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Commissioners Court approves Central Health budget, with concerns

Wednesday, September 30, 2020 by Jessi Devenyns

On Tuesday, the Commissioners Court unanimously approved Central Health’s $367.3 million budget, stamping its seal of approval on the 6.9 percent, or $76.5 million, increase for the Travis County health care provider and the corresponding $24.97 average increase in annual tax liability for homeowners.

“I’m no fan of signing off on a 6.9 percent increase … but let me try to qualify why I will vote for this thing,” Commissioner Gerald Daugherty said. “You can see that 96 percent of what they do is (service) delivery, and it’s not just primary care.”

While other commissioners agreed that providing health care to vulnerable populations was a critical responsibility for Central Health, they generally expressed concern with the speed and efficacy with which it was being done.

“The question is whether we are using the resources for Central Health to build a safety net for those that don’t have a lot of money,” Commissioner Jeff Travillion said. Both he and Commissioner Margaret Gómez noted that they have seen impatience in the community surrounding the implementation of additional services and clinics to provide care to disadvantaged populations. Travillion pointed out that while the majority of the Central Health budget is used to provide services, he saw the health care provider funneling a large amount of those dollars to projects downtown rather than toward the Eastern Crescent, which Central Health says it prioritizes.

Former Central Health Board Member Frank Rodriguez came to speak to the commissioners, saying, “It’s not enough just to spend more money on health care if the impacts aren’t being felt in the community.”

He previously sent a memo to the Commissioners Court outlining a host of concerns with an emphasis on Central Health’s relationship with Ascension Seton and the UT Dell Medical School. Since 2014, Central Health has paid Dell Medical School $35 million annually to provide care to indigent populations in Travis County. Over the last seven years, Rodriguez said these payments total $245 million, but “spending cannot be traced to corresponding impacts.” He also said Seton has not provided Central Health with a record of the number of Medical Access Program patients served by their health care providers.

Mike Geeslin, the president of Central Health, said the organization does track the care provided to MAP patients by its partners, but noted that access to data is “something we need to improve upon.” He said that was a topic of discussion between Central Health and Seton in their mediation.

Local attorney Fred Lewis, who continues to pressure Central Health over transparency concerns, pointed to the six-page budget Central Health presented to the Commissioners Court, saying its brevity not only lacked detail but obfuscated pertinent information. “You can’t tell how much money any of the partners of Central Health are getting,” he said. “I have seen lemonade stands that have better financial statements than you’ve been presented.”

Lewis told the Austin Monitor, “There is no detailed documentation of what UT provides under the specialties agreement,” which he said was an additional $12 million payment above and beyond the $35 million earmarked each year to fund the partnership. He said the lack of documentation was concerning and fiscally irresponsible. “When you’re spending the public’s money, you need to be completely and totally transparent.”

Commissioner Brigid Shea noted that the presented budget was a “little skinny.” In contrast, Travis County’s preliminary budget was 119 pages long. “I continue to want and need more info and don’t really get it,” she said.

To encourage Central Health to provide additional information, she cited language from the Texas Health and Safety Code Provisions that gives the Commissioners Court the power to “prescribe accounting and control procedures for the district,” including requesting a detail of the operations of the health care district by granting an inspector access to records, reports, books, papers and accounts.

“We provide a lot of information,” Geeslin said, saying that commissioners are given a budget book annually and that these items are regularly discussed in meetings of the Central Health Board of Managers.

Shea said she will work with county attorneys to devise a better methodology to gain more detail about Central Health’s annual budget for the future.

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