Texas budget writers got a briefing on the state’s health care programs Wednesday, and many of the biggest questions focused on how the state can reduce fraud and what to do about ever-increasing health care costs.

The state Senate’s initial budget proposal spends more than $70 billion on health and human services, a 2 percent increase from the current budget. But so far the Senate hasn’t funded enrollment growth in Medicaid, the program that provides health care for low-income and disabled Texans.

Audio: Ben Philpott's story for KUT News

It’s one of the health care budget’s biggest items. State Sen. Tommy Williams, who chairs the Senate Finance Committee, said the omission is intended to start the conversation on how the state funds the program. But Williams, R-The Woodlands, warned that the state can’t continue to fund growth in the program at the rate it has over the past decade.

The Texas Tribune thanks its sponsors. Become one.

“And hope to build all the facilities that our institutions of higher education have, to build the highways that we need, and the water infrastructure that we need for our state to continue growing," Williams said.

Williams said senators will propose many fixes in hopes of lowering costs but that he doesn't think "those choices have to be whether we’re going to serve that population or not — it’s going to be about how they are served.”

One of the most hotly debated political points of the health care budget is whether or not Texas will join in an expansion of Medicaid called for under the Affordable Care Act. Gov. Rick Perry and other Republican leaders have promised that the state will not join in the expansion. Democrats say the state would only have to spend about $1 billion a year over the next three years to get $27 billion in federal matching funds.

One suggestion lawmakers heard Wednesday would allow the state’s largest counties to use local tax dollars to draw federal matching funds — a point state Sen. Royce West, D-Dallas, wanted to emphasize.

"Let make sure I understand this: In order to cover an additional 1.2 million people in the state of Texas, we have the ability to allow counties, if they can do so, to use their GR to cover more Texans without the state encoring an expense," he said.

A staff member of the Legislative Budget Board told West he was correct.

The Texas Tribune thanks its sponsors. Become one.

One other expense that has been more popular one among Republicans is a call to change the state’s mental health system, which has grown louder amid recent mass shootings.

“We are going to bring you some ideas that we think will suffice in the area of mental health. It’s getting a lot of attention now," said Kyle Janek, the state's commissioner of health and human services, adding, "And I’ll point out to the committee, there is no silver bullet. Anything I could come up with you could say, 'That won’t prevent Aurora, that won’t prevent Newtown, that won’t prevent Virginia Tech.'”

The Senate Finance Committee will continue to hold hearings on each part of the budget over the next few days, then break into smaller groups to start making recommendations on cuts or increases.

Texas Tribune donors or members may be quoted or mentioned in our stories, or may be the subject of them. For a complete list of contributors, click here.