Commissioners question health care district contingency fund, postpone budget vote

The Travis County Commissioners Court took no action on the county health care district’s proposed budget and tax increase Tuesday after repeatedly questioning the wisdom of the district’s $379 million contingency fund.

The controversial fund grew rapidly in recent years as the health care district, which serves low-income residents and is known as Central Health, stopped paying Ascension Seton for millions in contracted health care services. Central Health claims Ascension has been serving fewer low-income patients at Dell Seton Medical Center than its contract requires. Ascension denies these claims. 

After multiple audits and months of mediation, Central Health sued Ascension for breach of contract in January. Ascension countersued soon after. Ascension officials accuse Central Health of planning to use the contingency fund to buy Dell Seton Medical Center.

In his presentation to commissioners Tuesday, Central Health President and CEO Mike Geeslin said the Healthcare Equity Plan in the proposed budget spends most of the contingency fund by 2030. He noted there is no plan in the budget to take over a hospital but there are options to provide health care if others fail.

“If a key partner can’t fill the gaps or won’t fill the gaps, we certainly will,” Geeslin said.

Precinct 4 Commissioner Margaret Gómez noted that the reserve fund is more than half of the $744 million budget. She wondered why Central Health has taken so long to build a clinic in her precinct with those kinds of reserves available.

“People need access to health care, and we’re still waiting to get it built. So they have to wait 20 years after the legislation passed,” she said.

Geeslin took responsibility for delays, saying, “If I could wind back the clock and accelerate this, would I do it? Absolutely.” 

Precinct 2 Commissioner Brigid Shea said she welcomed the Healthcare Equity Plan to fill the holes in the safety net but was concerned about the spending patterns behind the contingency fund. 

“You spent less than 40 percent of your budgeted health care services in 2020, 2021 and 2022. So it makes me wonder how much of the health care services in this proposed budget would end up in contingency,” Shea said.

Central Health Board Member Ann Kitchen said the district is accountable to commissioners and publicly committed to spending the reserve fund.

“That’s what this health equity plan is about – spending down in a responsible way over the next seven years to full implementation,” Kitchen said.

Addressing Geeslin, Shea said, “I appreciate your comment that we don’t see anywhere in this a plan to take over a hospital. But … you are seeking for the court to find Seton in material breach of their agreement, which triggers your legal authority to purchase the hospital at a fair market value.”

“That is a remedy that belongs to Central Health. You’re right,” Geeslin said.

Several speakers testified in person and several more called in. Most spoke in favor of Central Health and urged commissioners to pass the budget. 

Maria Emerson said she agreed with Commissioner Gómez that Central Health has taken much too long to build clinics. But she said positive changes have taken place in the last few years. 

“The previous administration did not do any community engagement and discouraged it, and would push us out. There’s been a big change in the past five years. Many new services have been developed. Many more need to be developed and that is the plan. That is why I’m in full support of their budget and proposed property taxes.”

Precinct 1 Commissioner Jeff Travillion asked for more information about service delivery and more documentation. 

“We are dealing with populations that are tremendously underserved. So my expectation is that we be able to provide more and better services. If that means a higher rate, so be it. But I want documentation. I want to be able to tell folks where they can be served, what services can be provided, who we’re partnering with.” 

Central Health officials and board members agreed to present new and reformatted information next week, when commissioners have another chance to consider the budget and tax increase. It will be their last chance to vote on it, as the deadline to levy new taxes for the next tax year ends Sept. 30. 

Photo by Larry D. Moore, CC BY-SA 4.0, via Wikimedia Commons.

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