AUSTIN, Texas — Central Health and Ascension Seton have both filed lawsuits against each other regarding the Medical Access Program (MAP) for low-income residents in Travis County.
Central Health's lawsuit claims Ascension Seton is failing to provide care for those residents. Meanwhile, Ascension's lawsuit says Central Health distorted numbers to misrepresent growth of the MAP program, which it claims is overenrolled and underfunded.
According to Central Health, Ascension was contractually obligated to provide health care to those within Travis County's established "safety-net population" after the two businesses formed an agreement between 2004 to 2013.
In that time period, the two businesses worked under a Safety Net Agreement to provide such care to low-income residents. Ascension re-committed to the contractual obligation in 2013, stating that the company would at minimum provide "the current levels of health care services," according to a press release from Central Health.
This recommitment would include patients enrolled in Central Health's MAP program and patients defined as "financially indigent" or "medically indigent" by Ascension's Charity Care Policy.
According to Central Health, Ascension's data for when it comes to providing care to patients has not met the agreed-upon levels set in 2013. During the contract year in 2022, Central Health said Ascension served around 8,000 fewer patients compared to 2013 – a 21% reduction in care.
Central Health also said that during the 2022 contract year, there were around 31,000 fewer patients hospital encounters, which includes inpatient services, outpatient services and emergency room visits as compared to 2013 – a 33% reduction.
But Ascension Seton said Central Health has refused to support increased demand for MAP services on its end and Central Health's lawsuit is "focusing on the wrong numbers."
"Central Health repeatedly cites a 10-year-old agreement in their lawsuit, but completely ignores 23 agreements they have ratified since then that detail baseline numbers for appointments in specialty care," Ascension Seton said in a release.
Ascension said Central Health has overenrolled individuals in the health care program while refusing to adjust its reimbursement to Ascension Seton to support the care for the additional patients. Ascension said that was not dictated by a lack of funds. It said Central Health's contingency reserves have multiplied eightfold in the past five years, currently sitting at more than $300 million.
“We question the need for maintaining such large reserves of taxpayer dollars when the critical health care programs those dollars are intended for remain underfunded,” said Andy Davis, president and CEO of Ascension Texas. “We are disappointed to see that Central Health is attempting to distort the facts surrounding demand for MAP services and the nature of our agreement. We are confident that the legal process will result in a solution that provides adequate funding for the MAP program moving forward.”
In its lawsuit, Central Health said Ascension had substantially benefited from its contracts yet failed to meet its commitments.
"Over the years, Ascension has cared for fewer and fewer patients and that’s neither acceptable nor contractually allowable." said Dr. Charles Bell, chair of Central Health's Board of Managers. "We reached a point where our only option was taking Ascension to court. We hoped it would never come to this."
Ascension Seton claims it continued to provide equitable care for all MAP patients for the past several years despite Central Health’s financial shortfall, and it will continue to support MAP patients as the legal process proceeds.
The lawsuit, according to Central Heath's press release, resulted because Ascension and Central Health were unable to reach an amicable resolution. The suit, which Central Health claims is a breach-of-contract, states the following:
- Ascension failed to provide the agreed-upon services to low income residents
- Ascension failed to provide healthcare services to MAP patients and those in the Charity Care patients definition "on a nondiscriminatory basis"
- Ascension would improperly bill Charity Care patients for all healthcare services
- Required reports were not provided to Central Health for monitoring on behalf of the low income residents
- This effort was to assist in monitoring Ascension's compliance with performance standards
In addition to the lawsuit, Central Health is pursuing a judicial declaration that would allow the company to terminate the agreement with Ascension, in addition to allowing Central Health to purchase the Dell Seton Medical Center.
“This option is not something we wanted to pursue,” Bell said. “But we have to do what is necessary to ensure that, in the future, this safety-net hospital will deliver the level and quality of care that Travis County residents with low income need and deserve.”
Read the full petition that Central Health has raised against Ascension Seton.