Why is Central Health suing Ascension Texas (Ascension)?

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

How did Ascension respond?

Ascension responded to Central Health’s lawsuit with a separate lawsuit and with a public-relations campaign containing multiple misleading statements.

How is Ascension failing Travis County residents with low income?

Ascension isn’t living up to its contractual obligations to Central Health, Travis County’s publicly funded hospital district, to care for residents with low income.

Voters created 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 provide 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.

Ascension’s own data shows that, for several years, it has failed to provide the healthcare services it agreed to for Central Health’s Medical Access Program (MAP) patients and to Charity Care patients. While Ascension substantially profited from contracts with Central Health, it failed to meet its contractual obligations. Travis County residents with low income suffered as a result. They deserve justice.

Ascension claims Central Health abruptly ended good-faith discussions
regarding a long-standing agreement to care for MAP Patients. Is this true?  

Ascension’s statement that Central Health “abruptly ended” the discussions is not true. 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 and the patients we serve. One of these obligations is for Ascension, as our safety-net partner, to provide inpatient hospital services to all individuals regardless of their ability to pay. Ascension has not fulfilled that obligation, nor has it met its contractual obligations to MAP patients.

The contractually required dispute resolution efforts were slated to end in early September. Despite that fact, Central Health kept negotiating with Ascension for an additional four-and-a-half months. The reason Central Health ended the negotiations is because Ascension refused to accept a reasonable compromise and to commit to living up to its obligations under the agreements it signed. At that point, Central Health had no other option but to file a lawsuit.

How are Ascension’s failures harming people with low income – specifically MAP patients?

One example is the declining care over the years. 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. Bottom line: People with low income are not getting the care they need and deserve.

Has Central Health “over-enrolled” people into MAP, as Ascension claims?

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. For Ascension to claim that Central Health acted unilaterally is false. While Ascension claims that it has incurred more costs due to the increased number MAP enrollees, its own data tells a very different story. Ascension’s own data reveals 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 own data show that Ascension has never provided services to 25,000 MAP patients in any given year, much less over 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.

How are Central Health and Ascension connected?

When it was formed in 2004, Central Health inherited the City of Austin’s relationship with Ascension, which was intended to help fulfill Central Health’s mission to care for Travis County residents with low income. As part of that relationship, Ascension operated University Medical Center Brackenridge Hospital and provided healthcare to Travis County’s safety-net population.

After Central Health was formed, it acquired the property on which University Medical Center Brackenridge sat; however, pursuant to a lease, Ascension continued to operate that hospital. Unlike other major urban hospital districts in Texas, Central Health has never operated a public hospital. Instead, it relies on Ascension to keep its long-standing contractual commitments to provide hospital and most specialty care to Travis County’s safety-net population.

In 2013, Ascension recommitted to its contractual obligation to care for Travis County residents with low income, and it agreed that going forward, it would provide at least “the current levels of healthcare services,” including hospital and specialty care, that it had been providing.

These renewed contractual commitments applied to patients enrolled in MAP, which is a health coverage program for uninsured Travis County residents with low income and to certain patients who are “financially indigent” or “medically indigent,” as defined by Ascension’s Charity Care Policy (Charity Care patients).


Per the 2013 Safety Net Agreement between Ascension and Central Health, Ascension continued to receive compensation for providing care and participated in projects eligible for Medicaid 1115 Transformation Waiver funding. Ascension also received additional public funding. In addition, Ascension was permitted to affiliate with the Central Health-supported Dell Medical School at The University of Texas at Austin, as part of the development of the new teaching and safety-net hospital—Dell Seton Medical Center at The University of Texas at Austin. In operating Dell Seton Medical Center, Ascension is standing in for Central Health, as the local hospital district, in providing healthcare services to Travis County residents with low income.

Ascension’s right to operate our community’s safety net hospital is conditioned on Ascension fulfilling its contractional obligations to Central Health. Ascension has failed to fulfill those obligations.    

Exactly what breaches of contract does Central Health’s lawsuit allege?

Central Health believes Ascension’s own data proves 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 relation to 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, on behalf of Travis County residents, Ascension’s compliance with performance standards.

Is Central Health buying a hospital? 

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

Exercising this is 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.

Is it too late for Ascension and Central Health to work this out?

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

What is the Medical Access Program (MAP)?

MAP and MAP Basic are health coverage programs for Travis County residents with low income. With MAP, patients who are residents of Travis County and who meet certain income requirements can see a doctor or dentist, get prescriptions, or get hospital care.

Through MAP and MAP Basic, Central Health provides care to low-income residents by connecting them to a broad network of providers for their physical, mental, and dental health needs. MAP is property-tax funded by the people of Travis County.

You may apply online at apply4map.net or call 512-978-8130.

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