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
Texas to require proof of identity, legal status for new vehicle titles March 5, 2026
EL PASO, TEXAS (KFOX14/CBS4) — A major change is coming to how vehicles are titled and registered in Texas, with local officials and border-area dealerships bracing for questions, delays and the possibility that some buyers could take their business out of state.
Beginning March 5, 2026, Texans applying for an original vehicle title and registration will need proof of identity and proof of legal status in the United States.
The Texas Motor Vehicle Board approved a new rule requiring county tax offices to verify that documentation before processing those transactions.
“If the person doesn’t have valid ID, we cannot register their vehicle,” said Ruben Gonzalez, the El Paso County tax assessor-collector.
Gonzalez said the rule is mandatory statewide and is not a local policy, but a state mandate he is required to follow as an agent of the DMV.
Under the rule, buyers must present a REAL ID-compliant Texas ID or other federally recognized documents, including a passport or permanent resident card.
Gonzalez said the rule takes effect March 5 for new titles and registrations, but proof of legal status for registration renewals will not be required until Jan. 1, 2027.
“We’re going to give a year’s time for those people to qualify, but more so to allow the entities, businesses like lean holders and dealers and the county offices to be trained on what’s an acceptable form of documentation to accept from people that are renewing online or in our offices,” Gonzalez said.
Destiny Venecia reports on Texas to require proof of identity and legal status for vehicle titles, registrations (Credit: KFOX14)
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Local dealerships said they are working to adapt, but some employees and customers are uneasy about the change.
Luis Fierro, president of the El Paso Hispanic Independent Automobile Dealer Association, said, “My personnel is a little bit scared to make a mistake. Within the dinner community, they’re all scared, they’re all lost in the system. They’re trying to figure out, as we all believe, an ID was a real ID. Now we find out that what we knew that was good to be used is no longer good.”
Border-area dealerships also worry customers could buy and register vehicles in New Mexico, taking taxes and fees out of Texas.
“Customers are scared of the new implementation, that they’re going to take their business to New Mexico, pay their taxes in New Mexico, and handle the registration and renewals in the state of New Mexico and avoid Texas,” Fierro said.
County leaders said the concern extends beyond lost sales to lost revenue for Texas counties.
“It’s going to be a loss of revenue because if they go to New Mexico, we can’t collect our fees that are due because they’re all they’re running using our highways,” Gonzalez said.
County officials said they expect an increase in questions and possible delays in the first few months after the rule takes effect March 5, 2026.
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Texas
North Texas middle school closes after a norovirus outbreak
A middle school in the Eagle Mountain-Saginaw ISD is closed Friday after an outbreak of norovirus.
According to the school district, they closed Creekview Middle School in Fort Worth on Friday to sanitize and clean the building. The district said they plan on reopening the school on Monday.
The district said children started to get sick on Tuesday with what appeared to be a stomach virus and that on Wednesday it spread to a larger group.
EMSISD said they reached out to the Tarrant County Public Health Department and that they recommended disinfecting and cleaning the school on Wednesday night and reopening the next day.
More cases continued to be reported on Thursday, so the public health department then recommended that they clean again and close the campus on Friday.
Parents were notified of the district’s decision on Thursday afternoon.
The district has not said how many students and staff were sickened in the outbreak.
Officials with Children’s Medical Center said that because norovirus is highly contagious and resistant to many common hand sanitizers, it presents a unique challenge for families.
The hospital says hand sanitizer isn’t enough and recommends thorough hand washing with soap and water. They also recommend parents keep their children home for a full 48 hours after symptoms stop to prevent further outbreaks.
The Centers for Disease Control and Prevention says there are approximately 2,500 norovirus outbreaks in the United States each year and that they are most common from November through April. For further tips on preventing the spread of norovirus, visit the CDC.
Texas
Trump heads to Texas, where 3 friends are battling it out in the Senate Republican primary
WASHINGTON — President Donald Trump just can’t seem to choose among friends in the Texas Senate Republican primary.
So when he travels to the state on Friday for his first post- State of the Union trip, where he plans to promote his energy and economic policies, Trump will have all three candidates in the competitive race join him — just days before his party casts ballots in the primary race.
Sen. John Cornyn is battling for his fifth term and is being challenged by state Attorney General Ken Paxton and Rep. Wesley Hunt in a primary fight that has become viciously personal. And all three men, missing the coveted endorsement from Trump, have been trying to highlight their ties to him as they ramp up their campaigning ahead of Tuesday’s vote.
For his part, Trump will be seeking to ride the message of his State of the Union address from Tuesday, where he declared a return to economic prosperity and a more secure America — two centerpiece arguments for Republicans as they campaign to keep their congressional majorities this fall.
Trump’s hesitation to endorse in the Texas Senate primary speaks to the tricky dynamics of the race.
Cornyn is unpopular with a segment of Texas’ GOP base, in part for his early dismissiveness of Trump’s 2024 comeback campaign and for his role in authoring tougher restrictions on guns after the 2022 school shooting in Uvalde, Texas. But Senate GOP leadership and allied groups see Cornyn as the stronger general election candidate, in light of a series of troubles that have shadowed Paxton.
Paxton beat impeachment on fraud charges in 2023, and has faced allegations of marital infidelity by his wife, state Sen. Angela Paxton.
Sen. John Cornyn, R-Texas, right, is joined by former Texas Gov. Rick Perry, left, during a campaign stop in Austin, Texas, Tuesday, Feb. 17, 2026. Credit: AP/Eric Gay
Senate Majority Leader John Thune and South Carolina Sen. Tim Scott, chairman of the National Republican Senatorial Committee, have urged Trump to endorse Cornyn. They and allied campaign groups argue that the seat would cost the party hundreds of millions more to defend with Paxton as the candidate.
“It is a strong possibility we cannot hold Texas if John Cornyn is not our nominee,” Scott told Fox News on Wednesday.
Hunt, a second-term Houston-area representative, was a later entry to the race, but claims a kinship with Trump, having endorsed him early in the 2024 race. Hunt campaigned regularly for Trump and earned a prime-time speaking slot at the Republican National Convention in Milwaukee.
If no candidate reaches 50% in Tuesday’s primary, the top two finishers will advance to a May 26 runoff.
Texas Attorney General Ken Paxton and Rep. Troy Nehls, R-Texas, arrive before President Donald Trump delivers the State of the Union address to a joint session of Congress in the House chamber at the U.S. Capitol in Washington, Tuesday, Feb. 24, 2026. Credit: AP/Allison Robbert
Cornyn’s campaign and a half-dozen allied groups have poured more than $63 million into the race since last fall, chiefly trying to slow Paxton but recently attacking Hunt in an effort to keep him from making it to the runoff.
Earlier this month, Trump feinted toward weighing in on the race when he said he was taking “a serious look” at endorsing in the Texas primary. He has since reaffirmed his neutrality.
Still, you wouldn’t know it from watching TV in Texas. Cornyn has been airing ads since last year touting his support for Trump’s agenda, even though his relationship with the president has been cool at times. Paxton and Hunt both have ads airing now featuring them standing with Trump.
“I like all three of them, actually. Those are the toughest races. They’ve all supported me. They’re all good. You’re supposed to pick one, so we’ll see what happens. But I support all three,” Trump said earlier this month.
The GOP battle comes as Democrats have a contested primary of their own in Texas between state Rep. James Talarico, a self-described policy wonk who regularly quotes the Bible, and progressive favorite U.S. Rep. Jasmine Crockett.
Trump hasn’t been shy about wading into other contested Republican primaries in the state. Parts of Corpus Christi fall within Texas’ 34th congressional district, where former Rep. Mayra Flores is fighting to reclaim her seat against the Trump-endorsed Eric Flores. (The two are not related.) The winner of the primary will face off against Democratic Rep. Vicente Gonzalez, long a target of the GOP, whose district was redrawn to make it easier for a Republican to win.
Eric Flores will be at the Trump event at the Port of Corpus Christi, which technically is located in a neighboring district.
Elsewhere in the state, the president has also endorsed Rep. Tony Gonzales, who is fighting calls from his own party to resign from Congress after reports of an alleged affair with a former staffer who later died after she set herself on fire. Gonzales is refusing to step down and has said that there will be “opportunities for all of the details and facts to come out” and that the stories about the situation do not represent “all the facts.”
Gonzales is facing a primary challenge from Brandon Herrera, a gun manufacturer and gun rights influencer who Gonzales defeated by fewer than 400 votes in their 2024 runoff. The White House did not return a request for comment on Thursday on whether Trump stands by his endorsement of Gonzales.
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