With the next legislative session a month away, lawmakers are preparing to move forward with a planned consolidation of the state’s five health agencies into a single commission.

Members of the Sunset Advisory Commission, a panel that includes lawmakers and makes periodic reviews of  state agencies and programs, unanimously approved on Wednesday a recommendation to combine the massive Health and Human Services Commission and the four smaller agencies it oversees.

At a Sunset commission hearing, lawmakers set forth a plan that would direct that the executive commissioner of the revamped health commission to establish seven divisions within the agency. Those include:

• Medical and social services

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• State institutions and facilities

• Family and protective services

• Public health services

• Regulatory services

• Centralized services

• Inspector general

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“This consolidation does present a monumental change to the delivery of health care services in the state,” said state Sen. Charles Schwertner, R-Georgetown, who chairs the Senate Committee on Health and Human Services.

While lawmakers on the Sunset Advisory Commission backed the recommendations, the full Legislature must approve the changes after it convenes for the next legislative session in January.

The proposed consolidation had been met with some opposition from advocacy groups for children and people with disabilities who worried that the state's neediest populations would be neglected under the new structure. During the hearing, Schwertner acknowledged that the consolidation would “certainly not be an easy transition” and that members of the commission would be involved in the process to ensure individuals are “not slipping through the cracks."

The large-scale integration of the state’s health agencies, which employed more than 54,000 employees and spent a combined $34.5 billion in 2013, would be the second in the last two decades. In 2003, lawmakers voted to combine 12 health and human service agencies into five.

In November, Health and Human Services Commissioner Kyle Janek endorsed the move, saying a merged commission would better serve the state’s most vulnerable populations.

The Health and Human Services Commission administers Medicaid, a joint state-federal health care program for the poor, and oversees four agencies that assist groups like foster children and the elderly. Sometimes, Janek said, the various agencies have had to draw up special contracts just to work with one another on issues related to Medicaid.

Lawmakers also endorsed a recommendation from state Sen. Jane Nelson, R-Flower Mound, to combine the Texas Women’s Health Program and the Expanded Primary Health Care Program, billed as covering treatment for “more comprehensive health problems.” The recommendation maintains the Department of State Health Services’ Family Planning Program in its existing form, but it would now be housed under the new health commission.

Nelson, who chairs the Sunset Commission and formerly chaired the Senate health committee, had previously indicated that she was looking to streamline or consolidate the state's programs that provide health services to low-income women. The programs were restructured after the Republican-led Legislature made sharp cuts to the state’s family planning budget and rejected a federally financed women’s health program in favor of their own.

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During the hearing, Nelson emphasized that the changes to the women's health programs should be made through the Legislature’s budgetary process, which the senator will now lead as the chairwoman of the Senate Finance Committee.

“We are setting a bold new course for these programs,” Nelson said. “I think we are on a great course to serve our most vulnerable citizens.”

If approved by Legislature, the health commissioner would then be required to submit a transition plan to a legislative oversight committee for approval by December 2015.