Texas
Even as state mental health spending rises, private psychiatric hospitals struggle to stay open
:focal(0x0:3000x2000)/static.texastribune.org/media/files/e3bc88cdb81bfa3fab3b52322c640541/NIX%20Health%20SAR%20TT%2001.jpg?ssl=1 "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.
Live Updates – Tennessee Lady Vols vs. Texas Tech Softball (WCWS)
Current Score: Tied 0-0
***Note: If you want the latest updates make sure to refresh the story***
First Inning:
Top: Karlyn Pickens strikes the first batter out. Texas Tech hits a single that went off the glove of Pickens. Jackie Lis comes to the plate. She advances the runner, but she grounds out to short. Pickens gets a massive strikeout to end the inning. Great job by the Lady Vols ace.
Bottom: Tennessee will now come to the plate. Kaitlyn Terry is the pitcher for the Red Raiders. Sophia Knight will start it off. Knight hits an infield single thanks to her speed. Here comes game one’s MVP, Elsa Morrison. Morrison strikes out. Ella Dodge hits a grounder to second, which gets the runner out, but she is safe at first. Emma Clarke hits a line out to Williams at second base to end the inning, as she had to make a vertical effort to bring that one down.
Second Inning:
Top: Here comes former Lady Vol Taylor Pannell. She pops out. Pickens will face the Red Raiders’ pitcher, who also hits. Pickens gets the Lady Vols off the field.
Bottom: Leach lines out to begin the inning. Makenzie Butt pops out to right field, which will be out No. 2. Gabby Leach is out to end the inning for the Lady Vols.
Third Inning:
Top: Quiroga lines out to begin the inning, and Pickens continues to move strongly. Halleman grounded out to second for out No. 2. Williams grounded out to third, which will get the Lady Vols off the field.
Bottom: Bella Faw singles to get on base. Holley grounds out, but Faw advances to second. Knight is struck by a pitch, and there are now two on base for the Lady Vols with only one out this inning. This gives Tennessee two on with a runner in scoring position. Here comes the Red Raiders’ ace, Nija Canady. Morrison fouls out. A wild pitch advances both runners. One at third and one at second now with two outs. Dodge is hit by a pitch, and bases are now loaded for the Lady Vols. Canady forced a full count for Clarke with bases loaded, and Clarke collided with Lis around first base, and the bases were left loaded. Texas Tech escapes.
Fourth Inning:
Top: Pickens forces a groundout. Lis grounds out, and the Lady Vols have put two away quickly. Pickens retires her 11th straight batter after forcing a groundout to second base.
Bottom: Leach reaches to begin the inning. It was via an error. She will be taken out of the game for a pinch runner. Saviya Morgan is on base. Makenzie Butt is up to bat. Canady strikes Butt out. Morgan gets picked off at second base. Gabby Leach hits a single to center field.
Pre Game Information
The Tennessee Lady Vols are set for their next matchup in the softball realm, as this is the second game they will play in the Women’s College World Series. In their first game, they were victorious against the Texas Longhorns, as they defeated the Longhorns by a score of 6-3 in a game in which they were viewed as the underdogs. Now they will have to play another great team with the hopes of continuing to hold on to their advantage of having no losses in a two-loss tournament. After today, only two of the eight teams that advanced and two of the six teams that remain will be able to say that.
The Lady Vols are up first out of the two games today, and they will be playing against the Texas Tech Red Raiders. The Red Raiders are entering this game with no losses after defeating the Mississippi State Bulldogs in their game. The Bulldogs entered the event as the biggest underdog, but the Red Raiders can compete with any of the teams at the event. They had to defeat a Florida Gators team that won a series against the Lady Vols to get to the Women’s College World Series.
This game will be one of the more anticipated games in the whole tournament, as this may not even be the only time that these two match up throughout the World Series. Regardless, the Tennessee Lady Vols will look for another big moment in the biggest game of their season thus far.
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COLLEGE STATION, Texas — After spending most of Friday night wasting scoring opportunities, Adrian Lopez and his USC teammates headed into the ninth inning with plenty of confidence. Unfortunately for the Trojans, Texas State wasn’t done yet.
Lopez gave the Trojans the lead in the eighth inning with a home run at Blue Bell Park, but USC couldn’t close out the opener of the NCAA tournament’s College Station Regional.
Texas State’s Chase Mora greeted USC closer Adam Troy with a monstrous two-run home run to left field in the top of ninth, propelling the Bobcats to 5-4 upset before a crowd of 6,956.
“To take the lead right there late, we’re riding high feeling real good and confident going into the ninth,” Lopez said. “I think … the ball fell how it fell. It is what it is. But we’re pretty stoked and excited going into the ninth with the lead.”
Texas State coach Steve Trout mused that it felt as though the Bobcats were “on the ropes” all night. As trite as that might sound, he’s right.
Unfortunately for the Trojans, they never could deliver the knockout punch. Texas State wasn’t as forgiving. Mora was sitting on Troy’s fastball, and he pounced for his 11th home run of the year.
“Sure enough,” Mora said, “I got the pitch I was sitting on and made a good swing.”
Troy’s blown save was a major part of the story. He arguably wasn’t the biggest reason USC lost, though. The Trojans had plenty of chances. They wasted most of them, leaving 13 men on base on a night they struck out 12 times.
Moreover, the Trojans wasted a major bases-loaded scoring opportunity when Isaac Cadena was picked off at second base for the second out of the fifth. Walter Urbon then flew out to right to end the threat.
“We got picked off there at second base with one out,” USC coach Andy Stankiewicz said. “That was kind of a gut shot. We have to be better on the bases. We have to be a little more aware when we get off the bag there.
“I thought we executed fine to get runners where we needed to get them. The second part is we got to get them across home plate. That’s the part we didn’t do as well tonight.”
The Bobcats’ shaky defense spotted USC two unearned runs. The Trojans will surely lament, however, stranding runners in scoring position in each of the first seven innings.
The Trojans will now prepare to face Lamar University, which blew a five-run lead in a 7-5 loss to host Texas A&M earlier Friday.
If Stankiewicz’s Trojans return to the College World Series for the first time since 2001, the 12-time national champions must do it out of the losers’ bracket.
“We’re just going to battle our tails off to keep showing up,” said Abbrie Covarrubias, who gave the Trojans a 3-1 lead with a home run in the fourth inning. “We’re in the fire, so we’re just going to battle our way through and pour our hearts out really.”
USC right-hander Grant Govel, an All-Big Ten First Team selection, settled for a no-decision after giving up three runs on four hits with two walks and six strikeouts over 5 ⅔ innings.
He was relieved by freshman left-hander Sax Matson with one on and two outs in the top of the sixth. Matson escaped unscathed in the sixth, but he was relieved by right-hander Andrew Johnson with one on and two outs in the seventh.
The Trojans, who reached the Big Ten Tournament semifinals, have lost four of their last five games.
“We left some runners in scoring position,” Stankiewicz said. “I’d like to have those back. But they made some pitches when they needed to.”
Stankiewicz, Adrian Lopez and Covarrubias are adamant that they believe in Troy, who has a team-leading 12 saves this season. No other Trojan has more than three saves.
“He’s been our guy, like coach said,” Lopez said of Troy. “He has a number … of saves. We trust him with everything we have. I wouldn’t want anyone else throwing the last couple pitches of the game. Going tomorrow, everyone’s available. If he’s back in that same situation, I’m just as confident as ever.”
OKLAHOMA CITY — Mississippi State softball is playing in an elimination game at the Women’s College World Series.
The Bulldogs (43-20) are facing No. 2 seed Texas (47-12) at Devon Park on May 29 (6 p.m. CT, ESPN).
Mississippi State and its fans are doing everything they can to muster up some good luck, including using broccoli, which has become the team’s rally prop throughout the NCAA Tournament.
Some fans and parents of the players are even wearing T-shirts with images of broccoli on them that read “Broccoli Power.”
Here’s what to know about the shirts and why MSU is wearing them.
Why are Mississippi State fans wearing broccoli shirts?
Broccoli became MSU’s good luck charm after a fan known as Broccoli Guy started cheering them on at the Eugene Regional.
He used broccoli as pom-poms while dancing in the stands. For the regional final, MSU brought broccoli for players to hold in the dugout for good luck.
This trend continued during the super regionals, with MSU bringing broccoli on the bus, holding it in the dugout and posting pictures and videos of it on social media ahead of Game 3 against Oklahoma. Broccoli Guy also showed up to support the Bulldogs again.
Now, with the Bulldogs facing elimination at the WCWS, fans, parents and players are hoping the broccoli shirts, along with their physical stalks of broccoli, will help power them to a win over the Longhorns.
2026 Women’s College World Series schedule
All times CT
- May 28
- Game 1: Texas Tech 8, Mississippi State 0
- Game 2: Tennessee 6, Texas 3
- Game 3: Alabama 6, UCLA 3
- Game 4: Nebraska 5, Arkansas 3
- May 29
- Game 5: Mississippi State vs Texas (6 p.m., ESPN)
- Game 6: UCLA vs Arkansas (8:30 p.m., ESPN)
- May 30
- Game 7: Texas Tech vs Tennessee (2 p.m., ABC)
- Game 8: Alabama vs Nebraska (6 p.m., ESPN)
- May 31
- Game 9: Game 5 winner vs Game 8 loser (2 p.m., ABC)
- Game 10: Game 6 winner vs Game 7 loser (6 p.m., ESPN2)
- June 1
- Game 11: Game 7 winner vs Game 9 winner (11 a.m., ESPN)
- Game 12 (if necessary): Game 7 winner vs Game 9 winner (1:30 p.m., ESPN)
- Game 13: Game 8 winner vs Game 10 winner (6 p.m., ESPN2)
- Game 14 (if necessary): Game 8 winner vs Game 10 winner (8:30 p.m., ESPN2)
- June 3
- Finals Game 1 (7 p.m., ESPN)
- June 4
- Finals Game 2 (7 p.m., ESPN)
- June 5
- If necessary, finals Game 3 (7 p.m., ESPN)
Tia Reid covers Jackson State sports for the Clarion Ledger. Email her at treid@usatodayco.com and follow her on X @tiareid65.
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