AUSTIN (KXAN) — The Central Health Board of Managers will take another look at its finances in a special called meeting Monday after Travis County Commissioners pushed back on the more than $744 million FY-24 budget proposed to them.

The budget breaks down to include the following:

  • Nearly $300 million for health care delivery
  • Nearly $30 million for administration
  • $35 million for an agreement with the University of Texas to provide services at Dell Seton
  • And more than $379 million for contingency reserves

That last bullet was one of the reasons Travis County Commissioner Brigid Shea pushed back on the proposed budget Tuesday in what she described as a “stern conversation” with Central Health staff.

“They’re putting twice the amount of money in their contingency reserve as they list as expenditures on direct health care services,” Shea said. “And their main mission is health care services for the poor.”

Central Health staff say building reserves is part of it’s strategic effort to build out a health care system that meets the demand of the growing number of patients it sees year-over-year. Central Health is starting a “seven-year ramp-up” of its action plan, which includes 150 new projects to meet the need.

“We have a very definitive plan, board approved, that we have continued to update Commissioner’s Court and the public,” Ted Burton, chief communications officer for Central Health, said. He continued: “And even as we increase services, open more clinics, that reserve is going to go down dramatically until 2030. And at that point, our reserves essentially hit our emergency reserve threshold that we can’t go below.”

Projection showing reserve levels until FY-30
Projection showing reserve levels until FY-30 (Courtesy Central Health)

County Commissioners also expressed the desire to see Central Health pay for the care of people in Travis County’s jail — which Commissioner Shea says can run $22-$25 million a year — and to start putting more money toward mental health diversion services, which has been a focus for the county.

“Jail is not the best place for someone whose main problem is they either haven’t been diagnosed or are not being treated sufficiently for their mental health illness. And so we want Central Health to help more with that,” Shea said.

That will factor in the conversations the Central Health Board of Managers will have Monday in its emergency meeting.

“I can’t predict what the board will do. I do know that they will take very seriously the input and questions from Commissioners Court, and then consider whether and how to make changes to our proposed budget,” Burton said.

How much will it cost you?

If approved, the tax rate will be 0.100692 for every $100 valuation. It will cost someone owning an average-value home an additional $56 a year.

If County Commissioners decide not to approve the new tax rate, a “no new revenue” rate will go into effect. The Central Health board will look at how quickly that would bring them to an emergency reserve level on Monday.

“I don’t think any of us wants to hurt their ability to provide more health care for the poor, but we want to see them doing more of that,” Shea said.

You can find the full budget here.

What is Central Health?

Central Health is the public health care district in Travis County which serves people who are low-income and uninsured. Voters approved creating the taxable district in 2004.

People at 200% of the federal poverty level qualify for health coverage through Central Health. That shakes out to roughly $60,000 a year for a family of four and $29,161 for a single person.

State law requires Travis County Commissioners to sign off on Central Health’s budget along with the tax rate it hands to voters every year. She said commissioners ultimately do not have the ability to make changes in the budget though, only to ask the Central Health board to make those changes or risk non-approval.

“It’s like trying to knit with oven mitts on because we only have up or down approval,” Shea said.

Central Health’s fiscal year starts on Oct. 1.

Performance review

Earlier this year, Travis County Commissioners unanimously voted to hire a third-party firm to do a performance audit of Central Health. KXAN previously reported the audit would cost the healthcare district $845,200.

“It’s vital that public entities such as Central Health, even the county and city, get a qualified, outside perspective to ensure they are continuously improving, growing, and thriving, to meet the needs of the people they serve,” Central Health President and CEO Mike Geeslin said at the time.

A 2018 review of Central Health showed room for improvement, including the need for a comprehensive analysis of safety-net health care system gaps. Central Health said it has implemented many of the changes revealed in that review.