As Central Health Prepares Budget During A Pandemic, Eastern Travis County Residents Seek More Care

Sep 9, 2020

Central Health announced it was buying land for a new health and wellness center in Southeast Travis County at the end of August, marking another step in the health care district’s efforts to improve access to care in the underserved area.

The 2.5-acre site is one of three new centers planned for the so-called Eastern Crescent. The area is home to many of the county’s low-income residents of color, who have been pushed farther east due to Austin’s history of segregation and gentrification. It lacks many of the services available in Austin, like health care, major grocery stores and recreational centers. 

Residents of Eastern Travis County have been calling for more health centers for years. A pandemic that’s laid bare preexisting inequalities in the area and a summer of protests demanding the city confront racial injustice have only amplified those calls. 

Maps from Central Health's 2020 demographic report show the concentration of families in poverty throughout the county.
Credit Central Health

“It’s long overdue,” said Jereka Thomas-Hockaday, who has worked in the medical field in Austin for the last two decades. “I’m glad that somebody’s finally listening, because there’s been a whole bunch of us saying this is the problem.”

Thomas-Hockaday founded the Central Texas Allied Health Institute, a health care college geared toward students who are at or below the federal poverty level, in 2019. Over the years, she’s been an advocate for improving access to care in Travis County.

“We have a whole lot of folks that are in need, and they can’t get to West Austin to get the services that they need,” she said. “I mean, we have a food desert and a medical desert out in Eastern Travis County.”

Improving Access

Central Health has been addressing health care access issues in Eastern Travis County by providing temporary facilities and services while plans for long-term facilities are underway. 

One temporary site opened in Del Valle in 2017; another opened in Hornsby Bend in February. Both are run by CommUnityCare, a network of federally qualified health centers Central Health funds, and offer primary care services a few days a week. CommUnityCare also has a mobile clinic that services Colony Park and Creedmoor.

For the long-term facilities, Central Health is focusing on three main locations: Hornsby Bend, Colony Park and Del Valle. It bought land for the Hornsby Bend site last year and for the Del Valle (Southeast Travis County) site in August. Mike Geeslin, president and CEO of Central Health, said the health care district is working with the city to buy land for a center in Colony Park.  

Geeslin said Central Health is determining what the centers will provide and preparing for the procurement side of things — getting engineering and construction firms. He said each step will go in front of Central Health’s board, and the community will be informed about the timeline as the projects move along.

“There are also steps that we go through that are part of our accountability process and procurement policies, and rules to ensure that we’re spending taxpayer dollars wisely,” he said. “So with all that in mind, we want to be real careful about what we commit to the community as far as timelines and be as accurate as we possibly can, but still providing that information as we move through this process.” 

But some have expressed frustration about the lack of a clear timeline and say things aren’t moving quickly enough. 

Tina Byram is vice president of the Del Valle Community Coalition, a group that’s been advocating for better infrastructure and services in the area for the last decade. She said she’s been particularly frustrated when it comes to the Hornsby Bend site. 

“We’ve been asking for that clinic to be built for a couple years, and we can’t get an accurate timeline,” she said. “We’ve been waiting a long time, and this area is a high need for health care.”

"If I get sick on a Friday night, I've got to wait until Monday to go see someone. That's unacceptable [especially] when a community itself is the most sick in the region. We're the most sick, so we should get the most help."

The majority of Travis County’s Latino and Black populations live in the Eastern Crescent. Illnesses like cancer, heart disease, diabetes and obesity already disproportionately impact these populations and now they're also testing positive for the coronavirus at higher rates. People of color continue to make up a disproportionate share of COVID-19 hospitalizations in the area. 

As a public entity, Central Health collects property taxes in order to connect low-income and uninsured residents in the county to health care.

Richard Franklin, a Del Valle resident for the last 20 years, said he feels he and his neighbors haven’t seen the benefits of having a health care district, despite having paid taxes to the district since it was created in 2004. 

He says the temporary facilities need to be open seven days a week, not just two or three days. 

“That means if I get sick on a Friday night, I’ve got to wait until Monday to go see someone,” Franklin said. “That’s unacceptable [especially] when a community itself is the most sick in the region. We’re the most sick, so we should get the most help.”

The question of where Central Health focuses its tax dollars has been a sticking point over the years. In 2017, Franklin and two other residents sued Central Health, arguing the health care district’s funds must be spent exclusively on providing medical services to the county’s poor and most vulnerable residents and that transferring millions to UT Dell Medical School each year is not authorized by state law.

Central Health argued the agreement with the school was legal and said, at the time, that nearly 300 medical residents were working in hospitals and clinics serving low-income individuals as a result of the partnership. 

The case was delayed because of COVID-19 and is still pending, Franklin said.

The Budget

Central Health is in the process of approving its fiscal year 2021 budget. Several of nearly 400 residents surveyed said they want Central Health to focus on prioritizing health care in Eastern Travis County and responding to COVID-19.

The proposed budget includes $9.5 million to start development on the three new clinical facilities; Central Health says it plans to use another $9.5 million from its reserves and to pursue debt financing for the projects, as well. It also says it's planning to put another $18.5 million toward the facilities in fiscal year 2022. 

While Central Health doesn’t directly operate clinics or hospitals, it does fund health care providers so low-income and uninsured residents can access care. In response to the pandemic, Geeslin said, Central Health is proposing to increase funds allocated to primary, specialty and hospital care. The district plans to spend $18 million more on health care services in the coming year.  

“We recognize that it’s going to be a while before there are vaccines, and even when there are vaccines, [COVID-19] is going to be with us for a while,” Geeslin said. “We will have cold, flu and coronavirus season here in Central Texas, and so we’re going to continue and make sure that we’re being supportive with those efforts.”

Geeslin said Central Health also plans to continue outreach and education efforts in response to the pandemic. For example, ensuring people – including those who don’t have internet access – have information about testing and available resources if they become sick. Central Health and CommUnityCare have been providing drive-thru and walk-up testing that doesn’t require payment or insurance at the Hancock Center clinic in Central Austin and at testing sites that operate on a rotating basis in Eastern Travis County. A longer-term site that offers tests five days a week opened off Burleson Road in Southeast Travis County at the end of August.

To fund Central Health’s proposed budget, the health care district is proposing a tax rate of 11 cents per $100 of valuation. If approved, the increase would mean the owner of a roughly $355,000 home would pay about $392 in property taxes for the year — about $25 more than this year.

Central Health is hosting a public hearing on the proposed budget and tax rate Wednesday at 5:30 p.m. Those who wish to show up in person at the Central Health offices can do so, but officials are urging residents to participate via video conference or phone. The Central Health Board of Managers will adopt the budget and tax rate Sept. 16. The items will then go before the Travis County Commissioners Court, which gets final approval, on Sept. 29. 

Cultural Proficiency

Providing more resources is just one piece of the puzzle in closing health care gaps in the county. Another component is making sure people feel comfortable using the medical services available to them.

As a Black woman working in health care, Thomas-Hockaday said she doesn’t see a lot of practitioners in Austin who look like her — and that hasn’t changed since she moved here from Houston two decades ago.

“Houston is one of the most diverse cities in the country,” she said. “I lived there and grew up there, so to move to Austin and walk into the facilities and see almost every face [was] white, it took me a long time to be able to be comfortable with that.”

"When you have white practitioners servicing folks that are not in their community, do not understand how their community works and don't understand the mental bias, the racial bias ... they cannot service them as well as folks who look like them and understand them."

She said she thinks medical providers in the county and Central Health need to actively recruit Black and Latino employees in order to see better patient outcomes.

“There’s a huge misunderstanding of African-American and of Latino culture here,” she said. “When you have white practitioners servicing folks that are not in their community, do not understand how their community works and don’t understand the mental bias, the racial bias … they cannot service them as well as folks who look like them and understand them.”

This summer, the Austin City Council declared racism a public health crisis, as COVID-19 hospitalized Latino and Black residents at disproportionate rates. The Black Leaders Collective, a group formed in July to tackle racial injustice in Central Texas, wants to work with Central Health to address the disparities in health care. Specifically, member Shuronda Robinson said, the group wants the health care district to improve representation in its staffing and partner with more Black-owned businesses.

“I think that Central Health can, as a public entity, do the hard work to change how health care is delivered to the Black population in Travis County,” Robinson said. “And the only way that they can do that is by listening to the lived experience and addressing that.”

Geeslin said Central Health is taking steps to achieve this. Central Health is planning to complete a disparity study in the next fiscal year, which will help the district understand where it can improve in contracting with women- and minority-owned businesses for a variety of needs, like outreach and engagement, building construction and site development.

He also said the district has been working on equity and inclusion efforts within its own leadership. About 70% of people enrolled in Central Health’s programs are Latino, according to a recent demographic report, while Latinos make up 40% of the Central Health organization. The current representation among Black employees looks better: About 6% of enrollees are Black, and 11% of the organization is Black.

“Even though we’re not directly interacting with the patients, like health care providers are, we’re accountable to the community," Geeslin said, "and we need to look and be the communities that we serve – and that’s across the enterprise, not just the health care delivery level.”

Got a tip? Email Marisa Charpentier at mcharpentier@kut.org. Follow her on Twitter @marisacharp.

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