Travis County Adopts Central Health 2025 Budget

Travis County commissioners approved Central Health’s 2025 budget Tuesday after weeks of contentious discussions — but also passed a motion directing staff to further examine the public hospital district’s financial and organizational practices.

Central Health’s nearly $889 million budget includes $353 million for health care delivery. Of that, $60 million is for services delivered by Central Health, rather than partner organizations. That’s the largest amount ever dedicated to care delivered directly by Central Health, which is in the midst of its ambitious health care equity plan to invest about $700 million in new clinics and services to address gaps in Travis County’s health care resources over the next few years.

County commissioners also approved a tax rate of nearly 10.8 cents per $100 of home value. That means the average Travis County homeowner will pay about $544 a year, a $66 increase from the previous year.

Although the votes approving the budget and tax rate were unanimous, commissioners noted ongoing concerns about Central Health’s $35 million annual payment to UT’s Dell Medical School, as well as a conflict between Central Health and its clinical partner CommUnityCare.

To address these concerns, commissioners adopted a motion asking staff to review the financial requirements Travis County has assigned to Central Health in 2017.

“I would like staff to study … how to clarify how and what information is provided to the Commissioners Court to help improve transparency and accountability — and to change any financial policies we deem necessary,” Travis County Judge Andy Brown said.

A closer look at Central Health and Dell Medical School

Commissioners also directed county staff to find outside counsel to advise on potential legal issues related to a affiliation agreement between Central Health and Dell Medical School. The agreement outlines how Dell Med should manage the $35 million Central Health gives it each year, thanks to a 2012 election proposition authorizing a tax to support “a new medical school consistent with Central Health’s mission.”

The annual payment has been a source of controversy for years and is the subject of a trial which alleges that Dell Med treated taxpayer money as a gift, when it should be spent exclusively on health care for poor residents.

Before Central Health’s budget was approved, an independent auditor found that Dell Med’s spending did not violate the agreement and that Central Health was not breaking any laws.

Fred Lewis, an attorney representing taxpayers suing Central Health for $35 million in damages, challenged the audit findings and filed a complaint against the lead auditor with the Texas Supreme Court’s Unauthorized Practice of Law Committee.

“The Mazars report found only that the medical school’s spending appeared to be consistent with the affiliation agreement. No one doubted that,” Lewis said in a statement. “The real question is whether the agreement complies with state law requiring that the funds be spent on health care for the poorest.”

On Tuesday, Travis County Commissioner Brigid Shea praised Central Health leaders for their progress on the health care equity plan. But she also agreed that an outside attorney should respond to accusations from Lewis and others that the affiliation agreement does not comply with Texas law. She suggested that a “renegotiation” of the agreement might be necessary and expressed disappointment that years of demands for a detailed accounting of expenses related to the $35 million payments have not yielded more results.

“I feel a little bit like Charlie Brown with the football,” Shea said. “For a number of years, we’ve had many assurances that we’re going to get more information, but we’re still not getting the kind of information that we need and that the public is asking for.”

Health sector partners at odds

Meanwhile, Judge Brown has relied on Central Health CEO Patrick Lee and board chair Ann Kitchen to find a quick resolution to the ongoing leadership dispute between Central Health and CommUnityCare.

The two organizations share a human resources department because of a complex co-applicant agreement to receive federal funding. Jason Fournier, CommUnityCare’s CEO, was recently placed on administrative leave by Lee due to unspecific allegations of misconduct. CommUnityCare executives say they don’t believe Lee had the authority to make that decision.

Lee told Brown that Central Health and CommUnityCare have each brought in independent investigators to resolve the dispute — but he did not give a specific reason for his allegations against Fournier while the investigations continue.

Brown said he would not withhold his vote on the Central Health budget because of his concerns, but stressed his positive impression of Fournier’s work and his unease about the conflict.

“I expect that people will realize that this was the way to go,” Brown said. “And if they don’t, I’m not going to be very happy.”