Ascension Texas (Ascension) is being untruthful with the people of Travis County, and Central Health must set the record straight.

Central Health nurse takes a patient's temperature

On Tuesday, January 24, 2023, Central Health sued Ascension Texas, formerly known as Seton Healthcare Family, for failing to meet its contractual obligations to provide healthcare for Travis County residents with low income.

Central Health is seeking healthcare justice for Travis County residents who deserve the care that Ascension is obligated to provide. After years of negotiations and attempts to mediate the issues that divide the two organizations, Central Health had no choice but to file a lawsuit to hold Ascension accountable for providing inadequate, inequitable healthcare services for people with low income.

Ascension responded to Central Health’s lawsuit with a separate lawsuit, with an inappropriate “deadlock letter” in March, and with a public-relations campaign containing multiple misleading statements. Here are the facts.


Voters created the Travis County Hospital District, now Central Health, in 2004. Between 2004 and 2013, Central Health and Ascension worked together under a “Safety Net Agreement” to provide healthcare services to Travis County residents with low income.

In 2013, Central Health and Ascension entered a series of new contracts, and Ascension recommitted to providing healthcare services for Travis County residents with low income. Ascension agreed that moving forward, it would provide the same levels of healthcare services, including hospital and specialty care, that it was providing in 2013.

The parties’ contracts permitted Ascension to affiliate with the Central Health-supported Dell Medical School at The University of Texas at Austin, as part of the development of its new teaching and safety-net hospital — Dell Seton Medical Center at UT. Ascension built and now operates Dell Seton Medical Center. Nevertheless, the 2013 agreements base Ascension’s continued right to own and operate Dell Seton Medical Center on its own performance, as it essentially “stands in” for Central Health when it provides healthcare services to Travis County residents with low income.

The bottom line: Ascension’s right to operate our community’s safety net hospital is conditioned on Ascension fulfilling its contractual obligations to Central Health.

Ascension has failed to live up to its contractual obligations.

Failed Negotiations, But No “Deadlock”

Central Health and Ascension talked and negotiated for years to try and rectify Ascension’s deficiencies without court intervention – to no avail. Ascension has refused to meet its contractual obligations to Central Health, harming the people of Travis County. One of these obligations is for Ascension, as part of the safety-net healthcare system in Travis County, to provide inpatient hospital services to all individuals regardless of their ability to pay. Ascension has not fulfilled this obligation, nor has it met its contractual obligations to Central Health’s Medical Access Program (MAP) patients.
In January, Central Health and Ascension reached the end of their contractually required alternative dispute resolution efforts. At that point, Central Health had no other option but to file a lawsuit.

In May, Ascension tried to restart this out-of-court dispute resolution process with a “deadlock notice,” which it first shared with local media before actually presenting it to Central Health. The healthcare district believes its lawsuit is the proper and timely venue for resolving any disputes between the parties.

The Math Doesn’t Add Up

Ascension’s own data shows that for several years it has failed to provide the healthcare services it agreed to for MAP patients and Charity Care patients. While Ascension has earned substantial revenues from the public funds controlled by Central Health, a hospital district funded in part by Travis County taxpayers, it failed to meet its contractual obligations. Travis County residents with low income suffered as a result. They deserve justice.

Ascension’s Own Data

In the 2022 contract year, Ascension served approximately 8,000 fewer patients in the hospital compared with the 2013 contract year, reflecting a roughly 21% reduction. Patient encounters also dropped. In the 2022 contract year, there were approximately 31,000 fewer patient hospital encounters (including inpatient services, outpatient services, and emergency room visits) compared with the 2013 contract year, reflecting a roughly 33% reduction.

Utilization charts show the decline in patients seen and patient encounters provided by Ascension since 2013.
Ascension Data: All Hospital Utilization

Unsubstantiated Claims: Over-enrollment in MAP

Ascension falsely claims that Central Health unilaterally over-enrolled people in MAP. The truth is that the number of MAP enrollees has increased due to expanded eligibility criteria that Ascension representatives approved years ago. Ascension representatives understood that this eligibility change would increase MAP enrollment.

While Ascension claims that it has incurred more costs due to the increased number of MAP enrollees, its own data tells a very different story. Ascension’s data reveal a trend of declining levels of care for MAP patients and rationing or limiting care, even though the number of MAP enrollees increased. Moreover, while Ascension claims it should be paid more for providing care to more than 25,000 MAP patients in certain years, Ascension’s data show that Ascension has never provided services to 25,000 MAP patients in any given year, much less more than 25,000.

A formal process exists for Ascension to request additional funding for costs above its service-level commitments to MAP patients. To date, Ascension has not requested, documented, or implemented a formal request for additional compensation. Yet, it claims insufficient compensation. That claim is neither substantiated nor based on actual care provided by Ascension.

Central Health nurse examines a patient's leg

Central Health: Out of Options

For years, Central Health has pursued every available option to make Ascension live up to its contractual obligations to provide adequate, equitable healthcare for the people of Travis County. It didn’t work. Our last resort was filing a lawsuit.

Central Health’s Lawsuit

Ascension’s data prove it has reduced, capped, and eliminated services for MAP patients and Charity Care patients, which is unacceptable. Central Health’s lawsuit asserts breach-of-contract claims against Ascension for:

  • failing to provide agreed-upon healthcare services to low-income Travis County residents, both overall and in several specialty areas;
  • failing to provide healthcare services to MAP patients and Charity Care patients on a nondiscriminatory basis;
  • improperly billing Charity Care patients for healthcare services; and
  • not providing required reports that Central Health needs to monitor Ascension’s compliance with performance standards.

Because Ascension’s failures are so consequential, Central Health had no choice but to ask for a judicial declaration that would entitle Central Health to terminate its agreements with Ascension and trigger Central Health’s option to purchase Dell Seton Medical Center.

Exercising this option is not something Central Health wanted to pursue. But Central Health can and must do what is necessary to ensure that Travis County’s safety-net hospital delivers the level and quality of care that Travis County residents with low income require and deserve.

For updates about Central Health’s lawsuit against Ascension go here.