Integral Care, the mental health authority for Austin-Travis County, recently made the decision to cut nearly 10% of its positions as part of their approved budget. This included laying off 48 individuals and eliminating 67 vacant positions. Employees in the union United Works of Integral Care expressed concerns about the layoffs, as they believed it would further strain an already struggling staff that is trying to meet the needs of a large client base. Integral Care is currently the largest local provider of mental health services, serving 27,550 people as of 2022.
One employee, Megan Moriarty, who works at Integral Care’s Second Street clinic, pointed out that even before the cuts, patients without health insurance were not receiving the services they needed due to a lack of organizational resources. Moriarty stated at the budget meeting that the agency did not have enough staff to meet the demand. The budget for the 2024 fiscal year is $131.5 million, which is $22 million less than the previous year’s budget. Officials attribute this decrease to unexpected changes in the funding Integral Care receives from federal and state sources.
Integral Care receives funding from the county, the City of Austin, and Travis County’s public hospital district, Central Health. However, the largest share of its budget comes from state funding. Previously, the state funding primarily came from a federal 1115 Medicaid Waiver, which finances programs that provide care to uninsured and low-income patients. Texas faced a temporary jeopardy for its 1115 Medicaid Waiver renewal when the Biden administration challenged it in 2021. Although the challenge was dropped, adjustments were made to how Texas supports entities like Integral Care.
Integral Care is now funded through the state’s Charity Care Program and Direct Payment Program (DPP), which offer less flexibility in how funds are used. Instead of providing grants to support entire programs, the state’s new model ties funding to the number of units of service delivered by the organization. Integral Care did not deliver as many services as expected during FY 2022 and must return $1.6 million to the state as a result. This has led to the official end of several programs, including the 15th Street respite center and mood disorder clinic, with their services being integrated into other offerings.
In addition to these changes, the expected $4 million in funding from the Legislature did not materialize this session. Only $400,000 in annual payments over the next two years were approved by lawmakers. While Integral Care leadership attempted to find alternative funding sources, they were unsuccessful in time for the budget process. The organization worked to reduce the shortfall as much as possible by exploring new and existing funding streams, as well as finding ways to reduce administrative costs.
At a recent budget meeting, concerns were raised by both employees and clients of Integral Care regarding the layoffs. In response, the board of trustees voted to approve the layoffs and reduced budget, but with the caveat that affected employees receive 12 weeks’ notice instead of six. They will also be informed of any available positions that may arise due to potential new revenue sources. The union representing Integral Care employees stated that while this change is an improvement, it is not a complete victory. The union plans to focus on seeking support from local funders over the next three months to prevent further layoffs and service cuts.