family background checks. In addition, DPRS should centralize the money it spends on private adoption agencies. These funds now are spread among separate regions, making it difficult to place a child from one region with a qualified family in another region. (See GG 9, Volume II.)
4. Increase Community and Parental Control over Children's Mental Health Services
The state's Health and Human Services Commission (HHSC) has estimated that as many as two-thirds of Texas children with severe mental and emotional problems are not receiving the help they need. This is due largely to the way in which the services that could help them are fragmented among different agencies, programs, and funding sources.
This situation is aggravated by the fact that troubled children often benefit most from a variety of treatments, rather than from the narrowly focused services that tend to be available from any one agency or program. The most successful recent initiatives in children's mental health care involve flexible, "wraparound" approaches that pool state and local funds. Such arrangements--as practiced in Franklin County, Ohio, Marion County, Indiana, and Milwaukee County, Wisconsin allow families to choose the services they need, with funding allowed to "follow" the patient rather than being tied to rigid categories. HHSC has piloted a Texas Integrated Funding Initiative similar to the Wisconsin program, but more can be done.
Action: Expand the Texas Integrated Funding Initiative effort statewide with grants to local communities to fund customized services and programs. (See HHS 10, Volume II.)
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