Task force urges McLennan County to expand primary care, weigh health-district option to shore up hospitals

A community coalition known as the Partnership for Accessible Care and Economic Sustainability (PACEs) presented its phase 1 findings to McLennan County commissioners and Waco city officials, urging coordinated investment in primary care and behavioral health and asking leaders to consider a permanent organizational structure or a health-district model to stabilize local health systems.

"Health care is not just a cost center, but it's an essential part of our economic infrastructure as a community," said Glenn Robinson, a PACE presenter and health-care consultant, as the group outlined why local leaders should act to prevent further erosion of hospital capacity and services.

The report says roughly 20.5% of working-age adults in Waco are uninsured, a rate the presenters described as nearly double the national average and a major driver of avoidable emergency-department use and uncompensated care. "When 1 in 5 working age adults in our community does not have health insurance, the emergency department becomes the front door for too many people," said Chris Lancaster, president of Baylor Scott & White Hillcrest, describing how delayed treatment increases hospital costs and reduces capacity for specialty care.

Ryan Adams, CEO of the Heart of Texas Behavioral Health Network and the local mental health authority, emphasized behavioral health as a pressure point: "Behavioral health is one of the most critical pressure points in our local health care system," and he described long waits, limited psychiatric beds and an unstable patchwork of state allocations that make workforce planning difficult.

Key findings and figures presented by the task force included: an uninsured rate among working-age adults of about 20.5%; Heart of Texas Behavioral Health Network reporting more than 5,700 behavioral-health visits to over 500 residents in 2023 and the broader network delivering roughly 60,000 outpatient behavioral-health services to nearly 6,000 residents; and a local estimate that hospitals share an ongoing uncompensated-care burden that once reached about $1.8 million in a single week. The report also presented modeled returns on investment: roughly 3.3-to-1 for a $1,000,000 investment in primary care and as much as 6.7-to-1 when structured chronic-disease management and specialty access are included; expanding integrated behavioral health in primary care was presented as magnifying those benefits and lowering overall system costs.

The task force put forward five recommendations: prioritize expanded access to primary care (especially through federally qualified health centers such as Waco Family Medicine); create a permanent organizational structure or entity to oversee coordination and implementation of PACE recommendations; ensure behavioral-health needs are fully incorporated into financing discussions; expand community outreach and public education about the findings and options; and continue study of long-term structural and policy options for sustainable funding.

Presenters discussed financing tools already used elsewhere, including Local Provider Participation Funds (LPPF) and hospital- or health-district taxing authorities. They warned that some funding streams (including portions tied to Medicaid and other federal or state mechanisms) are vulnerable to policy changes. "We worry about that," Robinson said of potential federal and state funding shifts and the downstream effect on Waco Family Medicine, the local FQHC the task force described as a key community asset that trains family-medicine residents and provides integrated care.

On the district option, presenters described a multi-step path that would require state legislative action followed by local voter approval. They said a health district is one of several possible models, and that design choices (for example, whether its governing board would be elected or appointed) would be for the community to decide. Several commissioners and city leaders raised questions about governance, the effect on city and county budgets, and whether a district would replace or supplement existing local funding.

Presenters and elected officials repeatedly returned to the importance of protecting and sustaining Waco Family Medicine, which the task force identified as financially vulnerable to swings in Medicaid enrollment and to decreasing federal and state reimbursements. The report highlighted the community benefit of that FQHC, including residency training that retains a portion of graduates locally.

Next steps identified at the meeting were procedural rather than prescriptive: the PACE task force requested direction from the county commissioners and city council on whether to pursue a formal next phase, suggested creating a small executive team or leader to carry implementation work forward, and recommended public engagement to test appetite for possible funding and governance options. The presentation concluded with the meeting moving on to other business; the commissioners voted to approve the day's summary notes before adjournment.

Why it matters: presenters framed the recommendations as both a health and an economic strategy — reducing preventable hospitalizations and uncompensated care, freeing capacity for specialty services, supporting workforce productivity, and helping the region compete for employers that consider health infrastructure in site-selection decisions.

The PACE report and presenters did not propose a single, final funding plan at the meeting; rather, they recommended a set of options for study, asked local leaders to consider forming a central coordinating entity, and urged deliberate public education and stakeholder engagement before any referendum or legislative request.