Central Health presents 2020 draft budget with substantial structural changes

Central Health, the Travis County health care district that provides medical care to indigent residents, unveiled its preliminary 2020 budget on Monday evening at a community discussion held at its headquarters in East Austin.

This year’s budget incorporates a 6.9 percent tax increase over Fiscal Year 2019, estimated to cost the average property owner an additional $23 per year. Additionally, Central Health has expanded its health care delivery budget by 12.4 percent for FY 2020 in response to growing demand for services from low-income residents. Of the five Travis County entities that levy property taxes, Central Health constitutes the smallest piece of a consumer’s tax bill, accounting for 4.3 percent of total property tax to be paid in FY 2020, the same as FY 2019.

“Since our budget was adopted, a lot of things have changed at the federal level – and will continue to change – that affect how Central Health funds care,” said Central Health CEO Mike Geeslin, as he outlined the budget for Travis County residents. “There have been changes in the way that federal funds can be used to fund hospital care … and in how (Central Health) funds primary and specialty care.”

On its face, parts of Central Health’s new budget look quite different than its FY 2019 counterpart, but most changes result from structural budget tweaks instead of substantive financial revisions. One change is due to a significant shift in how federal matching dollars are paid out to hospitals for uncompensated charity care.

In May, the Texas Legislature passed Senate Bill 1350 to create a local provider participation fund in Travis County – a type of financial instrument administered by public entities like Central Health. This LPPF enables private hospitals that serve large indigent populations in Travis County to pool part of their revenue to access matching federal funds for uncompensated care from the 1115 Medicaid waiver.

Prior to the creation of the LPPF, Central Health allocated a portion of its tax revenue in order to receive federal matching dollars, which then flowed through Central Health’s budget on their way to local hospitals. With the LPPF in place, recipient hospitals now match federal funds with a portion of their own revenues, so those federal matching fund transfers to the hospitals have been removed from Central Health’s budget, though Central Health will still help administer the federal funds through the LPPF.

Additional structural budget changes for 2020 include nearly $94 million in health care delivery expenses, including large expenditures for primary care, specialty care and post-acute care that are absent from the 2019 budget. At Monday’s meeting, Geeslin clarified that these are not new expenses. Central Health previously paid these delivery costs through the Community Care Collaborative, a public-private partnership between Seton Healthcare and Central Health established to implement the delivery system reform incentive payment funding from the 1115 Medicaid waiver. Since the DSRIP funds are being phased out ahead of their expiration in FY 2022, leaving the fate of the Community Care Collaborative up in the air, Central Health is shifting those CCC expenses back into its budget.

Other notable budget items include $7.7 million in capital expenses for two to three new clinic developments in East Travis County, to get underway in spring 2020, as well as $9.6 million in capital expenses for a new electronic health records system that will enable referrals from primary care providers to specialists. The new technology is expected to launch in December 2019, and will phase in providers gradually.

Public hearings on the new budget will be held at 5:30 p.m. on Wednesday, Sept. 11, and Sept. 18 at Central Health’s headquarters, 1111 E. Cesar Chavez St. The Travis County Commissioners Court will vote on the budget on Sept. 24, and the increased property tax rate will go before the Commissioners Court on Oct. 1.

Photo by Katherine Corley: Travis County residents listen as Central Health CEO Mike Geeslin explains the FY 2020 budget priorities.

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