Travis County commissioners approved Central Health’s 2025 budget Tuesday after weeks of contentious discussions — but also passed a motion directing staff to further scrutinize the public hospital district’s financial and organizational practices.
Central Health’s nearly $889 million budget includes $353 million for health care delivery. Of that amount, $60 million goes toward services offered by Central Health, rather than partner organizations. It is the greatest amount ever dedicated to care offered directly by Central Health, which is in the midst of its ambitious Healthcare Equity Plan to invest around $700 million into new clinics and services aimed at filling gaps in Travis County’s health care resources over the next few years.
County commissioners also approved a tax rate of nearly 10.8 cents per $100 of a home’s value. That means the average homeowner in Travis County will pay around $544 annually, a $66 increase from the previous year.
Although the votes approving the budget and tax rate were unanimous, commissioners emphasized ongoing concerns about Central Health’s annual $35 million payment to UT’s Dell Medical School, as well as a conflict between Central Health and its clinical partner CommUnityCare.
To address these concerns, commissioners passed a motion directing staff to revisit the financial requirements Travis County assigned to Central Health in 2017.
“I would like staff to explore ... clarifying how and what information is provided to the Commissioners Court to help improve transparency and accountability — and amending any financial policies that we think are needed,” Travis County Judge Andy Brown said.
A closer look at Central Health and Dell Medical School
Commissioners also asked county staff to find outside counsel to advise on potential legal issues related to an affiliation agreement between Central Health and Dell Medical School. The agreement outlines how Dell Med should handle the $35 million Central Health gives it annually, thanks to a 2012 voter proposition authorizing a tax to support “a new medical school consistent with the mission of Central Health.”
The annual payment has been a source of controversy for years and is the subject of a lawsuit that alleges Dell Med has treated the taxpayer money as a gift, when it should be spent exclusively on health care for poor residents.
Leading up to Central Health’s budget approval, an independent auditor found Dell Med’s expenditures have not violated the agreement and that Central Health is not in violation of any laws.
Fred Lewis, a lawyer representing taxpayers suing Central Health over the $35 million payment, took issue with the audit’s conclusions and filed a complaint against the lead auditor with the Texas Supreme Court’s Unauthorized Practice of Law Committee.
“Mazars’ report only found the medical school’s expenditures appeared to comply with the Affiliation Agreement. No one doubted that,” Lewis said in a statement. “The real issue is whether the agreement complies with state law requiring the funds to be spent on the poor’s health care.”
On Tuesday, Travis County Commissioner Brigid Shea complimented Central Health leaders on their strides on the Healthcare Equity Plan. But she also agreed outside counsel should address accusations from Lewis and others that the affiliation agreement does not align with Texas law. She suggested “renegotiating” the agreement might be necessary and expressed disappointment that years of requests for detailed accounting of expenditures related to the $35 million payments have not yielded more results.
“I kind of feel a little like Charlie Brown with the football,” Shea said. “For several years now … we've gotten a variety of assurances that we'll get more of this information, and we're still not getting the kind of information that we need and that the public's asking for.”
Health care partners at odds
Meanwhile, Judge Brown leaned on Central Health CEO Patrick Lee and Board Chair Ann Kitchen to deliver a quick resolution to an ongoing leadership conflict between Central Health and CommUnityCare.
The two organizations share a human resources department due to a complex co-applicant agreement to receive federal funding. Jason Fournier, the CEO of CommUnityCare, was recently placed on administrative leave by Lee due to non-specific allegations of professional misconduct. CommUnityCare leaders say they do not believe Lee had the authority to make this decision.
Lee told Brown that Central Health and CommUnityCare had each tapped independent investigators to address the conflict — but he would not give a specific reason for his allegations against Fournier while the investigations continue.
Brown said he wouldn’t withhold his vote on Central Health’s budget because of his concerns, but emphasized his positive impression of Fournier’s work and his discomfort over the conflict.
“I’m expecting that it will come out that that was the necessary way to go,” Brown said. “And if it doesn’t, I’m not going to be very happy.”
