After weeks of discussion and debate, Travis County commissioners gave final approval to a $744 million budget for local public hospital district Central Health on Tuesday. It was not a unanimous decision.
Central Health provides health care for low-income county residents. Because its board of managers is not elected, but appointed, state law requires its budget and tax rate to be approved by county commissioners each year. The $744 million budget puts $295 million toward health care delivery; $377 million will remain in the organization’s contingency reserve fund.
Commissioners also approved a tax rate of 10.07 cents per $100 valuation, which will add $56 to the average homeowner's bill.
With this budget, Central Health will be able to launch its Healthcare Equity Plan, a seven-year effort to add new clinics and services to serve low-income residents.
“We now have one of the few opportunities we’ve ever had to make our health care more inclusive and comprehensive,” Dr. Cynthia Brinson, vice chair of the Central Health board of managers, said.
A seven-year plan
The commissioners' approval came after a week-long delay, after they expressed frustration about approving a tax rate increase while Central Health has hundreds of millions of dollars available in contingency reserves. This fund has been criticized by other entities as well, including Ascension Seton, which is currently locked in litigation with Central Health.
The hospital district plans to significantly draw on its reserves to support the Healthcare Equity Plan. The plan consists of 150 projects Central Health says will “close the most dangerous gaps in the safety-net system,” at a total cost of $682 million. Without the effective 6.5% tax increase — and the $30 million in revenue it would bring — Central Health leaders said their ability to execute the plan would be hampered.
“This is the time for us to make this move toward running and controlling Central Health, and … taking care of the indigent patients completely, not relying on others."Cynthia Brinson, vice-chair of the Central Health board of managers
“Thirty million less today impacts, cumulatively, the ability to implement the Health Equity Plan over the next seven years,” Ann Kitchen, a member of the Central Health board of managers, said at a Commissioners Court meeting last week.
The board of managers traces the roots of the Health Equity Plan to the results of an independent performance review audit Travis County ordered in 2017. The third-party auditor noted that Central Health was unique among public hospital districts in Texas in that it does not itself operate a hospital that provides care to poor and indigent residents. Rather, it contracts with Ascension Seton to offer these services at Dell Seton Medical Center. The auditor said the model has benefits, but also means Central Health has “less day-to-day control over how care is being delivered.”
In the years since that audit, Central Health has developed the Healthcare Equity Plan with a goal of building a comprehensive health care safety net for people who struggle to afford care—a system where services are directly provided by Central Health.
“This is the time for us to make this move toward running and controlling Central Health, and … taking care of the indigent patients completely, not relying on others,” Cynthia Brinson, vice-chair of the Central Health board of managers, said at a board meeting Monday.
Final countdown
The board convened Monday at Travis County Judge Andy Brown’s behest after Commissioners Margaret Gomez and Brigid Shea said they were not prepared to support the tax rate as proposed last week.
Brown encouraged Central Health leaders to return Tuesday with more detail about its track record of providing care at health centers in Eastern Travis County, along with how it plans to spend its contingency reserves. He also pushed them to consider contributing funding to Travis County inmate health services and its mental health diversion center pilot.
“I’m trying to help you here,” Brown said, “because I think right now it’s not going great for y’all.”
On Monday, the Central Health board of managers voted to accommodate several of Brown and the commissioners’ requests; they earmarked $2 million in reserve dollars to support Travis County inmate health services and said the $1.5 million they had already approved for the diversion center would be an annual commitment. Additionally, they committed to continuing their support of the county’s mental health authority, Integral Care.
However, several board members said they felt backed into a corner by the commissioners’ eleventh-hour requests.
“I just feel like this has been pushed down our throats,” Brinson said. “We haven't had any time to plan. We haven't had any time to understand what it is we're even going to agree to.”
Mixed public feedback
When Central Health leaders returned to Travis County commissioners to make their final bid for budget approval Tuesday, some 30 community members also arrived to speak. Some supported Central Health, like Ofelia Zapata, an Austin ISD trustee and community organizer.
“They really do go out and listen to the community. The priorities laid out for the next seven years are what the community asked for,” Zapata said.
Others, however, lobbied commissioners to deny Central Health any tax increase until a new independent audit could be conducted. In April, Travis County commissioners approved an $845,200 contract for an audit, but that review has yet to begin. A driving force of the audit is to ascertain whether $35 million in annual funding to Dell Medical School has been appropriately used to fund health care for poor residents — also the subject of an ongoing lawsuit. That line item was again approved in this year’s budget.
“A budget [should] not be approved until the completion of the performance audit. That will provide more transparency,” said Gloria Leal, a lawyer and president of the local League of United Latin American Citizens chapter.
The budget ultimately passed with Brown and Commissioners Jeff Travillion and Ann Howard voting in favor. But Shea cited the pending audit as a reason for abstaining. Commissioner Margaret Gomez voted against both the budget and the tax rate.
Commissioners also unanimously passed a motion requiring Central Health leaders to meet with them on a quarterly basis to discuss the budget, an effort to increase transparency throughout the planning process and receive up-to-date reports tracking Central Health’s spending on health care services.
“It needs to be more than just a presentation,” Gomez said. “We need to be able to question the information that’s presented.”
