Travis County Commissioners Court approved Central Health's $240 million fiscal year 2016-17 budget and tax rate Tuesday amid feedback from some residents who think the county’s health care district should be scrutinized for its spending and what some have called a lack of transparency. The five-member court voted 4-0 to approve the budget and tax rate, with Precinct One Commissioner Ron Davis abstaining after telling the court he wants "to send to clear message to both sides that they need to get together," and noting the transparency concerns. The court also ordered Central Health develop a proposal to allow for regular financial reviews. The budget’s major expenditures include health care delivery initiatives, such as helping provide primary care, specialty care and behavioral health services; University Medical Center Brackenridge campus redevelopment plans; and Affordable Care Act education and enrollment efforts. Central Health's total property tax revenue of $169.8 million is its largest revenue source; the second largest source is Seton Healthcare Family lease revenue for the University Medical Center Brackenridge property, budgeted this year at $31.5 million. Public concerns In a letter to the court Monday, Austin attorney Fred Lewis said the county should not approve Central Health’s budget until the public health agency agrees to comply with an independent third-party audit and share more information about how it spends taxpayer funds. At the meeting, Lewis told the court Central Health has not adequately proven that it is serving its mission to provide health care to low-income and uninsured residents with the $70 million it has paid in the past two years to The University of Texas at Austin’s Dell Medical School. “Central Health has spent several hundreds of millions of dollars without providing to date any detailed documentation that these funds have gone to indigent health care,” Lewis told the court. “It matters because Texas has very limited Medicaid funding and there are 200,000 Travis County residents without any health coverage. Central Health’s funds should … only go to indigent health care.” Members of the community spoke about long wait times for sub-specialty care, with some citing yearlong waits. Clay Johnston, dean of the UT Dell Medical School, said the university is working with Central Health to address the long wait list for sub-specialty care and to begin a pilot program this year that would shorten wait times for patients who need urgent care, in some cases to 25 days. Frank Rodriguez, president and CEO of the Latino HealthCare Forum and a founding board member for Central Health, said on Tuesday he is concerned Central Health is relying on reserves to balance its budget. “You’ll see a troubling pathway where Central Health is going to have to increase taxes considerably to fund its current operations,” he said. Central Health President and CEO Patricia Young Brown said in her remarks to the court that the agency does not use reserves to balance budgets. "It's a misunderstanding to think we've been balancing our budget through contingency reserves," Young Brown said. Ellen Richards, chief strategy officer of Austin Travis County Integral Care, spoke in support of the budget and explained funding from Central Health helps ATCIC support critical areas including in-patient care for people who experience psychiatric crises but cannot pay for services. Representatives from local nonprofits including Health Alliance for Austin Musicians and United Way of Greater Austin also spoke in support of the budget. About Central Health Since its inception in 2004, Central Health has aimed to create what Young Brown calls a “system of care” that provides access to health care for low-income and uninsured residents in Travis County. Central Health leverages federal funds through a system called intergovernmental transfer that involves matched dollars for every local dollar of tax revenue. The proposed tax rate for FY 2016-17 is 11.0541 cents per $100 valuation, a decrease of the FY 2015-16 tax rate of 11.7781 cents per $100 of valuation. Central Health discussed its five-year outlook at a May board meeting and expects to spend more money as the vulnerable population in Travis County rises during the next five years. Additional reporting by Evan Marczynski.