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Central Health’s budget raises eyebrows at commissioners court

Wednesday, September 11, 2013 by Mark Richardson

Officials with Central Health laid out their FY 2014 budget plan before the Travis County Commissioners Court on Tuesday, explaining to some skepticism how the agency’s tax rate is growing by more than 60 percent and its budget will increase by $59 million.


Central Health, the eight-year-old health care district that serves Austin and Travis County’s uninsured and underinsured patients, is in the process of restructuring after voters passed Proposition 1 last November. That measure raised Central Health’s property tax rate to 12.9 cents per $100 of assessed property value, up from 8.79 cents. That is a significant jump in the agency’s tax rate, which has hovered between 6.75 and 7.75 cents since it was created in 2005.


That, according to Central Health CEO Patricia Young Brown, will generate some $139 million in tax revenue for FY 2014, up from about $80 million last year. That spurred the formation of a new Community Care Collaborative which will essentially manage the delivery of health care services for the agency.


“This will be a very different year for us,” said Christie Garbe, Central Health’s Vice President of Planning and Communication. “We have fundamental changes in our budget, driven by changes the voters approved in November. Working with the University of Texas and the Seton Healthcare people, we formed a Community Care Collaborative to deliver those services.”


She said the collaborative would manage the health care delivered through Central Health’s partner agencies, such as CommUnityCare, Lone Star Circle of Care, People’s Community Clinic, and others in the provider network. 


But a significant part of Central Health’s budget – about $35 million – will begin funding elements of the planned University of Texas Medical School. That and a separate budget for the collaborative brought concerns from a couple of commissioners.


“Previously, your budget contained detailed information about your programs and even showed salaries of many of your key people,” said Pct. 1 Commissioner Ron Davis. “This budget doesn’t do that. It only gives us numbers for the major programs. Those things should be listed in the budget.”


Davis said he needed more transparency.


Brown explained that under the new structure, the collaborative brings its budget to the Central Health Board for approval, and then Central Health brings its overall budget to the county. She explained that under the new structure, Central Health would directly manage the agencies that deliver health care, and would be responsible for them.


Pct. 3 Commissioner Gerald Daugherty and Pct. 2’s Bruce Todd both questioned the Court’s apparent loss of control over the agency’s programs.


Brown responded that under the new structure, Central Health does not operate University Health Center at Brackenridge or any of the various agencies that deliver care under the collaborative.


“We had to create the mechanisms that will allow us to provide the most health care in an efficient manner,” she said, adding that all those agencies budget documents could be made available to any commissioners that wanted on.   


That answer did not seem to satisfy Todd, who commented that “We should have nothing less that total transparency.”


Daugherty picked up on another aspect of the budget, a $35 million expenditure earmarked for the UT Medical School.


“I’m confused,” he said. “How does that money get to the medical school? Why are we sending money to a medical school that isn’t there yet?” 


Central Health’s Jeff Knodel said that money was considered an investment. “It comes with the delivery of medical education services,” he said. “We will get some services now, and we will get more services after the medical school is built.”


Brown explained that the new property tax revenues, along with other sources of income, would fund Central Health at $219.8 million in 2014. She said some $211 million of that would go directly to health care delivery, with only $9.2 million used to cover administrative costs.


Central Health will return to Court Chambers on Sept. 17 when commissioners are scheduled to approve the agency’s budget.

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