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 needs at least $174 billion to avoid water crisis, state says
AUSTIN (Texas Tribune) — Texas communities will need to spend $174 billion in the next 50 years to avert a severe water crisis, a new state analysis revealed Thursday. That’s more than double the $80 billion projected four years ago, when the Texas Water Development Board last passed a state water plan.
The three-member board presiding over the agency authorized the highly anticipated draft blueprint Thursday, the first administrative step toward adopting the water development board’s plans for the next 50 years. The plan, released every five years, encompasses the projects that 16 regional water planning groups in Texas said are the most urgent, water development board officials said.
The board’s latest estimates come as the state’s water supply faces numerous threats. Growing communities across Texas are scrambling to secure water, keep up with construction costs and cope with a yearslong drought. This week, Corpus Christi officials said the city may be just months away from declaring a water emergency. Meanwhile, other rural cities by the Coastal Bend are rapidly drilling wells to avoid a crisis. Residents in North Texas have also been bracing for groundwater shortages.
In an effort to restrain the crisis, lawmakers last year called an election in which voters approved a $20 billion boost for communities to use on water-related expenses. The water development board’s estimate shows that what lawmakers proposed on the ballot falls dramatically short of the needed cash, experts said.
“What this number tells me at the end of the day is if we don’t get serious about (funding water projects), there are going to be serious consequences for Texas,” said Perry Fowler, executive director of the Texas Water Infrastructure Network. “Even with the billion-dollar-a-year plan kicking in, it’s not going to be enough to offset the costs of the projects that are going to have to be executed.”
The new estimate accounts for 3,000 projects, from regional infrastructure upgrades to smaller endeavors such as drilling new water wells. Texas’ water supplies are expected to drop by roughly 10% between 2030 and 2080, according to the water plan. In that same time frame, the maximum amount of water communities can draw is also expected to decline by 9%.
The 80-page plan notes approximately 6,700 recommended strategies that would add water to the state’s dwindling portfolio. The recommendations — which are not accounted for in the cost — include developing new supplies from aquifer storage and recovery, brackish groundwater, desalination and recycled water. It also calls for water conservation.
The report suggested that if Texas does not implement the plans and recommendations, the state is one severe drought away from an estimated $91 billion in economic damages in 2030.
The state’s plan attributes a variety of reasons for the bigger price tag, such as higher costs of construction due to inflation, impacts of the COVID-19 pandemic on supply chains, and a growing backlog of water supply projects.
“There’s a plan that can meet our needs,” said Matt Nelson, deputy executive administrator for the Office of Planning at the water development board, adding that they take their cues from the regional planning groups. “These are local projects that folks need to implement; they’re needed regardless of how they’re funded. It’s important to remember these are not top-down projects or state projects.”
Experts told The Texas Tribune that the board’s estimate is only a fraction of what Texas communities will need to ensure they have water in 50 years’ time, saying growth and development are outpacing the state’s ability to keep up.
“This is a bigger water plan in terms of volume strategies and capital costs compared to anything we’ve ever seen before,” said Jeremy Mazur, the director of infrastructure and natural resources policy at think tank Texas 2036.
Mazur suggested that the $174 billion only covers water supply projects and does not account for updating aging infrastructure, adding that the actual price could amount to a quarter of a trillion dollars.
“There’s a substantial magnitude with regard to the capital investment needed to both fix our aging and current systems and potentially develop the water infrastructure, water supply projects that we need.“
The report largely confirmed what many water experts have warned regarding threats to the state’s water supply, said Sarah Kirkle, director of policy at the Texas Water Association.
“Population growth, extreme weather, and economic development needs are all increasing demands on our infrastructure, and the state is going to need more water, sooner,” Kirkle said. “This is all while water projects are becoming more costly and complex because the easiest and cheapest local projects have already been developed.”
Fowler, with the infrastructure network, said he expects the Texas Legislature to take up the issue next year, when lawmakers meet for the 90th legislative session. He said the state should take a bigger role in ensuring that communities can afford their respective water projects.
“It’s going to have to be a top-down priority, there’s no way around it,” he said. “The challenges are so immense that it’s going to take all hands on deck.”
Texas residents have until the end of May to comment on the proposal. Water development board officials must adopt it by January 2027.
Alejandra Martinez contributed to this story.
This article originally appeared in The Texas Tribune at www.texastribune.org. The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans – and engages with them – about public policy, politics, government and statewide issues.
Texas
Co‑worker confesses to killing missing North Texas man and stealing his car, police say
A North Texas man reported missing earlier this week was found dead Friday, and police say a co‑worker has confessed to fatally shooting him and stealing his car.
The suspect, Gregory D. Lewis, 34, remains in custody and faces a forthcoming capital murder charge, according to the Fort Worth Police Department.
Lewis is accused of killing 31‑year‑old Thomas King, who had been last seen in his Taco Casa work uniform. King was reported missing on Tuesday after failing to return home Monday from the fast‑food restaurant in the 1100 block of Bridgewood Drive.
Car found at Arlington motel
Police said King’s car was found at the Quality Inn on I‑20 in Arlington, and surveillance video showed Lewis arriving in King’s vehicle shortly after King left work.
Detectives identified the man in the video and arrested him on unrelated charges.
Body discovered on Fort Worth’s East Side
King’s body was located on Friday in an open field on Fort Worth’s East Side, authorities said.
According to police, Lewis confessed to shooting the victim and stealing his car.
Medical examiner review pending
The Tarrant County Medical Examiner will determine the cause of death.
CBS News Texas has reached out to Taco Casa for comment.
Texas
Exclusive | Mexican mayor urged relatives in US to vote for Texas Dem for Congress who would ‘take care’ of their city
WASHINGTON — A Mexican mayor earlier this month urged her constituents to get their relatives in Texas to vote for House Democratic candidate Bobby Pulido because he would “take care” of their city if elected to Congress.
“We need to get out the vote for him,” said Patricia Frinee Cantú Garza, mayor of General Bravo in Nuevo León, less than two hours from the US border, in a recent Spanish-speaking Facebook reel,which The Post reviewed and translated.
“Talk to your families in the United States. Make sure they go vote,” Garza added, noting that she would be presenting the keys to the city to Pulido, a two-time Latin Grammy winner, on April 3.
“When he becomes a congressman,” she also said, “we want him to take care of Bravo.”
The city ceremony celebrating Pulido in General Bravo never received enough funding and was cancelled, the Mexican outlet El Norte reported.
Pulido has headlined concerts in General Bravo as recently as November 2023. Local officials promoted the show and the current mayor and her husband, then-mayor Edgar Cantu Fernandez, appeared.
“Bobby doesn’t know the mayor and has never met her,” a Pulido campaign spokesperson said in a statement. “He declined the invitation, didn’t attend the event, and isn’t responsible for unsolicited comments made by other people.”
Bradley Smith, a former chairman of the Federal Election Commission, said the statements wouldn’t pose legal or ethical issues for Pulido — but that the remarks may have a political cost, given the focus on foreign involvement in US elections in recent years.
“If you were making financial contributions, that would be a different thing, but just to exhort people to vote,” Smith said, “I don’t think that’s going to be a problem for them.”
Jessica Furst Johnson, a partner at the Republican-aligned campaign finance and election law firm Lex Politica, noted that event appeared to function as an in-kind contribution to Pulido’s campaign but it would be difficult to determine without “more details.”
Congressional Republicans have thus far failed to pass a bill this session aimed at beefing up identification requirements for voters when registering, though many have said laws as currently written are too lax and could lead to non-citizens casting ballots.
State investigations and audits have shown in recent years that thousands of non-citizens ended up being registered, but few have ever illegally voted. Those who have are federally prosecuted.
Pulido is challenging incumbent GOP Rep. Monica De La Cruz in the Texas district this November and has faced questions from the press about his ties to Mexico, where he has said he maintains a home for parts of the year.
The Latino music star admitted to splitting time with his family between there and Texas just two years before launching his campaign, telling a YouTube show in a 2023 interview that he’s a “summer Mexican” but “winter Texan.”
“We live on the border,” he has also said. “My wife and I have a house in Mexico. So, we travel there, and we spend time over there.”
There was no indication of a current mortgage on a property either there or in the US, according to financial disclosures that Pulido filed April 15 with the House. Those filings also revealed he holds a checking account at a Mexican bank.
“Bobby lives in his family home in Edinburg, Texas, where he was born, raised, and is raising his own family,” the Pulido campaign rep noted. “He is in complete compliance with all House disclosure rules — the property you are referencing is not his primary residence so is not required to be listed.”
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