SAN ANTONIO — Bexar County officials are considering changes to the county’s preventive health programs as federal pandemic relief funding expires at the end of 2026 and budget pressures grow.
The county created its Preventive Health Division in 2022 using American Rescue Plan Act (ARPA) funds. The division now operates on an annual budget of about $10 million and has 28 staff positions, according to a county budget document.
The division supports programs addressing domestic violence, elder abuse, health education, healthcare access and other public health initiatives.
County commissioners are now considering whether some programs should continue under the county, face cuts or move to University Health’s Public Health Division, which also received temporary ARPA funding when it launched in 2022.
During an Aug. 4 Commissioners Court meeting, Commissioners Grant Moody and Justin Rodriguez raised the possibility of consolidating some public health efforts with University Health.
“A public health consolidation between [University Health] and between Bexar County makes a lot of sense,” Moody said. “How can we streamline that and make it more effective and save taxpayer dollars?”
Rodriguez said the county would need to determine how to continue programs that officials consider effective after ARPA funding ends.
“We are having to make tough decisions here at the county related to the ARPA dollars coming off,” Rodriguez said. “There are some programs that we established with ARPA dollars specifically in preventative health [and] behavioral health that we’re going to have to figure out a way to put our heads together and continue some of those programs, because they have been impactful.”
Programs expanded after pandemic
Bexar County established the Department of Preventative Health and Environmental Services in 2022 after setting aside $60 million in ARPA funds to expand public health services.
The department absorbed existing county functions, including animal control and behavioral health, while creating the Preventive Health Division.
The county initially approved about $2 million in annual funding for the new division, which later expanded its staff and budget.
The division now includes a population health data manager, public information officer and more than a dozen domestic violence case managers.
Its Safety Team Active Response program assists victims of domestic violence, while the Senior Justice Assessment Center investigates and reviews cases involving elder abuse, exploitation and neglect.
The division also has supported youth and family resilience programs, healthy eating and exercise initiatives and healthcare access efforts, including mobile clinics serving communities outside San Antonio.
Much of the division’s work grew from concerns about health disparities highlighted during the COVID-19 pandemic. Lower-income areas of Bexar County experienced higher rates of chronic conditions and COVID-19 deaths than more affluent areas.
Former Bexar County Judge Nelson Wolff, who helped establish the division, said he had hoped the county would place greater emphasis on preventing illness rather than relying mainly on acute medical care.
However, Wolff said he was unsure whether the division had achieved its intended goals.
“I don’t know whether they’ve done any good with it or not,” Wolff said. “Maybe just another bureaucratic department, as far as I know, and if that’s true, then there’s no need to have it.”
County considers consolidation
University Health created its own Public Health Division in 2022 with ARPA funding. The division operates separately from the county and maintains emergency preparedness programs, school-based health centers, an emerging infectious disease identification lab and HIV/AIDS outreach.
Moody and Rodriguez suggested that University Health could take on some county programs as officials look for ways to maintain services after federal funding expires.
Bexar County Judge Peter Sakai said the county is reviewing positions funded through ARPA and determining which ones could remain.
“We are now going through a review and analysis of all the ARPA positions, and one of the difficult discussions that will be had in this time period is what positions will remain,” Sakai said in July.
The county has not determined which programs or positions could face cuts or transfer to University Health.
Commissioners are expected to continue discussing the future of the preventive health programs in the coming months as the county prepares for the expiration of ARPA funding at the end of 2026.