Commissioners Court - Special Meeting

Seven years ago, El Paso experienced a tragedy that changed our community forever.

Today, we honor the 23 lives lost.

We read their names with remembrance, respect, and gratitude.

And we stand together, united in resilience and hope.

Andre Anchondo, Jordan Anchondo, Arturo Benavides, Jorge Galville Garcia.

Leonardo Campos Jr. Adolfo Serros Hernandez.

Angelina Silva Anglesby.

Maria Nunez Flores. Raul Estrada Flores.

Guillermo Memo Garcia.

Maribel Hernandez Loya.

Gerhard Alexander Hoffman.

David Alva Johnson. Luis Alfonso Juarez. Maria Eugenia Legarreta Roth. Ivan Manzano. Gloria Irma Marquez.

Elsa Mendoza.

Sara Estorregalado Monreal. Margie Record.

Javier Amir Rodriguez.

Teresa Trinidad Sanchez Guerra.

Juan De Dios Velazquez.

so

Come on!

So today we are at Azcárate Park where we are celebrating the 4th of July. Of course, we all know this is a very special year because it's America's 250th birthday. So we're really excited that we can provide this opportunity, this public celebration for our community. And we gave away 250 commemorative coins that were specially designed for the County of El Paso by the El Paso County Historical Commission. We're really glad that we see so many families out here enjoying themselves, getting ready for the big fireworks display.

I can't even tell you, the emotion is unbelievable to see what's happening now and see that we're celebrating 250 years at a park that is so iconic to El Paso. And then on top of that, having a partnership with Ford Bliss. If we're celebrating 250 years, that's because of what veterans did for our country. They died for our country, they served our country, and here we are.

I think the kids are really enjoying seeing the tanks out there that Fort Bliss was able to bring to Azcárate Park. And I think what makes the experience really special is talking to some of the soldiers who manned those tanks. So we're really grateful to Fort Bliss for their collaboration. We hope that we can count on them to join us every single year at our Fourth of July celebration.

You know, it's awesome being a part of an event like this, especially 250 years, a lot of heritage, a lot of history behind it, and actually being able to wear this uniform and say I was here at 250 and to be part of that, it's an absolute privilege.

I don't know the names of the tanks, but it is awesome just even just being able to see it up close. I've never seen a tank up close, but I was learning that a tank over here in front of me is 73,000 pounds, and it's just awesome to see how there's men and women that are dedicated to serve our country. Just enjoy your family today, you know, enjoy your family, enjoy music, and just enjoy life, and God bless America.

Every day, El Paso County works to improve the quality of life for our residents. Sometimes that work happens here at home. Sometimes it takes us across Texas, across the nation, and around the world. County leaders advocate for infrastructure, public safety, veteran services, transportation, and mental health priorities important to our residents. Through legislative meetings, funding requests, and various policy discussions, your county is working to ensure El Paso's voice is heard. Strong partnerships help bring resources, expertise, and opportunities back to El Paso County. Through collaborative efforts with our state and federal partners, our position on critical matters can be shared and heard by those making decisions at the highest levels. Participation in organizations such as the National Association of Counties, Texas Association of Counties, and other professional networks also allows county leaders to learn from successful programs across the country and bring innovative ideas back home. El Paso County's commitment to economic growth extends far beyond our borders. Throughout the year, elected officials and staff travel across Texas, the United States, and internationally to promote El Paso as a premier destination for business investment and expansion. These efforts allow us to build relationships with industry leaders, showcase our region's unique advantages, and compete for new jobs and economic opportunities. The true measure of success is not where we travel to, but what we brought home. At the midpoint of 2026, our grant portfolio remained strong and productive. To date, we have applied for a total of 50 funding opportunities, with 21 awards secured, resulting in more than $15.6 million in grant funding awarded. Every trip represents one purpose, serving the people of El Paso County. Whether advocating in Austin, collaborating in Washington, or building partnerships across borders, our mission remains the same, creating opportunities, delivering services, and building a stronger future for our community.

Seven years ago, El Paso experienced a tragedy that changed our community forever. Today, we honor the 23 lives lost.

We read their names with remembrance, respect, and gratitude.

And we stand together, united in resilience and hope.

Andre Anchondo. Jordan Anchondo. Arturo Benavides. Jorge Calvillo Garcia.

Leonardo Campos Jr. Adolfo Serros Hernandez.

Angelina Silva Anglesby.

Maria Nunez Flores. Raul Estrada Flores.

Guillermo Memo Garcia.

Maribel Hernandez Loya.

Gerhard Alexander Hoffman.

David Alva Johnson. Luis Alfonso Juarez. Maria Eugenia Legarreta Roth. Ivan Manzano. Gloria Irma Marquez.

Elsa Mendoza.

Sara Esther Regalado Monreal. Margie Record.

Javier Amir Rodriguez.

Teresa Trinidad Sanchez Guerra.

Juan De Dios Velazquez.

so so Come on, Oscar!

So today we are at Azcárate Park where we are celebrating the 4th of July. Of course, we all know this is a very special year because it's America's 250th birthday. So we're really excited that we can provide this opportunity, this public celebration for our community. And we gave away 250 commemorative coins that were specially designed for the County of El Paso by the El Paso County Historical Commission. We're really glad that we see so many families out here enjoying themselves, getting ready for the big fireworks display.

I can't even tell you, the emotion is unbelievable to see what's happening now and see that we're celebrating 250 years at a park that is so iconic to El Paso. And then on top of that, having a partnership with Ford Bliss. If we're celebrating 250 years, that's because of what veterans did for our country. They died for our country, they served our country, and here we are.

I think the kids are really enjoying seeing the tanks out there that Fort Bliss was able to bring to us out at the park. And I think what makes the experience really special is talking to some of the soldiers who manned those tanks. So we're really grateful to Fort Bliss for their collaboration. We hope that we can count on them to join us every single year at our Fourth of July celebration.

You know, it's awesome being a part of an event like this, especially 250 years, a lot of heritage, a lot of history behind it, and actually being able to wear this uniform and say I was here at 250, and to be part of that, it's an absolute privilege.

I don't know the names of the tanks, but it is awesome just even just being able to see it up close. I've never seen a tank up close, but I was learning that a tank over here in front of me is 73,000 pounds, and it's just awesome to see how there's men and women that are dedicated to serve our country. Just enjoy your family today, you know, enjoy your family, enjoy music, and just enjoy life.

Live from El Paso County, Texas, the Veterans Capital of the USA. From inside the Alicia Chacon Commissioners Courtroom of the Enrique Moreno County Courthouse, you are watching the El Paso County Commissioners Court Meeting.

Good morning, ladies and gentlemen. Today is Tuesday, August 4th, 2026. Commissioner's Court is meeting in special open session.

Good morning. I would now like to call this joint session for the budget workshop of the El Paso County Hospital District Board of Managers and El Paso County Commissioners Court to order. Today is Tuesday, August 4th, 2026, and the time is 916 AM. And I believe we have a quorum.

Yes, Madam Chair, we do.

And I don't believe there's anyone signed up for public comment at this time.

No, there is not.

So, Jennifer, would you please read the two items in the record?

Yes. We're going to do the Pledge of Allegiance. Okay. Thank you.

Please rise for the Pledge of Allegiance. I pledge allegiance to the flag of the United States of America and to the Republic for which it stands, one nation under God, indivisible, with liberty and justice for all.

At this time, Madam Chair, I'll go ahead and read our two items into record. Our first item, discuss and take appropriate action regarding the fiscal year 2027 El Paso County Hospital District operating capital and debt service budgets. Mr. R. Jacobson-Throne, District President and CEO, and Mr. Michael Nunez, District Chief Financial Officer. Agenda item two, discuss and take appropriate action regarding the proposed tax rate for the El Paso County Hospital District. Mr. R. Jacobson-Throne, District President and CEO, and Mr. Michael Nunez, District Chief Financial Officer.

THIS MORNING, WE'RE JOINED BY ASL INTERPRETERS CELINA SOLUM AND KATIA GARCIA. ITEM NUMBER THREE IS PUBLIC COMMENT. AT THIS TIME, I DO NOT SHOW ANY PUBLIC COMMENT, JUDGE. I'LL TAKE NO ACTION. Item number four from the regular agenda.

Let me welcome them. I'm sorry, sir. Thank you. I'd like to welcome all of you to our Commissioner's Court for the joint agenda. Thank you very much. I think all of you understand your great partners and the great things that need to happen going forward. also including the mental health component and our health component. I think we're positioned to be one of the most incredible communities as the way we handle these challenges. And thank you, Jacob and Cindy, everybody else, and the boards, obviously, that we made a big, huge commitment during the pandemic. We discovered so many things and so many challenges, and we cannot forget the number of people that died with underlying conditions. So, you know, we start hearing about some health challenges that are happening and food, you know, food contaminations, and we always hear, you know, that the underlying conditions are really, really, bad for a community. So thank you for what you do. I think we, you know, we're trying to get ready for any challenge, any health challenge or mental health challenge. But I feel so comfortable just with knowing who's here in the room, that it's a challenge that we'll all welcome and we'll do the best because of this deep love that we have for our beautiful community. So thank you very much for being here today.

Item number four from the regular agenda. Item 4A, receive a presentation regarding the El Paso County Hospital District's fiscal year 2027 operating capital and debt service budgets. And item number 4B, discuss and take appropriate action regarding the El Paso County Hospital District's fiscal year 2027 operating capital and debt service budgets, as well as the proposed tax rate.

Good morning, Commissioners and Judge. Jacob Seenthron, President and CEO of the El Paso County Hospital District. Thank you, Judge, for your comments. You know, seven years ago yesterday, this community went through a horrible tragedy at Walmart. And, you know, we commemorate the losses that people went through and how it changed our city from that point on. Then you look fast forward to 2020, just a few months later, we got hit with a COVID pandemic and how we had to prepare for that as well. It is through the foresight and support of our commissioners and judge and our board that helped us be in a position that in those two events, we were prepared. Certainly, we talk here about numbers, we talk about budgets, we talk about capital spend and so forth, and that is the what. What's important is the why. Why do we do this? How does it impact our own community, our own hometown? And so what I'd like to do is introduce Ruben Vogt, and he's gonna remind us about the why we are here as a, not only as a hospital that provides care for those that have no insurance, we provide care for all patients regardless of their ability to pay. but also how we're a teaching hospital and the impact we have in bringing in future healthcare workers, including physicians, to our community. So with that, I'd like to have Ruben take the podium.

Thank you, Jacob.

Welcome. Good morning, judging commissioners. I think all of us got the memo on wearing blue today, which is really fantastic, except Commissioner Butler, but we know it's in your heart, so it's okay. As Jacob mentioned, all of you know that a budget is so much more than revenues and expenses and financial projections. It's really about sustaining our healthcare system, which makes a difference every single day. And so before Michael begins the presentation on the fiscal year 27 budget, we wanted to talk about what the investments in the budget make possible. We'd like to introduce you to the Dominguez family. Their experience really reflects the many ways in which our hospital system is there for families when they need us most. Martha, for example, received care at UMC following a brain hemorrhage, amongst other care provided. Her daughter, Luz, then received care with us for ovarian cancer. Today, Luz's grandchildren, Mathias and Jackson, are able to receive care at El Paso Children's Hospital by way of insurance through El Paso Health. And following the trajectory that her family went through in healthcare, Nayeli Dominguez has pursued a career in healthcare. Today she serves as a certified medical assistant and medical interpreter at UMC. And so for the Dominguez family, care wasn't defined by a single visit or a single location. It really was about a system of care that was there for them when they needed us most. Now, each of our seven district entities plays a very unique role in and of themselves. However, combined, they form an integrated healthcare system that is there for our community at every stage of life, whether it is trauma care or care for seniors, whether it is specialized care for children or healthcare coverage. It could also be around philanthropic support that advances patient care or partnerships that bring more physicians and specialists to our region. But quite frankly, a healthcare system is only as strong as its ability to serve the people that it is trying to reach. And that's why every location on this map extends far beyond just one hospital. And each access point represents exactly that, access to healthcare, education, jobs, and opportunity. Together, they form a network that brings care closer to home, even to your doorstep through our mobile medical units. Thank you to the county for their support in our mobile health unit that we used during the pandemic and to this day continue to use in the community. Now, all of this growth was not an accident. It is decades of thoughtful vision and investment, and it's in our budget that you will see that continued commitment around those same items. Now, in today's healthcare environment, it's no secret that every organization is competing for talent, which is why our greatest asset isn't in our buildings, it's in our associates. That investment translates into something that you can absolutely not build overnight. And that's experience, continuity, and trust. And so as we celebrate 25 years as the community's only level one trauma center, we are honored to spotlight a few of our pillars in that history. The first is Gloria Salazar, a registered nurse who has dedicated 50 years to UMC and being a part of the family. From her early days in the emergency department to helping shape the actual trauma program, she has spent her career mentoring caregivers and strengthening the care that we provide. Raul Huerta, photographed there, represents another powerful example of legacy, serving a combined 20 years at UMC. At 19, he was juggling work, getting an education, and three children. Today, he serves as UMC supervisor of nursing education, and his three kids have followed in his healthcare footsteps. In fact, one of his children, Andrea, works as a neuro ICU nurse at UMC. It's that kind of commitment that Gloria and Raul represent that does not happen by chance. In fact, it is nurtured by a system that values, supports, and invests in its associates. Now supporting our associates, as you are very well aware, means more than just recognizing their contributions, it means investing in them. And so thanks to the work that we've done alongside our commissioners' court and our board of managers, we've been able to raise the minimum wage from $10 in 2016 to $15.50 today. However, what you'll hear about later in the presentation is an effort this year to go up to $16, starting in fiscal year 27, July 1, that will come at an impact of $300,000. Annualized, that'll be an impact of a million dollars. And it really impacts only the first five pay grades above that minimum wage. And so Isabel will talk about that in her portion of the presentation a bit more. And we're really proud of this progress, but we know that we can do more. And so, again, Isabella and Michael will both talk about how we're working to ensure that our associates are receiving every possible benefit they can by working in our system. Now we don't just hire talent, we develop it. The strongest of healthcare systems creates pathways for people to be able to grow, advance, and to build their careers. And so Michael Mendoza, photographed there, is a great example of that. After serving seven years in the army, two tours in Iraq, he returned home with the desire to be a registered nurse. When that pathway was not as straightforward as he had hoped, he went to EPCC and became a paramedic. In 2022, he started with UMC and through our CARES pull-up program was able to go back to school while still working full-time with full salary and benefits and become a registered nurse, fulfilling his dream. And that's the purpose of programs like these. It really is to remove barriers and ensure that we're helping our associates be able to reach their absolute full potential. And some of those programs, as I just mentioned, is the CARES Pull-Up Program, which creates pathways for associates to advance in high-demand healthcare roles. Our Student Loan Assistance Program, which offers up to $5,200 annually for qualified degree plans. And our HOME Program, which offers up to $10,000 in closing costs and down payment assistance. And now these investments are helping associates build careers, strengthen their families, and create a future right here in our community, but it's also creating very meaningful results. Our combined weighted turnover rate for the district has fallen dramatically since the height of the pandemic and is now some of the strongest in the industry. More importantly, when you think about why turnover is important and why we mention it, when you have lower turnover, it means experienced caregivers remain at the bedside, stronger teams are working together, and patients receive more consistent high quality care. Now, our responsibility extends far beyond just today's workforce. It means preparing tomorrow's healthcare leaders as well. And that requires intentional investments and creating very strategic partnerships. Project Arriba, which we support at a $200,000 annual investment, has helped launch countless healthcare careers, as the court is very well aware. Veronica Ramirez, pictured in that photo there, holding a photo of her mother, is one of those success stories. She completed Project Arriba and only applied to work at UMC where she received a job. She's been with us now for 21 years and has risen in rank to now be our Assistant Chief Nursing Officer. Prior to her joining our team, her mother Camila served at Thomason for 32 years taking care of children. And today, Veronica's son, Steven, started in our emergency department as a nurse, went on to the Paul Foster School of Medicine, and is now an emergency physician in our very own community. So another example of legacy. Now that same commitment to partnership extends far beyond Project Arriba. It also goes toward UTEP with a $1.5 million contribution that we made to help expand their nursing and occupational therapy programs. and our $100 million collaboration with Texas Tech to be able to support physician education, clinical training, call coverage, et cetera. Now together, these investments are creating a pipeline of talent at every level. And one of the clearest examples is our continued growth in our residency and fellowship programs with Texas Tech. Together, we're training future physicians to remain right here in our community, but our commitment extends far beyond physician training. We now have over 50 partnerships with community institutions to be able to train up to 4,100 individuals a year now from different healthcare professions. Those examples are how we're growing our own for our community. Now, those investments only matter if we're actually improving lives. And I know that's a topic of discussion that we've had in the past. This past year, those investments have translated into meaningful accomplishments across our health system. Both UMC and El Paso Children's Hospital earned the Pathway to Excellence designation, recognizing the culture that we built to support and empower our nurses. UMC was again recognized as one of the nation's top 100 hospitals for spine surgery, and El Paso Children's Hospital launched its mobile clinic, which is going to be able to address healthcare needs in hard-to-reach parts of the county. But our goal isn't simply to earn recognition, it's the ability to also be able to have prevention as well. So across our health system, as you'll see on this slide, we're connecting more families to screenings, vaccinations, and preventative health care before a crisis occurs. This year, we reached up to 119,000 patients through preventative outreach, increased our well child visits above the state average through El Paso Health, and provided preventative and wellness training to 134 school nurses across our community through El Paso Children's Hospital. But a strong healthcare system is also there in those moments when you don't expect for something to occur. For Javier Diaz on the screen, a routine day at work became a life-changing moment. After suffering a devastating electrical injury in the oil fields, Javier was brought to UMC, where Dr. Fidler and his team provided very specialized care. Now, while our burn center is yet to be completely built out through the bond, as you are aware, that expertise is already here, so we're keeping more individuals in our community not having to leave for that care. And Javier's story is a perfect example of why we continue to invest in the future of healthcare for our community. And in November 2024, our community made that future a priority by approving our nearly $400 million bond obligation. Over the next six years, we'll deliver on more than 20 projects from the burn center, the cancer center, expanded critical care access, neighborhood clinics, ambulatory surgical centers, and the satellite emergency departments as well. That work is well underway with our first $275 million tranche already at play. Projects are in design, and two of our projects are under construction, our eighth floor observation unit and our east rehabilitation services location. But preparing for the future isn't just about building the facilities, it's really also about navigating the very rapidly changing healthcare landscape. At both the state and federal levels, we're working to protect the resources that keep healthcare strong in our community. And no matter how the healthcare landscape changes, our commitment to the community will continue to remain the same. Now these stories that we've shared with the court today reflect what's possible when vision is backed by very strategic investment. And with that, I'll turn it over to Michael to present the fiscal year 27 budget that will carry us into the future.

Thank you, Ruben.

Thank you.

Good morning, commissioners. My name is Michael Nunez. I'm the District Chief Financial Officer for the El Paso County Hospital District. Ruben was talking about the journey that we have gone through and a lot of the information I'm gonna be sharing is gonna cover some of our key operating statistics going back to 2017. And we couldn't have done this if it would not have been for the support of previous commissioners, courts, and also our previous board of managers. And you'll see where a lot of these hit access to healthcare. So on the next slide here, when we talk about inpatient admissions, Going back to 2017, we've seen a 37% growth since 2017. UMC has seen a 40% increase in inpatient admissions, while El Paso Children's has seen about a 24% increase. Keep in mind that we continue with the only expansion that we had when we acquired the assets of the surgical hospital and its 40 beds. We are still pretty much operating at the same bed capacity. as we have been over the previous couple of years. Our emergency room visits, you'll see since 2017, there's been a 65% increase. When you're looking at UMC, it's increased by 76% and El Paso Children's about 33%. You'll see the increase here between 2021 and 2022 That was when we added the satellite emergency room centers in the east and northeast part of town. So previous, going back to 2017, the main emergency room at the main campus was doing about 65,000 emergency room visits. It continues to do about that level. But now combined we're doing about 100,000 with the growth primarily coming in the satellite emergency rooms. So when that bond issue was passed, that provided access to a lot of El Pasoans and these have worked just as designed. because what we are seeing is although there's a lot of a lot more uh emergency room visits the lower acuity patients are going to the satellite emergency room visits where only five percent of those emergency roommates are actually inpatient admissions while the the higher acuity of patients are going to the main campus when you look at our Outpatient visits, that's grown about 65% since 2017. UMC has grown about 60% while El Paso Children's has grown about 155%. When you look at on the UMC neighborhood clinics, we do about 183,000 annual visits or about 15,000 a month. El Paso Children's Clinics are currently doing about 20,000 annual visits, or about 1,600 monthly visits. And then our UMC Healthcare Partners, which is our physician acquisition practices, they are now seeing about 80,000 annual clinic visits, or about 6,700 visits a month. So this all is important as we continue to provide more access to healthcare. Surgical cases, 82% increase from 2017. UMC has grown about 103% during this time frame. El Paso Children's has grown about 33%. Now back in January of 2024, at that time we did purchase the assets of the surgical hospital and that has really helped us out in terms of expanding our surgical cases mainly in the outpatient area. Moving on to El Paso Health. El Paso Health, when you look at their Medicaid programs, the State of Texas Access Reform, otherwise known as STAR, this is our Medicaid program. They have about 59% market share. They've been the market leader since about 2014. When you look at Star Plus, Star Plus, they entered this market September of 2024. At that time, they had a 43% market share. Now as of June 26th, that market share has increased up to 46%. And then when you look at their Chip and Chip Perionate programs, they have about a 67% market share. So those are some of the key statistics as it pertains to El Paso Health. Looking at the district's financial health, you look at our rating agency scores. Now, we are rated by Kroll, Fitch, S&P, and Moody's, and our scores are indicated in blue. We have, for comparative purposes, shown the other El Paso hospitals in terms of what their bond ratings are, and you can see, with the exception of Moody's, we are above or equal to the other El Paso area hospitals. When you look at our district days cash on hand, you'll see back in currently right now, we're about 32 days. The last couple of years, we've been ranging around the mid-30s. And back in 2020, because of the pandemic, that's when we were receiving some of the COVID-19 monies from, was it from the federal government? So that helped with our cash position back in 2020, 21, and 2022. When we look at some of our budget challenges going into 2027, first of last summer, the administration signed on July 4th what was known as House Reconciliation Bill number one, one big beautiful bill like OB3, it's had many names. So currently right now, CMS just recently published proposed rules on May 20th as to how they're going to implement the medicaid reductions that are forthcoming in a couple of years so currently the current policy is that medicaid rates can be paid up to average commercial rate and what i mean by that is you when you look at your payers medicaid is typically your lowest payer then you have medicare and then you have your average commercial rates well this the the supplemental medicaid supplemental programs allow you to go from medicare to average commercial rate But what's going to happen starting September 1 of 2028 is that for non-expansion states like Texas, that reimbursement is going to drop to Medicare plus 10. Now currently right now, CMS and Texas Health and Human Services Commission are going through the calculation, where is Texas in this Medicare scale? Are we at Medicare plus 30 or Medicare plus 40 as we start that reduction starting September 1 of 2028? Now, going back to 2021 of 2028, this year in 2027, we are still receiving the Medicaid rates as we currently are being reimbursed. Then in our fiscal year 28, we will have 11 months of our current rates, and then the last month in September is when the reductions will start. Texas statewide has about a $9 billion state directed payment budget. That will now decrease by 900 million starting September 1 of 2028, going down to 8.2 billion and then another 10% the following year to 7.2 billion until Texas hits that Medicare plus 10 floor. So that will be coming down the pipe. Other things that we are facing is currently right now, just recently, July 22nd, CMS proposed what's called their calendar year 2027 outpatient proposed rules. Now the headlines read that outpatient services are going to receive a 2.4% increase in their reimbursement rates However, hidden in the detail, there are some reductions that are included in this proposed bill. One of them is going to be pay at site neutral rates for certain imaging services being done at off-campus departments. This will continue to be an item that we will continue to look for in future years as CMS begins to reduce rates, particularly at off-campus locations. There's also an effort on our 340B drug pricing program to increase the number of drugs that are going to be on the exclusion list. This current year in 2026, there was about 10 drugs that were on this exclusion list that we are not enjoying the benefits that we used to. And then starting January 1 of 2027, there's about another 15 drugs that are going to be included in this exclusion list. And then one other item that we are preparing for, for all our off-campus locations, they're going to be what's called, they're going to be required to have a separate identifier. It's called NPI, a National Provider Identifier. So each of our off-campus locations, although we're still gonna be building under the tax ID umbrella of UMC, each location will have its own identifier. My opinion is this is where CMS is going to start the premise in terms of all the off-campus locations being reduced, being paid at a reduced rate, so it'll be easier for them to identify where the off-site locations. So that's something that we continue to monitor. in terms of currents on the budget challenges at umc now on december 21st of 2025 the affordable care act subsidies expired now the hospitals are throughout the country are now starting to see increase in in uninsured rates now currently right now at least through june 30 of 2026 umc's uninsured rate continues to be the same as what it was six months ago so although we have yet to see a degradation of our payer mix. My personal opinion is that people that had coverage under the Medicaid exchange plans may be going without healthcare, such as some people did during the pandemic, and later on as they become more ill, then that's when they'll be showing up probably as uninsured in our emergency rooms. Now, one item that's actually affecting UMC, El Paso Children's, and El Paso Health is the current status of the 2027 Comprehensive Hospital Increase Rate Program, otherwise known as CHRP, between CMS and HHSC. Annually, Health and Human Services submits what's called a preprint, or it's planned, in terms of how the hospitals are going to get reimbursed starting September 1, which is the state's fiscal year. Normally, that would be already approved by July 15th for a September 1 implementation date. CMS has yet to approve this. In fact, I was just on a call with Health and Human Services and THA last week, as we probably do not expect the 2027 plan to probably not to be approved until possibly October or November. So what this is going to mean is that as El Paso Children's and UMC provides Medicaid services to those members from the Medicaid and managed care organizations, we'll get reimbursed, but only at the base rate that we have with the managed care organizations. We will not be getting that enhanced rate. and not until when CMS approves that, then at that time that's in the managed care organization. So go back and re-adjudicate all those claims going back to September 1st. So we may experience a little bit of some cash flow decreases during the month of September, October, and November. And then the other item I just talked about was about the maximum fair price and reimbursement as it pertains to some of the negotiated drug prices. El Paso Children's, they are investing in growth in 2027, where they're launching new program services and expanding outpatient facilities. Some expense pressures as they continue provider recruitment challenges, so some of the areas that they don't have employed or contracted, they're having to use what's called locum tenens, which is at a higher cost. Now we talk about operating room capacity. Earlier I talked about where El Paso Children's had grown about 33% in their surgical cases. One item is that they're starting to reach capacity. So we're gonna need to find methods to try to find additional operating rooms for El Paso Children's. When we go through the budget assumptions, I will just now turn it over to Isabel who will go through the budget assumptions for each of the entities.

Thank you, Michael.

Welcome.

Good morning, Judge, Commissioners. My name is Isabel Briones. I'm the district controller at the El Paso County Hospital District. I will start with the budget assumptions for UMC. On revenue, we are budgeting a growth of 2% in inpatient and outpatient volumes. And we are planning the no new revenue tax rate. Michael will go into further detail on. And in addition, this is the last year of our NAEP supplemental program. This is $12 million and this will end August of 2027. On the expense side, we are planning a 2% merit increase. This would be at an annualized cost of $9.5 million, including benefits. This would be effective December of 2026, as our evaluations take place in October and November. We're also planning market adjustments to keep our pay competitive. This will be at an annualized cost of $5.6 million, and this will be effective July of 2027. As Ruben mentioned earlier, we're also planning an increase to our minimum wage from $15.50 to $16 per hour, and this will be at an annualized cost of $1 million. We're also planning an increase in our retirement contribution to TCDRS. We're moving our employer match from 200 to 225%, and that would take place January of 2027 at an annualized cost of $3.7 million. Moving now towards El Paso Children's Hospital, we're also planning a 2% volume growth. On the Medicaid supplemental side, we are planning a preliminary increase of $44 million in CHRP. This will be partly offset by $33 million in the local provider participation fees. We're also planning a 2% merit increase there, and that will take effect April of 2027. Moving to El Paso Health, we're planning a 5% decrease in the STAR Medicaid membership. This will be partly offset by a Medicaid capitation rate increase from the state, and that would be $30 million. For the medical loss ratio, we're budgeting 89%. This would be an improvement from 2026 of 94%, and this moves us back towards our historical ranges. Now taking us to the district as a whole, this graph shows our revenues and expenditures for the past decade. And you can see that our budget has increased 300% since 2017. Moving to our forecasted revenues and expenditures, this is our forecast for how we expect the year to finish. It's our best estimate on where the year will land. And on the revenue side, we are projecting $2.061 billion. And on the expense side, we're coming in at $2.012 billion. For the budgeted revenue and expenditures, on the revenue side, we are budgeting $2.144 billion. That's an increase of about $83 million or 4%. And the largest contributors to this growth are patient service revenue at an increase of about $47 million. And also we have premium revenue at an increase of about $37 million. And Medicaid supplemental revenue up about $25 million. On the expense side, we are budgeting $2.132 billion, an increase of about $120 million, or 6%. And the largest contributors here are supplies, wages, and benefits, up about $65 million. Intergovernmental transfers up about $31 million, and supplies and pharmaceuticals up about $16 million. For the budgeted pair mix, the pair mix has remained consistent over the last several years and the funded pair mix is coming in at about 80%. UMC's funded pair mix is at around 75% and El Paso Children's is at about 95%. For our annual net position change, this chart shows our change in the district's net position since 2023. The 2026 forecasted net position is at about $49 million. When we normalize this out, removing one time items such as the COVID FEMA assistance funds of $25 million and an IGT refund of about $8 million, we arrive at a forecasted net position of $15 million. Our 2027 budgeted net position is at $12.4 million. And with that, I will give back to Michael to go over the property taxes.

Thank you, Sybil.

Thank you.

So last time is gonna be is what does this mean for the taxpayer? So going from left to right, and yesterday the Central Appraisal District leadership did give their presentation regarding the property values for January 1 of 2026. And one of the items that was included was one of the legislative changes that had occurred regarding as it pertains to business personal property exemptions where you have $125,000 per owner per location. As they reported yesterday, because the county's property tax rolls, the values are very similar to UMC's, but there was a reduction from last year to this year of about $1 billion. So that definitely had an impact in terms of the potential revenue coming to UMC. That $1 billion is about $2.5 million in terms of what we would have generated in 26 compared to what we would have generated in 25. So going from left to right, Let me start with the 2026. Last August, when we adopted our budget, we had a total taxable value of $74.1 billion. At our tax rate of 24 cents, that would generate about $178 million in total property tax revenue. Now you fast forward now to those same January 1, 2025 property values that were just updated by the Central Appraisal District in July, the taxable value decreased. You were at 74.1 billion, now that's at 73 billion and that's because of the additional exemption that the legislature had approved effective January 1. So even though that's still at 24 cents, we're still at right about 178 million. In previous years, we normally would have received about a $2 or $3 million pickup because from the standpoint of some of the protested values that were on the rolls as of July that had been summarized, we normally would have had a pickup every year, but this year we did not. So let's move forward now to our 2027 budget. Now the key element, particularly because of that business property tax exemption, is the difference between what's being calculated as a no new revenue rate versus if you take the sum of your no new revenue rate, M&O rate plus your debt service rate, that was a difference of about three cents. So you'll see here that currently our taxable value is gonna be at about 76.7 billion. The no new revenue rate as computed did decrease now to 23.6 cents. In 2026, we were at 24 cents. So with the increase in overall property values, which does include new property values of about 1.5 billion, we are expecting about 182 million in total property tax revenue. The second column is where if you were to take the sum of the no new revenue M&O rate plus your debt service rate, that delta would have been about an additional $2.8 million. So this spread, this difference was more pronounced this year simply because of the business property tax exemption. And then for other illustrated purposes, had we kept with a current rate of 24 cents, that would have been an additional $3 million over and above the no new revenue rate. And then the voter approval rate would have been an overall tax rate of about 25.4 cents, generating about 196 million in property tax revenue or a difference of about $14 million. But for purposes of this budget, this hospital district is going with a no new revenue rate. Let me pause there and see whether there's any discussions regarding the proposed tax rate for our 27 year. Okay, hearing none, when we look at the impact to the taxpayer, looking at average home value, the current average home value is about 232,000 using January 1, 2025 property values or annual property taxes to about $559. The average home value now using the January 1, 2026 property values is about $240,000, so annual property taxes of about $568, an increase of $9.72 for the year, or about 81 cents per month. When you look at our property tax rate over the last decade, a couple of things here, you'll see that on the far right, our 2027 overall rate is about 23.6 cents. The first item that I did want to mention was you'll see that at the height, our tax rate was in 2020 and 2021 at about 26.7 cents. But if you look at 2021, our maintenance and operations tax rate was about 21.7 cents, and right now we're about 17.6 cents. So you'll see that our maintenance and operations rate has dropped about 4 cents since 2021. As was illustrated yesterday by Carmen during her presentation, these are the adopted tax rates for the taxing entities going back to 2021. Historically, UMC has been around 8.5%. Now because of the voter approved bond issue back in November of 2024, we did go up to about 9.1% of the El Paso County tax rate. And as illustrated earlier in now, this shows five of the last six years did not include 27 because we have not adopted that. But we have adopted five of the last six years, either the no new revenue rate overall or the no new revenue maintenance and operations rate. When Isabel was mentioning about UMC's funded payer mix, now we have about 25% unfunded payer mix. So we're estimating for 2027, the estimated cost to provide care for unfunded patients is about $277 million. The maintenance and operations portion of our property tax rate is about 136 million, so just right about 50%. So every year, what we face is that we have to make up that difference over the next 12 months just to fund that difference. But that percentage has historically been between 45 to about 50%. One of the items where we like to compare ourselves is with the other large public hospitals. Now, I do show UMC El Paso because that's the taxing entity, but for comparative purposes, when I look at the other Texas large public hospitals, I'm going to refer to the bottom left where we combine both adult and pediatric services because the other four large Texas hospitals have adult and pediatric services. You'll see that between UMC El Paso and El Paso Children's, on a $1.27 billion budget, 12% of our budget comes from property tax revenues. Now looking at Parkland Hospital in the upper middle, their property tax rate is about 27% of their total revenues. University Health in the middle bottom, 22% of their revenues come from property taxes. Upper right, Harris Health, 37% of their revenues come from property taxes. And then the lower right, JPS Hospital in Fort Worth at about 26%. So this is a comparison in terms of the less reliance that the hospital district does have on property taxes. The flip side of that is in the darker blue part of the pie, you'll see that our patient service revenue is about 65% compared to others. Parkland is 45%, University Health 61%, Harris Health 28%, and JPS about 48%. So that just goes to show in terms of how we fare up with the other large Texas hospitals. A couple of other slides, when we look at our routine capital budget for next year, we are proposing a $43 million routine capital budget, 17 million coming for University Medical Center, about 23 million for El Paso Children's. I earlier talked about some of their investments in their outpatient facilities that they plan for 2027. And then El Paso Health, about a little under $3 million, and most of this is information technology related. Was it for their claims management system? Our debt service budget totals about $49 million, but as property tax backed is about $45 million, and those cover the following three bond issues, the 2025, bond issue. This is the one that the voters approved back in November of 2024. And then we have some refunding bonds. Our 2024 refunding, which refunds the original 2005 and 2013 general obligation bonds, about 15 million. And then the 2017 refunding that refunded the original 2008A bond issue. And this was what we refer to as the Children's Hospital bond issue. And then we do have a revenue bond. These are paid for by hospital revenues, not by property taxpayers. And this was a couple years ago when we had purchased the assets of the surgical hospital, and that has a debt service of about $3 million. Our next steps, where we go here, today's August 4th. We are presenting our first budget work session. Next Tuesday, we do have another regularly scheduled board meeting for the board of managers. Now, we have one here on August 17th. Now, since we, the hospital district, is not proposing, or we are proposing the no new revenue rate, we are not required to have a public tax hearing since we're not proposing a rate above the no new revenue rate. We do have planned, if needed, on Tuesday, August 18th, if there's a second budget work session that is needed between the Commissioner's Court and the Board of Managers. And then currently right now, we do have on our calendar for Monday, August 24th, that we would like to come back and have the Commissioner's Court approve the operating capital and debt service budgets for the hospital district. So with that, that does, and then there are some other slides here in terms of some other additional information. You can take that as your leisure, but as of right now, I will pause, and this will conclude the Hospital District's 2027 budget presentation, and I'll open it up to the court if there are any questions.

Yep. Commissioner Butler, and then Commissioner Steltz, please.

I have some questions. Thank you very much for the presentation and the overview. It was a lot of information. So I might, I'm gonna try to stick to certain topics. But the first question on my mind is about the, UNCOMPENSATED CARE AND THE UNFUNDED PAYER MIX THAT YOU MENTIONED A FEW SLIDES BACK, MICHAEL. YOU SAID THAT IN FISCAL YEAR 2026, THERE WAS 25% UNFUNDED PAYER MIX. AND WE'RE BUDGETING AND YOU'RE BUDGETING AN INCREASE, A SUBSTANTIAL INCREASE FOR UNCOMPENSATED CARE IN FISCAL YEAR 27. AND SO IN TERMS OF THE PAYER MIX INCREASES, WHAT DOES THAT AMOUNT TO? THAT JUMP FROM 260 TO 277?

The increase here that's being reflected is the additional increase in volume that's being planned between 2026 and 2027. So as we are projecting more admissions, more surgical cases, more outpatient visits, although the funded payer mix or the unfunded payer mix we're budgeting to be approximately the same as 25%, it's just the incremental volume related that's increasing the cost.

So you're assuming it's going to stay around 25%. Do you have a number of how many people might have lost coverage under the Affordable Care Act that are now uninsured that you're going to have to account for?

So first off to your question, we are assuming the same unfunded payer mix as we currently have since we have not seen a degradation of our payer mix. And in terms of numbers of people that have lost insurance that are coming to UMC, that still remains approximately the same currently as of right now, six months post the expiration of the Affordable Care Act tax credits.

Are you all doing any forecasting to see if there's gonna be a future impact?

We continue to look at this monthly in terms of whether our paramex decreases and or the numbers of patients that are coming in that do not have insurance. But so far right now we have not seen that. But although we continue to look at this monthly because we do feel, or I personally feel, that that may be coming down the road. We just have not seen that yet.

Is there a way to predict or forecast that for the next fiscal year, what that might look like?

We can look at national statistics as that's becoming available. However, until we see whether patients come into our hospital, we don't have actual numbers.

So there's no database to show how many people in El Paso County are losing health insurance coverage?

Right, I think every hospital's worried about this. We all take patients, and if they come into the ER, even the for-profit hospitals are required by law to see those patients. So right now, We haven't seen the impact hit. We do think it's gonna come. We're working on how do we project that. I mean, Michael's gonna look at national figures. More importantly, it's gonna be state and local figures. And we'll be working with our partners to see if there's a trend we see coming, one, and then what can we do to help mitigate the trend. So for example, if you have people that said, Because of the, you know, the requirements that are impacting Texas directly, you know, we're dropping off the Medicaid rolls. How can we help them get back on? In some cases, it might be, you know, do they need assistance in filling out the application? In others, it might be that we're going to see that impact. So, you know, there's a lot of unknowns. What's going to happen at the midterms? What's going to happen, you know, two and a half years from now? So we are trying to get that data, but right now it just isn't there, and it wasn't there enough for us to impact this budget to the way it is. I mean, we have seen challenges over the years, and we try to be as stable as possible. There may be a time that if the uninsured amount increases, we may have to come back for a tax increase. But given all the pressures, honestly, that have been hitting El Paso taxpayers, in appreciation also for the support they did in the voter-approved general bond, we felt that at this point there wasn't enough for us to say, we see a trend to reserve a certain amount. But we're going to be monitoring it monthly. And as you know, we present quarterly reports. We'll be glad to give you updates then.

One of the items that we're also doing between our neighborhood health clinics leadership and El Paso Health is as the patients are coming in to our neighborhood health clinics and are having insurance working with El Paso Health and whether they can assist them in filing for Medicaid coverage or so. So those are some of the things that our neighborhood health clinics leadership is working with El Paso Health.

Yeah, I think that's gonna be increasingly more important over the next year or two, is trying to get more of our residents enrolled in Medicare and Medicaid. And I know everybody in this room knows this, and so I don't mean to preach to the choir, but for the benefit of the public, that's what sets UMC apart from every other hospital system in the county. That's what sets the county apart from other local governments. The responsibility for indigent care lies on the hospital district. And so the more uninsured we have, the less healthy our community is, the more that our taxpayers are gonna have to pay to cover the cost of that healthcare. And so I would really, and I know I talked about this last year, but I'd love to see some data on health outcomes. So the investment that UMC is making in healthcare across El Paso County, How is it actually moving the needle on health outcomes for our community? So are we seeing a decrease in disease rates, in cancer rates, in preventative care? Are we catching cancer earlier than we used to? How many uninsured are we seeing compared to previous years? Do we have any of that information that's available now?

We track data, we don't have it with us, but we do track data, for example, if somebody has diabetes, you know, that our clinics, and you're exactly right, these neighborhood clinics were designed to provide care for anybody in our community, whether you have insurance or not. And you can go there and get your preventative care. We encourage preventative care because the more you get preventative care, the less risk that something happens with your health that will require a higher level of care. And secondly, our clinics track their quality metrics in terms of how we're providing care for our patients in certain disease-specific areas. As you know, Texas Tech is building a cancer center that we're working in a partnership with that would help us in terms of cancer rates. Cancer rates are sort of hard to say, well, we're gonna reduce cancer, but more importantly, how do we assure that we're providing care to reduce the mortality rate in cancer? And then there's some others that we might have an impact. For example, as I mentioned before, we have diabetes. Is it a matter of working with our partners like the El Paso Diabetes Association? and their kitchen, and how to make sure that we not only address the issue of how do we manage their diabetes, but how do we change their habits in terms of eating and care to reduce the impact of diabetes on a person.

I think that as we look at the fiscal impact and tax rates and budgets, it's also important to understand the healthcare needs of the community, right? So not just seeing Children's and UMC expanding, but also what are those issues that we're trying to address in that expansion. We have data to say where chronic diseases might be more prevalent or which chronic diseases exist in El Paso County. So maybe in future meetings we can talk about how those two things align. both UMC's growth across the board, just its physical impact and footprint, but also how it's impacting patient outcomes throughout the county.

That's a very good idea. I agree. We'll do that.

And then lastly, I had just a question, more of maybe a forward-looking question, because I noticed in the financials that we're projecting that UMC and El Paso Health will be operating under a net loss in fiscal year 27. El Paso Children's will be operating in the positive, and so that's really carrying, it looks like, the overall budget here. Is that correct?

Yes, that is correct. And up on the slide where we're showing the combined district budget of about $12 million, UMC is coming in about a $6.7 million negative. As Isabel was going through, although in this year we're increasing that position to 47, once after you back out the one-time revenue items or COVID-19 money that we finally got reimbursed last year. et cetera, El Paso Children's coming in at about 24 million. Now they are the beneficiaries of a Medicaid supplemental rate increase for STAR Kids. Now in previous years, the Medicaid supplemental programs only covered STAR and STAR Plus. This year it's gonna cover STAR Kids, where the majority of those patients will be going to El Paso Children's. But now keep in mind, we're probably gonna be only realizing this for the next two years, before September 1 of 2028 when those reductions began. Then El Paso Health, you'll see this year they're about a projected about a $22 million negative deficit. A lot of this has to do with the increased utilization in the STAR program and in the STAR Plus programs. Unfortunately, here, we did, when the rates, when the state set the capitation premium revenue rates, particularly for STAR Plus, they were using data from the predecessor for the STAR Plus program. So now that they have come over to El Paso Health, the increased utilization or the cost in the medical claims has been higher. than their predecessors. Their predecessor, when they were going out of the business, they were not doing assessments on their members. So we did get a partial relief coming in 2027 from the state, but it usually takes two years of when they look at your claims data so that the premium revenue catches up. So they will receive a partial relief in 2027, but we do expect in 2028 to get the full benefit of their medical costs being incurred in 2026. But those are the two items that we are looking at specifically for UMC and then also for El Paso Health.

Okay, so you expect that to kind of balance out in fiscal year 28 is what you're saying so that we're not over relying on children's for balancing this budget.

Yes, ma'am. Truly, we don't. I mean, this fiscal year, UMC's gonna do well. It'll end in the black. Keep in mind that children's payer mix is 95%. UMC's is 75%, and in particular because we absorb about 136 million in free care that we provide. So this has been typically the story. We come in at a little bit of a loss, but we make up a lot of that loss through other ways in terms of the uncompensated care that we budget for each year, so given that we're coming in at a no new revenue rate, we're reducing our tax rate, given that we are expanding services, addressing employee benefits, I think we're gonna come in at about 12 million positive in net position as a district as a whole, and that's good, and as far as what Michael mentioned with El Paso Health, typically they are in the black. We took on a new program, and the premiums will right-size at fiscal year 28. Yeah.

That's good, and I think overall it's definitely a win for the community that we have children, that it's under the umbrella of the hospital district. I mean, I think it's... a success story of all the reasons why Children's Hospital exists and why we need it in El Paso. And it shows how many kids are getting the care that they need. But I'm looking beyond this fiscal year, right? So what is this going to look like in 28, 29, 30, and is this sustainable?

One of the items which I do want to mention when I talk about El Paso health performance in 2026, when they entered the Star Plus market in 2024, with a predecessor, UMC, we did not receive many of those members coming to UMC. But now that El Paso Health started in the Star Plus market. We are, UMC is now the beneficiary of a lot of those Star Plus members. So although you may see a loss on El Paso Health as medical expenses, we at UMC are receiving it in premium revenue. So it's one of those things in terms of diversification Usually if it's a low medical claims utilization, it's good for the health plan, but not good for the hospitals. But if it's high utilization, it's bad for the health plan, but it's good for the hospitals. So there's where we talk about diversification so that we don't have all our eggs in one basket.

Diversification is great. The last thing that I wanted to mention is just the uncertainty tied to federal policies and reimbursement rates. Just to, I guess, emphasize that as federal law continues to change, as some of these changes start to take effect now and moving into the next fiscal year or two, there's a lot of volatility in that. And Paramix is great, but if half of our Paramix is relying on the federal government and state government to reimburse us, that's scary for us. Correct.

In fact, between Ruben and his government relations team and us in the fiscal, we're continuously just looking at what's happening at the federal side, what's happening to the state side, so that we can be up to speed or with the latest information as we know. But, yes, you are correct. Those are the headwinds that we are facing, you know, coming up in the next 24 months.

Okay. I think that's all I have for now. Thank you. Commissioner Stelton.

Thank you all for the presentation. And I want to thank Commissioner Butler for bringing up the issue of outcomes. I think you all have heard me for a number of years talk about looking at more preventive care, the root causes of what's making people sick and all of the infrastructure in which we have invested billions of dollars and it continues to grow. but outcomes are still the same or getting worse, right? People are still sick. And so I'm glad to hear you pick up that baton since I won't be around after this will be my last budget hearing with UMC. as County Commissioner, but I want to also reiterate her points that I think that UMC and our public hospital district should definitely do as much as we can. TO LOOK AT WHY THOSE OUTCOMES, EVEN THOUGH WE'VE BEEN SPENDING SO MUCH MONEY ON INFRASTRUCTURE, ARE NOT GETTING BETTER. BECAUSE IF WE CONTINUE TO HAVE TO, AND WE'RE LUCKY THAT WE ARE ABLE TO GO DOWN TO THE NO NEW REVENUE RATE THIS YEAR. it's gonna get worse if we don't pay more close attention to what's causing these issues and instead of treating the symptoms, treat the cause. So, I WANTED TO MENTION THAT. I ALSO HAD A QUESTION ON SOME OF THE COSTS. ARE WE STARTING TO SEE AN INCREASE IN SOME OF OUR COSTS IN THIS BUDGET BECAUSE OF THE EXPANSION? I MEAN, I KNOW THAT, FOR because we're going to be building all this new infrastructure, right? The cancer treatment center and the neighborhood clinic and the burn unit. Have we started onboarding the... healthcare professionals, the personnel, to man those positions yet? Is that something that we're seeing now, or is that something we're gonna see in future budgets? Very little.

I mean, for example, we have Dr. Fidler, who's our trauma burn surgeon, who's come on board, and he's come on board before the actual burn center is built, but we're already taking care of a large number of burns in our community in our current ICU. So we brought him on. You'll see as the cancer center, for example, continues to develop, it's planned opening is October of 2028. You're gonna see that we're gonna start recruiting oncologists now so that when the clinic opens, they're onboarded and ready to go. At some point, you know, more than likely about six months before a clinic opens, you'll start seeing the upsurge in bringing staff on board and training them so that we can, you know, take care of those. So it hasn't been as impactful this year. You'll start seeing a slight increase next year, and I think the budget reflects that. And then as each phase comes in, we'll try to get them in about six months before the particular entity opens up.

Okay.

And in reference to the slide up above where we talk about the 2024 general obligation bond, we're about one year from when we received the what I call tranche number one, the $275 million. So over the next two years, currently right now a lot of these projects are in design phase, but once we, and I believe I think Betsy may have mentioned this yesterday with some of the county's projects, Once we're past the design phase, then the expenditure and the construction of those physical assets will be taking place so that sometime here in the next 24 months we'll probably be going out for the second tranche of this bond issue, which is the remaining $122 million.

Commissioner Butler, we definitely understand the need to provide maybe additional information on prevention. We did include on slide 16 just a very high level example of some of the areas where we're doing some of that work. Really a lot of credit to our neighborhood health clinics and the work that they're doing to ensure that individuals won't have access to care which i think was such an issue in the past not just to primary care but to specialists but two to ensure that they're meeting and understand what their needs should be or are within their health care space so do you need to get your vaccines on a more regular routine time frame do you need to be reminded to get your colonoscopies which we're now doing with a a technology we're using to send folks text messages and emails So all of that starts to build those healthier behaviors, which lends to folks, making it easier for folks to be able to get the healthcare that they need. So although we may not have given as much information today, that was just at a very high level, but we can certainly think through how to provide additional information on how that can provide better insight on the work that's being done at the facilities.

Thank you. And also I wanted to just also make sure that we're reaching out to our union friends at SEIU as we continue through this budget process. I'm going to be reaching out to them as well, sending them the budget booklet and asking if they have any feedback. I'm sure they'll be happy with the fact that we're going to a $16 an hour minimum wage. So thank you all very much for indulging at least myself. I don't know who else asked for it, but I know that that's something that I asked you all to look at. So thank you very much to the board and to the staff for being able to work that in. over the years, right? I think as you look at that chart coming from $10 to $16 over the last 10 years, the goalpost is always a little further away as economic challenges continue to burden us. As long as we're chipping away at that, I think we're heading in the right direction. So thank you all very much for working on that and including that in the budget. I know that it's not always easy to find that money, but I think it's well worth it. I think we need to do as much as we can to make sure we're paying as close to living wage as possible, When we're out here asking for companies that we're incentivizing, for example, at the county to do the same, we need to be on top of that. And I just want to thank everybody for the work. It's been a fun 12 years working with you all. When I came into office in 2015, Of course, the Children's Hospital was in a lot of turmoil. And man, the great things that are happening there. So kudos to Cindy Stout, who I'm not related to, as everybody asks. But we just say we're long lost cousins. But you've done a great job. We went through, I think, five CEOs in a couple of years there at Children's. But since you've been at the helm, we've just seen great strides and really amazing things happening. And Jacob, as well, to you and your team, you've put together a great team over the years. And I'm proud to have had the opportunity to work with you all.

So thank you. Thank you.

Thank you, Commissioner.

Thank you, Michael. I just have a couple of comments. Having gone through the challenges from after COVID, the realization of the work that needed to be done in terms of the health services that our community needs. I think this is a great time for celebration. Your stewardship over all this time period and to come out in this position is incredible. I applaud not just the administration, but the board for having guided. And not only that, the community responded well because they approved those bonds. And I think with respect to the preventative care, I think what you guys have done with respect to trying to give equity to the services at the clinics is gonna help with that prevention. I think quite a long ways. I think we need to continue working on that. You know, it's great that we're gonna have a burn center. I don't know why Lubbock has a burn center that's smaller than us, the community, than we don't. but y'all understand why. I think it bodes very, very well for the future for our hospital district. I can't be more proud of the services y'all are providing. Our community should really stand up and applaud you because you're guided. We have a lot of challenges, and a lot of those challenges, really, it's out of our control, including your control, and that's a state level. But that's something that I think is going to change here pretty quick in this, you know, hopefully in the next 90 days or so. And I'm hoping that that is something that this state pays attention to because we are one of the poorest metros in the state with a lot of need. But man, have we addressed those challenges. I want to, you know, again, thank all of you. Like I said, Commissioner Stout now will be around, but I'll always be around to support whatever y'all are doing. So thank y'all very much for the work that you do, and our community should really give you a lot of thanks. And they have my responding to those bonds, and appreciate y'all. Thank you.

And kudos to the board too, obviously. I would be remiss if I didn't thank you all. I mean, we've had a number of board members come through, but I feel like all amazing public servants. This is one of the most involved boards that we appoint to as a county commissioner's court, one of the most important boards that we appoint to. It's really been great to see how many amazing people we've been able to attract to this board. Special shout out to Dr. Mena and the work that she did with me on the geriatric clinic and on the geriatric accreditation. Just, I mean, we have such superstars at UMC and on the board. And of course, to my appointee, Isidro, thank you very much for representing Precinct 2. Just one of our most amazing community members running NAMI Texas now and then working on the board. Thank you for your service. Thank you.

Thank you judge and thank you commissioners and special thank you to Commissioner Stout and Commissioner Coronado for all of your service to this community.

Thank you. I also just want to thank Michael, Jacob, Cindy, everyone for all of the incredible work that they did. UMC is making a huge investment in our community and the benefits that our community is going to revert are just going to be incredible. So thank you for all of your hard work. Thank you for always keeping us updated about everything that's happening at UMC. The work that you all do is phenomenal and I'm just very, very grateful for it every day. So thank you.

Thank you, Commissioner. I think what I've seen that's really been effective is the outreach, the mobile units, getting the clinics to the right place. We're very proud because I don't think too many communities have that kind of reach. We saw during the pandemic and so many individuals that were out there that didn't get any attention. And we sort of left it up to them, figure out how to get to a clinic, figure out how to get to the hospital. And so I really encourage that outreach, We're growing tremendously throughout the rural areas. I just really encourage that we get out there and make sure we meet them where they're at.

If I may, the slide that I just brought up talked about our outpatient visits. You see we were at 800,000 outpatient visits in 2017. Now we're about a million three. Now we talk about... the health outcome, but at least now there's more access points for people to get their healthcare. And hopefully, just like Jacob mentioned, it's more hopefully getting in the preventative side so that they don't get, you know, they don't come to our hospital. But this has enabled our health clinics, El Paso Children's, their multi-specialty centers, so it's all these access points that we've been able to do. But a lot of it's been able to do because of the support of this court and previous courts in terms of the bond issues.

That outreach to the nurses, to me, that's, I mean, I'm thinking, I mean, I go back to the pandemic because it sort of put it in front of us, like, what's wrong? What do we need to do? And the impact on the children and not being able to figure out, you know, as you remember, we're sort of looking at the general population. And then we realized we got children and we got, you know, older people that are sort of out there. So this continued outreach to the children, the nurses with the children's hospital. I think that's pretty impressive to be able to do that. Michael, thank you. Okay.

If I may, before I turn it over to Omar for the next steps, there are many people that I want to thank. Although Ruben, Isabel, and I are making the presentations, there's a lot of people that have come here in terms of the finance teams at UMC, the finance teams at El Paso Children's, El Paso Health, our 501A clinics. They're the unsung heroes in terms of putting this budget together. So at this time, for the people that are here, if you can please stand up so you can be acknowledged.

Thank you for that, Michael.

With that, Omar, do we have next steps?

Michael, just on a point of clarification, the modification for the increase to minimum wage.

Yes. What we'll be doing since the increase to the 27 cost for the $16 minimum wage are not reflected in these numbers, we will be going back and including that additional cost so that we can, that will be our Our final budget, so we will go back through, make those changes, get revised books to everyone, and that will be our final budget for for 2027.

And I would invite any discussion from the board if they have any concerns regarding that.

Does anyone know? I do believe the board is ready to take action today on both the no new revenue rate as well as the 2027 budget.

And I'll go ahead and read those motions into the record. In accordance with the Texas Health and Safety Code Section 281.096, propose the no new revenue rate for the El Paso County Hospital District. which is a tax rate of $0.236904 per $100 assessed value. That consists of $0.176631 per $100 assessed value for the purpose of maintenance and operations and $0.060273 per $100 assessed value for interest and debt service of the hospital district for consideration and adoption by the El Paso County Commissioners.

Motion to approve.

Second.

Thank you. We have a first and a second. I'll take a formal vote. Dr. Mena? Yes. Dr. Pettis? Yes. Judge Chu? Yes.

Dr. Paz?

Yes.

Mr. Torres?

Yes.

Thank you. The motion as written to record by Mr. Villa is approved.

The second motion will be for the budget. Subject to the modification proposing a district minimum wage increase to $16 per hour, approve the fiscal year 2027 operating capital and debt service budget, and recommend for consideration and final approval of said budget by the El Paso County Commissioner's Court pursuant to Texas Health and Safety Code Section 281.091. Motion to approve. Second.

Thank you. We have a first and a second. Dr. Mena? Yes. Dr. Pettis? Yes. Judge Chiu? Yes. Dr. Paz? Yes. Mr. Torres? Yes. Thank you. Motion number two as read into record by Mr. Omar Villa is approved.

I believe now there's a motion for the county judge for, do you currently have that?

Judge? Sorry, if I may, Cesar, can we read in item 4B, please, for the agenda?

Absolutely. Item number 4B, discuss and take appropriate action regarding the El Paso County Hospital District's fiscal year 2027 operating capital and debt service budgets, as well as the proposed tax rate.

Betsy? What I have here is what you want me to read?

Yes, sir. I believe that they have given you the no new revenue tax rate.

So the hospital district has proposed a rate of $0.236904 per 100 assessed valuation consisting of $0.176631 per 100 assessed valuation for maintenance and operations and a rate of $0.060273 per 100 assessed valuation for payment of the principal and interest on the debt of the hospital district. The proposed tax rate does not exceed the no new revenue rate. Further, and in accordance with the Texas Code Chapter 26 published notice of a meeting to vote on the proposed tax rate to be held on Monday, August 24, 2026, at 9.30 a.m. in the Commissioner's Court Chambers, Third Floor, Room 303, El Paso County Courthouse, 500 East San Antonio Avenue. Members of the public may attend in person or participate and address the court via video conference or telephone. Instructions on how to participate via video conference are available at epcounty.com. A notice of this meeting will be posted at the courthouse and online at www.elpasocounty.com. Is that your motion, Judge?

Yes. Thank you, sir. We have a motion from Judge Samaniego and a second from Commissioner Stout. The voting is open.

Aye.

Thank you, Judge. Commissioner Olguin? Aye. Thank you. Motion carries. Thank you.

So the meeting to be adjourned.

Yes, if there's no further business, I would like to adjourn this joint session of the board of managers with the county commissioners and the time is 1039 AM. Thank you, thank you.

Judges complete all the items on our agenda. Thank you.

Once again, thank you for being here. Thank you for all your work. We really appreciate that. And, of course, Betsy and everyone else and her team, administration, everyone that gets together. So we look forward to August 24th. Thank you.

Thank you.

This concludes today's meeting at 1038, 1038 a.m.