The Facts

* Institutional care for persons with developmental disabilities in Texas is provided through SSLCs. These institutions were initially fully funded by the state and called state schools. In 1971, Congress authorized a new optional benefit to Medicaid—Intermediate Care Facilities for the Mentally Retarded (now referred to as ICF/IID facilities)—that brought federal funding for institutional services that are matched by state dollars.

* A 2013 brief by the Legislative Budget Board stated, “Texas continues to operate SSLCs despite 40-year nationwide trends of deinstitutionalization and expansion of community services, as well as ongoing quality of care concerns at the SSLCs highlighted by the Department of Justice.”

* DADS operates 12 SSLCs across the state—Abilene, Austin, Brenham, Corpus Christi, Denton, El Paso, Lubbock, Lufkin, Mexia, Richmond, San Angelo, and San Antonio—and contracts for IDD services at the Rio Grande State Center for a total of 13 sites, each of which is named in state statute. 

* Texas maintains the highest number of SSLCs in the nation. California and Florida each operate five state facilities. Michigan operates none.

* The average monthly census in the facilities has declined 74% from 1973 to 2013 (from 13,700 to about 3,600). The last SSLC closure was in 1996, yet despite a 42% decline in census since that time, all 13 facilities remain open.

* The DADS operating budget indicates the average monthly cost per individual served in a SSLC for FY 2011 was $17,521 compared to a community ICF-IID rate of $4,813. FY 2014 budget increases the SSLC cost 26%. 

* Cost per individual in SSLCs excludes repair and renovation of more than $6.4 million in FY 2013 and $49 million in FY 2014. Capital costs are not reimbursed separately in community care and are instead included in the rate.

* The DADS operating budget also anticipates 514 confirmed incidents of abuse, neglect, or exploitation (ANE) at SSLCs in FY 2014.


* The number of SSLCs should be reduced through consolidation and closure from 13 to no more than 5 over the next two biennia. 

* Ultimately, only forensic facilities should remain, and only in areas with adequate access to behavioral health specialists in the community. 

* The movement toward services provided in the community will continue to decrease the census in the state’s 13 SSLCs. Yet DADS is unable to adequately respond without clear legislative direction.  

* Criteria should be established for closure based on factors such as census, ability of staff to achieve substantial compliance with the DOJ settlement, survey of private sector interest in adding capacity in the area, and the condition of SSLC facilities.