Travis County Healthcare District provides care for indigent

Travis County Healthcare District provides care for indigent

Written by Christi Covington Friday, 18 July 2008

Just a few years ago, the City of Austin owned the University Medical Center at Brackenridge.

Anyone from anywhere, whether in need of emergency assistance or not, could come for help and the city, or Seton, who operated the hospital, might be stuck with the bill. Many patients did not live in the city and did not pay city property taxes.

It was largely that situation that led to the creation of a taxing entity, known as the Travis County Healthcare District, which was designed to bring more residents into the revenue base and provide more uniform care, remembers Pete Perialas, who helped campaign for the district.

“There was no question,” said Perialas, a former board member of People’s Community Clinic, which receives funding from TCHD. “The political and central force of that idea [the Healthcare District] emanated out of Austin.”

TCHD formed in 2004 by voter approval to serve the local uninsured and underinsured in the county, including Austin residents within the county. The city and county each took a portion of its tax and designated it for the district. The city was estimated to give $31 million and the county $8.6 million in the first year, both numbers that represented how much would have been spent without the district. The county also provided an additional $1.7 million as a one-time resource.

Current status

Last fiscal year, TCHD had revenue of almost $90 million with around $58 million of that amount coming from property tax revenue paid by Austin and Travis County property owners. Approximately $83 million went to healthcare services.

Along with taking over Brackenridge, which it leases to the Seton Family of Hospitals to operate, TCHD is responsible for the Community Health Centers in Austin where patients can receive clinical help.

Similar to the situation with Brackenridge, the Healthcare District does not manage the clinics. It acts more as a funding and oversight mechanism. The CHCs are still operated by the city — although that will change next year when a nonprofit organization is scheduled to take over management.

Who receives care

Before the district formed to provide health care, the city and county each funded its own services with money imbedded in the general tax revenue.

Travis County then contracted with the city to provide the actual assistance to its residents. The City of Austin estimated from 1980 to 2005, it spent more than $650 million from the general fund for city and Travis County residents’ health care.

“Texas has one of the highest rates of uninsured. When you have 25 percent uninsured, the best thing you can do is get them covered by a plan in a clinic to get them care, preventive care, so they don’t have to go to a hospital,” said former Austin City Councilwoman Betty Dunkerley, who also promoted the district’s inception and would like to work with it in the future.

Often, patients needed more clinical-type help or could have prevented the severity of their situation with prior health care, but each county and city provided a different level of service, Perialas said.

That is why at first organizers wanted a regional district with Travis, Williamson, Hays and other counties involved, but Perialas said it was soon obvious that Travis was the only likely county to approve a new taxing district, so the effort was isolated to that area.

By state statute, each entity was already required to serve those residents who had an annual income of 21 percent of the Federal Poverty Level or less.

Using FPL’s standard for this year, a county or city would have to provide health care to someone earning $2,184 or less annually.

By board member decision, the Healthcare District provides for any Travis County resident earning 100 percent of the FPL through the Medical Assistance Program, including primary health care, pharmacy benefits and hospital care at Brackenridge without co-pays. For this year, that means a family of four qualifies if it has an annual income of $21,200 or less.

Those individuals making between 100 and 200 percent of the FPL can receive primary care at community health centers and pharmaceutical services, but will not get their hospital bill paid.