Texas
Even as state mental health spending rises, private psychiatric hospitals struggle to stay open
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As Texas embarks on a $2.5 billion expansion of its 163-year-old state psychiatric hospital system, the private psychiatric hospital industry, which offers a more accessible entry point for those who are seriously mentally ill, would like a word.
How about a raise to the Medicaid rate for inpatient psychiatric care?
In the past year, 65 private psychiatric hospitals have banded together to form the Texas Association of Behavioral Health Systems (TABHS), bringing more attention to how the rate paid for Medicaid patients hospitalized in their facilities hasn’t budged in 16 years. The inattention has crippled this critical mental health industry, forcing some hospitals to close their doors in communities with few treatment options.
A letter sent nearly a year ago by TABHS to the Texas Health and Human Services Commission outlined their concerns.
“As HHSC is aware, inpatient psychiatric hospital Medicaid rates have not increased in Texas since 2008 and in fact, the Legislature decreased the rates by 8% in 2011,” the letter, signed last October by Oceans Healthcare CEO Stuart Archer, the group’s president, stated. “These 15-year-old rates are unsustainable. HHSC must act now to protect and support the Texas behavioral health safety net.”
That rate sits at about $529 a day. Care for each patient costs nearly twice that.
“Ballpark? It’s about $700 to $900 a day,” said Alan Eaks, senior vice president and CEO of Signature Healthcare Services, which operates five psychiatric facilities in Texas, including ones located in San Antonio, Georgetown, DeSoto, Houston and Lockhart.
Although the number of private beds is small – about 3,658 are located statewide in these standalone hospitals – 80% of Texas inpatient Medicaid claims for mental health and substance use treatment come from private psychiatric hospitals, Archer said.
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While the Texas Medicaid program is so restrictive that the only adults who qualify are low-income moms of young children or disabled individuals, this group can make up a third of a private hospital’s patient load.
And now after more than a decade of no rate increase, Texas’ reimbursement rate is now less than several other states, including Oklahoma ($665), Louisiana ($738) and Mississippi ($648). By comparison, Medicare, the federal health insurance plan for Americans aged 65 and older, pays $896 a day per patient to psychiatric hospitals for inpatient care.
Mental health spending and state-run psych hospitals
For years, Texas has been held up as a stingy national example when it comes to mental health care, cited often as ranking dead last when it comes to finding help.
But those statistics often fail to account for what the Texas Medicaid health insurance program – designed to cover mostly poor children, their mothers and disabled adults, as well as to provide nursing home care for qualifying seniors – spends on behavioral health: about $3 billion every two years since 2015, according to the Meadows Mental Health Policy.
Factoring that in, Texas climbs the ranks to 33rd.
However, the figure includes all Medicaid mental health spending: counseling sessions for children, prescriptions and emergency room care.
Overall, Texas has spent more on mental health care in recent years. State expenditures on behavioral health by all agencies have soared from $6.9 billion in 2015 to $11.6 billion in 2023. A sizable chunk of the increase includes millions to construct new local mental health facilities and the $2.5 billion expansion of the state’s state psychiatric hospital system, many of the beds of which are reserved for the seriously mentally ill patients now confined in jails and not competent to stand trial.
The state health commission operates nine state psychiatric hospitals and its multi-billion dollar makeover will add at least 700 new inpatient beds. Many state-operated psychiatric beds have been set aside as “forensic” or “maximum security unit,” reserved for inmates in the state’s jails or prison system. In 2023, more than 60% of patients in the state hospital system came from the criminal justice system. The construction project will build more forensic and general public beds.
The few beds available to the general public in these facilities must meet certain criteria and patients must first go through a local mental health authority.
The move to expand the state hospital system comes following years of reports of mentally ill individuals found languishing in jails without treatment. The inmate waitlist for these psychiatric beds, a chronic problem, has dropped dramatically in the past year – from 1,056 in February 2023 to 645 last July. There was also a similar drop in the waitlist for non-forensic beds. But it is creeping back up, and in July 1,181 Texans outside the criminal justice system were on a waitlist for a psychiatric inpatient bed.
So where do people suffering a mental health crisis go?
According to Archer and others, they are typically treated first in hospital emergency rooms. While some general hospitals have psychiatric beds, hospital stays are very limited there and depending on where you are in the state the number of those ER beds can vary.
“Parkland barely has 20 beds,” Eaks said, referring to Parkland Memorial Hospital in Dallas. “Where Houston (UT Health Harris County Psychiatric Center) has around 100 beds.”
Who is a private psychiatric hospital patient?
That’s where the little-discussed private psychiatric hospital industry, clustered in Texas’ larger cities, enters.
These facilities concentrate too on the most seriously mentally ill and those in need of substance abuse treatment. Their patient load typically comes from acute hospital ERs, law enforcement or schools. This is where families take loved ones for intensive extended care.
While most people pay for treatment through private insurance, the Medicaid patients treated in private psychiatric hospitals have been a known loss leader in Texas for years, hospital officials say.
“We’re 90% percent full and we’re losing money,” said Eaks, with Signature Healthcare. “That’s why we’re sounding the alarm. We really are the safety net.”
Adds Steve Page, CEO of Sun Behavioral, which also operates in Texas: “Addressing the base (Medicaid) rate would create stability.”
Fragile industry
Overall, providers say doing business in Texas has always been tough and they, too, wince at headlines announcing another closure or sale of competitors’ hospitals.
In August 2019, Nix Medical Center in downtown San Antonio, which had 15 geriatric psychiatry beds, closed. Three months later, the company operating Nix closed two other locations, removing 115 adult beds and 31 child beds from the inpatient psychiatric industry in Texas.
In January 2023, New Jersey-based Cedar Health Group bought one of the Nix properties with plans to reopen it as a mental health facility. The main Nix tower was sold to a hotel operator and another Nix property was sold to a Houston-based hospital chain, according to local news reports. It is not clear at this time whether Cedar Health plans inpatient or outpatient mental health services.
“Houston and Dallas have been graveyards for psych hospitals in the state,” Archer said.
The problem is widespread – more than half of the nation’s inpatient psychiatric facilities report operating in the red, Archer wrote in the letter to the state last year.
Raising the Medicaid rate would be a boon but TABHS members also say it’s time to allow psychiatric hospitals better access to federal money that general hospitals have been able to tap. They point to the complicated, decades-old exclusion of psychiatric hospitals from other federal funding that general hospitals access.
After last year’s letter, the state health commission confirmed to The Texas Tribune that officials met with providers to hear more about their concerns. There’s no word yet on whether a rate increase is in the offing.
“It’s just a complicating factor for us. That’s something most of our legislators don’t understand,” Eaks said.
Texas
Political fighting pervades Texas politicians’ responses to Austin shooting
Texas elected officials and candidates’ response to the deadly shooting in downtown Austin on Sunday quickly turned political, as Republicans sharply criticized the country’s naturalization process and Democrats called for stricter gun reform laws.
Republicans’ rebukes of the immigration system came after media outlets identified the gunman, whom police killed within a minute of arriving at the scene, as a naturalized citizen from Senegal. The Department of Homeland Security said the man entered the United States on a tourist visa in 2000, became a lawful permanent resident by marrying a U.S. citizen in 2006 and was naturalized in 2013.
Shortly before 2 a.m. Sunday, the gunman killed two people and injured 14 others at a bar that sits among several popular nightlife venues on West 6th Street.
Many Texas Republicans, including Gov. Greg Abbott, suggested the gunman wasn’t properly backgrounded before he was granted U.S. citizenship, but did not provide details of what should have prevented his naturalization. When asked about his criminal history, DHS only said the man was arrested in Texas in 2022, after he was a citizen, for “collision with vehicle damage,” a misdemeanor crime typically given when someone leaves the scene of a wreck.
The New York Post reported that gunman, 53-year-old Ndiaga Diagne, was arrested for “illegal vending” in New York City in 2001. Citing unnamed sources, The Post said he was arrested in New York three other times between 2008 and 2016, but those cases are sealed. The Post did not report on whether he was convicted of any crimes.
At least one GOP candidate for attorney general has called for an audit into immigrants who are in the country legally.
“Audit all ‘legal’ immigrants’ papers and deport as many as possible,” Aaron Reitz said on X.
Reitz and others also voiced their opposition to Islam, which has become a key campaign pillar for some Texas Republicans competing in Tuesday’s GOP primary. The gunman wore a sweatshirt emblazoned with the words “Property of Allah” and a shirt with a design of the Iranian flag, according to the Associated Press. The shooting happened after the United States and Israel bombed Iran.
Austin police did not disclose a motive for the shooting, but the FBI is investigating it as a potential act of terrorism, the Associated Press reported late Sunday.
The Texas chapter of the Council on American-Islamic Relations, an American Muslim civil rights group, condemned the attack in a statement Sunday and rejected any efforts to blame the whole community based on one individual’s action.
“We encourage elected officials, law enforcement, faith leaders, and community members to come together to support the families of the victims and reaffirm our shared commitment to public safety,” the organization’s statement said.
Abbott and state Rep. James Talarico, an Austin Democrat running for U.S. Senate, quarreled on X about the shooting. Abbott said that “allowing unvetted immigrants who are hostile to America, who are loyal to our adversaries like Iran, must end. This was an act of terror, James.”
“The way to end it is to end the current open immigration policies,” he continued. “You and your immigration policies would make America less safe.”
Talarico responded to Abbott by saying “dangerous people should not be allowed into the country. Dangerous people should not be allowed to get guns. Texans understand this — you apparently don’t.”
Austin Police Association President Michael Bullock criticized Talarico on X for politicizing the incident.
“With all due respect sir – now is not the time. All of the information has not come out. How can policy be made on incomplete information?” he said. “The action that needed to happen did – officers heroically ended the violence.”
“This applies to all candidates and elected officials regardless of party,” he continued. ”Now is the time to focus on the victims and first responders impacted, not campaigns.”
U.S. Rep. Chip Roy, who is also running for the GOP nomination to be state attorney general, posted alleged details about the gunman’s immigration to America and naturalization. He said the gunman was granted legal residency during George W. Bush’s administration, “amid GOP celebration of the joys of ‘melting pot’ legal immigration.”
“This is why we are losing our country, our immigration system is a joke, and should PAUSE ALL immigration,” Roy said.
Naturalization is the legal process of becoming a citizen after meeting certain requirements.
Denise Gilman, director of the Immigration Clinic at the University of Texas at Austin, said there has long been extensive vetting in the naturalization process, including criminal background checks. She also said immigrants can’t immediately become citizens without first going through prior steps, such as becoming a lawful permanent resident, that require scrutiny.
“Naturalization is just the last step of many steps that all require vetting,” she said.
Immigrants are eligible for naturalization if they are 18 years old or older and have been green card holders for at least five years (three years if they are married to a U.S. citizen). They also have to take tests proving they’re able to speak, read and write in English. As of last fall, the Trump administration added more requirements, such as a more rigorous civics test, and having to prove to an immigration officer that they are “a person of good moral character.”
When asked about Diagne’s reported arrests, Gilman said generally arrests can be considered when evaluating moral character or discretion but will not automatically bar green card status or naturalization. Certain convictions, however, may result in actual bars.
“It really depends on the nature of the crimes involved,” she said.
Around 818,500 people were naturalized in the fiscal year of 2024, according to U.S. Citizenship and Immigration Services, which has not published 2025 data yet — nearly 10% lived in Texas. The total was a 7% decrease from 2023, the agency said. From 2022 to 2024, the country has added more than 2.6 million new citizens through naturalization.
U.S. Sen. John Cornyn, who is up for reelection this year, said on Fox News that the shooting underscores “the importance of vetting people before they come across the border,” and is an example of “what happens when people become radicalized.”
Cornyn blamed the Biden administration for having “open border policies that let who knows what into the country,” Cornyn said.
Texas Democrats, meanwhile, responded to the shooting by pushing for stronger gun laws, but did not provide specifics on what policies would have prevented the man from obtaining weapons. Austin police also did not release details on how the man obtained the two firearms they say he used in the shooting.
Republicans control both chambers of the Texas Legislature and have routinely loosened gun restrictions while Democrats’ bills to curb access gain little traction.
Austin-based U.S. Reps. Greg Casar and Lloyd Doggett also denounced gun violence, but did not issue any specific policy proposals.
“We must end America’s gun violence epidemic,” Casar said in a post on X. “Americans should be able to have fun at a bar without it turning into an unspeakable nightmare like this one — and I will redouble my efforts in Congress to prevent the next tragedy like this.”
Doggett said: “Gun violence is preventable. This devastating loss of life was preventable. Until Republicans find the courage to say no to the [National Rifle Association] our country will be plagued with more tragedies.”
Disclosure: University of Texas at Austin has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
Texas
South Texas Blood & Tissue sends blood units to Austin after 6th Street mass shooting
SAN ANTONIO — South Texas Blood & Tissue worked late last night and early this morning to prepare and send blood units to Austin in the wake of the mass shooting on 6th street early Sunday.
The Blood Emergency Readiness Corp (BERC) has been activated and an additional 140 units have been sent from various blood centers, including O negative and O positive.
The blood bank says community support is critical and community members are encouraged to donate at any local donor center.
3 dead, 14 injured in Austin mass shooting on 6th Street, suspect fatally shot by officers
Mayor Gina Ortiz Jones shared her condolences, adding that commonsense gun reform may prevent such tragedies in the future.
I’m deeply saddened to hear of the mass shooting in Austin that killed and injured so many,” Mayor Jones said in a statement. “Let’s keep our neighbors to the north in our prayers, that those injured recover quickly and the families of the victims who were needlessly murdered are comforted. We must prevent such tragedies from happening through commonsense gun solutions. Thank you to the first responders who were at the scene and prevented further loss of life.
U.S. Congressman Joaquin Castro condemned the country’s gun violence in an X post saying in part “Congress must continue to work to end the scourge of gun violence in our country.”
San Antonio’s FBI office is also assisting the Austin Police Department in their investigation, officials shared at a press briefing this morning.
Special Agent Alex Doran said the joint terrorism task force is helping investigate potential early indications of terrorism.
“We have members from our Evidence Response team as well as our many other specialty teams, including our digital forensics folks that are on scene, helping to address the scene and gather additional evidence,” Doran said. “Obviously, it’s still way too early in the process to determine an exact motivation, but there were indicators that on the subject and in his vehicle that indicate potential nexus to terrorism. Again, it’s still too early to make a determination on that.”
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Texas
St. Andrew’s Prom Closet helps North Texas teens shine without the high cost
It’s that time of year again – prom season. For many students, it’s a night to remember, but between dresses and other expenses, the costs can add up quickly. Every year, St. Andrew’s Methodist Church steps up to help ease the financial burden for families, offering free prom dresses and accessories to young women.
“I’m feeling very excited, very happy, you know it’s all like coming to me at once,” said Gabrielle Bennett, a high school junior.
Prom season is a moment many young girls look forward to, and finding the perfect dress.
Boutique experience for every shopper
“It was a lot of searching through a lot of dresses.. and seeing what fits, what doesn’t, what looks nice, and then you finally find one, and it fits perfect,” said Ally Atkins, a high school senior.
For 17 years, St. Andrew’s Methodist Church has opened its prom closet to girls across North Texas, helping those who may not be able to afford the high cost of prom. This year, organizers hope to serve 1,400 shoppers. There are more than 5,000 dresses to choose from in different colors, styles, and sizes.
“Every young lady should feel special at prom. Every young lady deserves to be beautiful, and in some cases, some of these young ladies, this would not be possible,” said Kathy Moore, a Prom Closet chairman.
Community donations make it possible
The experience is designed to feel like a real boutique – from trying on dresses to grabbing the perfect shoes, bag, and accessories. Everything is donated.
“I had one yesterday that walked into our dress area, and she stopped and just said, ‘wow,’ and so right there, that moment, that’s why we do it,” Moore said.
Organizers said the event is made possible by community donations and dozens of volunteers, but they’re always looking for more help. Next year, they hope to serve even more girls, continuing their mission to make more prom dreams come true.
“I want to thank this whole organization, I’m very grateful,” Bennett said.
How to participate
If you know someone who may need a prom dress this season, the Prom Closet is open until March 7. It is by appointment only. For more information, visit: https://standrewmethodist.org/prom-closet/
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