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What's going on with Central Health and Ascension Texas' legal saga?

An ambulance drives under a sky bridge at Dell Seton Medical Center.
Gabriel C. Pérez
Travis County's publicly funded hospital district and its private hospital system partner are at odds over an agreement to serve the county's low-income residents.

This week brought a new development in a series of legal ultimatums between Travis County’s public hospital district, Central Health, and its private partner, Ascension Texas. At stake in the conflict is the maintenance of a functioning health care safety net for Travis County.

A history of partnership and conflict

Since Central Health’s creation in 2004, the publicly funded hospital district has contracted with Ascension Texas — then, Seton Healthcare Family — to operate Travis County’s safety net hospital serving low-income and uninsured residents. At the time, that was University Medical Center Brackenridge.

When Dell Seton Medical Center replaced Brackenridge in 2017, Ascension continued its operations. This arrangement sets Central Health apart from other public hospital districts in Texas, which typically operate hospitals directly.

The two entities announced they were suing each other in January, each accusing the other of breaching their partnership agreement to provide care to Travis County’s low-income residents — people who earn 200% or less of the federal poverty level and do not qualify for Medicaid or Medicare.

The lawsuits followed a long and unfruitful mediation process in which Ascension and Central Health disputed how they should manage their nonprofit funding partnership, the Community Care Collaborative.

What’s in the lawsuits

Central Health’s lawsuit came first. It leveled claims that Ascension had served a diminishing number of patients enrolled in Central Health’s Medical Access Program (MAP), intentionally “reducing, capping, and eliminating” services for low-income patients. Central Health cited data provided by Ascension showing a 21% reduction in the number of MAP and charity care patients served since 2013.

Ascension's responding lawsuit claimed Central Health had in fact overenrolled patients in the MAP program, without adjusting the funding it provided to Ascension. It said the numbers Central Health cited were actually evidence of improving long-term health outcomes for Travis County’s low-income patients.


Most recently, Ascension sent Central Health a “governance and funding deadlock” on Tuesday. According to a 2013 agreement between the parties, this is a notice either Central Health or Ascension may serve after a period of prolonged dispute.

A deadlock notice should kick off a series of events. The CEOs of both entities would meet in the next month. If they can’t come to a resolution, a new mediation process would begin. If mediation fails, Ascension or Central Health could initiate the termination of their partnership. They could also seek an opinion from a judge to decide what happens next.

“The deadlock notice is an effort under the parties’ contracts to get Central Health back to the table to work collaboratively in a way that will better meet current and future needs of Travis County,” Ascension said in a written statement.

However, a Central Health representative said this protocol was an attempt to circumvent the legal proceedings already in place, and that the matter is already in the court’s hands.

“We will not be distracted by this latest legal maneuver,” Central Health President and CEO Mike Geeslin said in a written statement. “We have a pending lawsuit against Ascension in court, and this is our focus.”

Central Health representatives say they expect the legal process to be a lengthy one. If they win their case, they are seeking a termination of their agreement with Ascension and to trigger an option to purchase and operate Dell Seton Medical Center.

Community criticism

As legal proceedings continue to unfold, critics in the community say the disputes are distracting from Central Health and Ascension's charge to serve local health needs.

In a letter to Travis County commissioners in March, representatives from the League of United Latin American Citizens criticized Central Health and Ascension leadership.

"We believe that both entities have forgotten that their primary mission is to serve patients, particularly the poor," LULAC said.

LULAC is also among critics who have called for greater transparency into Central Health's finances, particularly regarding the growth of its reserves and its moves to build new, self-operated clinics rather than lean on existing community partnerships.

Travis County commissioners approved a contract to audit Central Health in April.

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Olivia Aldridge is KUT's health care reporter. Got a tip? Email her at Follow her on X @ojaldridge.
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