Podsession

Texas Medicaid: A Waiting Game That’s Killing Families

View the Texas Watchdog article Texas Medicaid: A Waiting Game That’s Killing Families here. 

For families with special needs children in Texas, hope comes with an expiration date. Caught in the convoluted web of the Texas Medicaid Waiver system, thousands of families are left waiting — not just for services, but for relief from a state-run program that seems designed to fail them. With more than 158,000 individuals trapped on waitlists, some waiting over a decade for basic support, the Texas Medicaid Waiver system is less a safety net and more a bureaucratic hell. Promises of home and community-based services (HCBS) remain just that: promises that rarely come to fruition. What should be a compassionate system has instead turned into a slow, suffocating disaster for the most vulnerable.

The Texas Medicaid Waiting List: A Decade of Limbo

A System Designed to Delay

Texas’s Medicaid Waiver system operates like a dystopian lottery. More than 158,000 people are on various interest lists for Medicaid Waiver programs, including Home and Community-Based Services (HCBS), Texas Home Living (TxHmL), Community Living Assistance and Support Services (CLASS), and the Deaf Blind with Multiple Disabilities (DBMD) program. While these programs are designed to help families avoid institutionalization, the reality is far more grim. Some families have been waiting for services for over 16 years — long enough that their children may never receive the assistance they need during their most formative years.

Slots That Never Open

The Texas Health and Human Services Commission (HHSC) has recently approved the release of a meager 1,549 slots across various waiver programs for the 2022–2023 biennium. That number — 1,549 — is absurdly small when compared to the 158,000 still waiting. It’s an insult to families who are desperately hanging on, hoping their child will get one of those golden tickets. But the math is unforgiving: the chances of receiving assistance before it’s too late are slim to none. Families who don’t secure these slots are left to fend for themselves, forced into making impossible decisions — like whether to give up full-time work to care for their child, or, in the worst cases, institutionalize them.

Delayed Funding: When Bureaucracy Becomes a Death Sentence

A State That Can’t Keep Up

Texas doesn’t just have a waitlist problem; it has a funding problem. The federal government mandates that Medicaid applications be processed within 45 days, but Texas has blown past that timeline for years. As of January 2024, nearly 40% of Medicaid applications in the state were taking longer than the required timeframe. These delays leave families without access to healthcare and force them to make desperate choices, like delaying critical medical treatments or paying out of pocket for care they can’t afford. For many, this backlog isn’t just an inconvenience — it’s a life-threatening crisis.

Healthcare Providers Strangled by Delays

Delayed funding doesn’t just affect the families; it strangles healthcare providers too. Texas Children’s Hospital, the largest pediatric hospital in the country, has been forced to lay off employees and cut services due to delayed Medicaid reimbursements. Safety net clinics across Texas, already operating on razor-thin margins, have reported a 30% decrease in Medicaid revenue as families lose coverage or wait indefinitely for approvals. The result? Service cuts, layoffs, and an increasing number of families left without care. Clinics that serve low-income and rural communities — already some of the most vulnerable populations — are teetering on the edge of financial collapse.

Legislative Paralysis: The Ideological Stalemate on Medicaid Expansion

Refusal to Expand Medicaid

At the heart of Texas’s Medicaid crisis is its stubborn refusal to expand Medicaid under the Affordable Care Act (ACA). Texas remains one of only ten states that have yet to adopt Medicaid expansion, leaving an estimated 1.4 million low-income adults without coverage. This refusal is a political choice, not a fiscal necessity. Expansion would bring billions in federal funding into the state, easing the pressure on both hospitals and families, but Texas’s Republican leadership has turned it into a political hill to die on — even if that means millions are left without healthcare.

Abbott and Paxton: Playing Politics with People’s Lives

Governor Greg Abbott and Attorney General Ken Paxton have been instrumental in fighting federal pressure to expand Medicaid. When the Biden administration rescinded a Trump-era extension of Texas’s Medicaid waiver, Paxton didn’t look for solutions — he filed a lawsuit. It’s all part of a long-standing ideological war against federal intervention, but the victims of this war aren’t bureaucrats or politicians. They’re families with disabled children who can’t get the care they need because Texas refuses to admit that Medicaid expansion is the right thing to do.

The Real Victims: Families Devastated by Inaction

Stories of Struggle and Survival

For the families waiting on the Medicaid Waiver system, life is a constant struggle against a ticking clock. Micaela Hoops, a North Texas mother, found herself buried under a $3,000 hospital bill after losing her son’s Medicaid coverage due to a procedural error. This isn’t an isolated case — it’s the everyday reality for thousands of families across Texas. Many are forced to take on massive debt to cover medical expenses or forego treatment altogether. And it’s not just about the money. The emotional toll on these families is devastating. Parents are pushed to their limits, often having to quit their jobs to provide full-time care for their children while waiting for Medicaid services that may never come.

Economic and Emotional Devastation

For families who are already financially strained, these delays and denials are catastrophic. Many are one medical bill away from financial ruin. Families are choosing between paying rent and paying for their child’s medical equipment. The constant stress of navigating a broken system takes a toll on mental health as well. The emotional exhaustion of fighting for care — all while watching your child suffer — is more than most people can bear. In a state that prides itself on family values, these families are left abandoned.

Comparing Texas to Other States: The Model of Failure

Medicaid Expansion That Works Elsewhere

Texas isn’t the only state that has struggled with Medicaid, but it’s one of the few that has refused to fix the problem. In contrast, states like Oregon, Minnesota, and Louisiana have embraced Medicaid expansion and implemented efficient systems that automatically renew coverage for eligible individuals. Louisiana, for example, uses an express lane eligibility process that pulls data from SNAP applications to automatically renew Medicaid for families. It’s a system that cuts down on paperwork, reduces wait times, and keeps families insured.

Texas’s Pathetic Performance

Meanwhile, Texas’s Medicaid renewal rate is embarrassingly low. While states like Oklahoma and Washington have ex parte renewal rates of over 75%, Texas limps along at 3.7%. The difference is stark: in states where Medicaid has been expanded and streamlined, families get the care they need without constant delays and roadblocks. In Texas, however, the system is built to fail, trapping families in a cycle of bureaucratic red tape and endless waiting.

Economic Impact: The Hidden Costs of Medicaid Failures

The Economic Fallout

Texas’s refusal to fix its Medicaid Waiver system comes with a price tag that extends far beyond the healthcare industry. The Perryman Group estimates that Medicaid disenrollment in Texas could result in a staggering $58.9 billion loss in gross product annually, along with the elimination of 509,200 jobs. These are numbers that should set off alarm bells, but the state’s leadership remains unmoved. The economic ripple effect is undeniable. Families who lose Medicaid coverage are forced to spend more out of pocket on medical care, which means less disposable income for everything else. Small businesses suffer, local economies stagnate, and communities fall further into poverty.

Uncompensated Care and Collapsing Clinics

Uncompensated care costs are skyrocketing as hospitals and clinics treat patients who can’t pay for services. Many healthcare providers, especially in rural areas, are being forced to close their doors because they simply can’t survive without timely Medicaid reimbursements. For rural communities, the loss of a clinic or hospital often means losing the only accessible medical care for miles. Texas is bleeding from the inside out, and the state’s refusal to fix Medicaid is at the heart of the problem.

The Human Cost: Children Left Behind

Children Paying the Ultimate Price

The long-term effects of Medicaid failures on children are the most heartbreaking aspect of this crisis. Children with severe medical needs, like those with autism, cerebral palsy, or neurodevelopmental delays, are missing out on crucial treatments because of Texas’s Medicaid disaster. Research has shown that children with continuous Medicaid coverage fare better in school, have lower mortality rates, and experience fewer health complications as adults. Texas is condemning these children to lives of struggle by denying them the services they need at critical developmental stages.

A Generation Sacrificed

As of March 2024, more than 1.35 million children had lost Medicaid coverage due to administrative issues, not because they were ineligible. This isn’t just a healthcare problem — it’s a ticking time bomb for the state’s future. Children without healthcare are more likely to suffer academically, drop out of school, and face lifelong economic hardships. Texas is sacrificing an entire generation on the altar of political ideology, and the consequences will be felt for decades.

A State That Refuses to Care

The Texas Medicaid Waiver system is a moral and economic failure. It’s a system designed to keep families waiting, suffocating them under layers of bureaucracy until they either give up or their needs become too urgent to ignore. For the 158,000 families on the waitlist, every day is a reminder that Texas values budget cuts over human lives. The state’s refusal to expand Medicaid or even streamline its processes is nothing short of a dereliction of duty. Until Texas confronts the reality that its Medicaid system is broken, families will continue to suffer — and the most vulnerable will continue to pay the ultimate price.

View our sources and citations in our research document here.

Parks and Desperation: How Texas Prioritizes Trails and Trees While Neglecting Its Most Vulnerable Citizens

Visit the Texas Watchdog article Parks and Desperation: How Texas Prioritizes Trails and Trees While Neglecting Its Most Vulnerable Citizens here. 

In Texas, where political bluster about freedom and family values is as commonplace as cowboy hats, the state has quietly written a $1 billion check to expand its network of state parks. On the surface, it’s an easy win for lawmakers on both sides of the aisle. Who doesn’t love parks? Picturesque trails, rolling hills, and serene lakes make for fantastic photo ops and good press. But while politicians congratulate themselves for preserving open spaces, another group of Texans has been relegated to the margins: individuals with intellectual and developmental disabilities (IDD).

The same state that found $1 billion to throw at its state parks could only muster up a measly $75 million for services designed to support people with IDD. These are citizens — Texans — who are desperately waiting for care, stuck on Medicaid waiver waitlists that stretch over a decade long. It’s not just a funding oversight; it’s a deliberate choice, one that says loud and clear what the state prioritizes. Parks are scenic, profitable, and popular; people with disabilities are none of those things, and it shows in the budget.

A Billion-Dollar Distraction: The Inordinate Focus on Parks

The $1 billion set aside for parks is a massive windfall for Texas’s natural recreation areas. It will expand current parks, fund the creation of new ones, and help conserve historical sites. The Sporting Goods Sales Tax (SGST), a dedicated revenue stream, ensures that the state has a pot of money specifically earmarked for such projects. On paper, it sounds great — a rare example of a government program that’s well-funded and proactive.

But this is a state that still has more than 156,000 individuals waiting for crucial services through Medicaid waiver programs. These waivers, designed to help individuals with IDD live at home and avoid institutionalization, are as backed up as a traffic jam on I-35. Some people have been on the waitlist for as long as 16 years — longer than most state parks have even existed.

While the SGST ensures that parks will flourish, the funding for IDD services is cobbled together through a combination of state and federal Medicaid money. It’s an entirely different — and far less glamorous — budget conversation. While parks expansion has the potential to boost tourism and generate revenue, services for people with disabilities offer none of those economic boons. Instead, they offer something far less quantifiable: dignity and survival for thousands of people who have no other options.

Neglecting the Vulnerable: The State’s Token Funding for IDD Services

Texas’s budget for IDD services is nothing short of an insult. The state allocated $75 million in the 2023–2024 budget for IDD services, a figure that’s laughably small in comparison to the need. The average wait time for IDD services in Texas is 16 years, with some families waiting as long as 19 years for help. That’s not a misprint: nearly two decades of waiting for support that can mean the difference between life at home and institutionalization.

For these families, the $75 million is a drop in the bucket, offering little hope of clearing the immense backlog of waiver applicants. The reality is that thousands of people are languishing on waitlists, stuck in limbo as they await basic services. Meanwhile, $1 billion is being spent on making sure Texans can enjoy a hike or a kayak ride on their weekends.

The truth is stark: In Texas, it’s easier to secure funding for trees and trails than it is to ensure that individuals with disabilities can live with dignity. This isn’t just an oversight in the budget; it’s a statement of values. And those values suggest that, in Texas, the needs of vulnerable individuals rank far below the desire for more parks.

What $75 Million Buys for IDD vs. $1 Billion for Parks

To put things in perspective, let’s break down what $1 billion could do if it were redirected from parks to IDD services. With $1 billion, Texas could vastly expand the number of Medicaid waiver slots available, drastically reducing the years-long waitlists. It could provide a living wage to the state’s Direct Support Professionals (DSPs), who currently earn a paltry average of $10.60 an hour. It could help fund desperately needed respite care services for families who are stretched to the breaking point as they care for their disabled loved ones 24/7.

Instead, the $1 billion is being used to buy a feel-good project for lawmakers, something they can point to in the next election cycle as a win for Texans. The state’s parks are a priority because they’re a visible, tangible investment. People can visit a park and see where their tax dollars went. The same can’t be said for IDD services. They’re hidden away, affecting a population that doesn’t have the luxury of public visibility or political clout.

Meanwhile, $75 million for IDD services doesn’t even begin to cover the gaps in care. The state’s budget for IDD services is barely enough to maintain the status quo, let alone reduce the overwhelming waitlists. This is the grim reality for families in Texas: Parks are expanding, but for those caring for loved ones with disabilities, the future looks as bleak as ever.

The Politics of Parks: Why Nature Wins and IDD Services Lose

So why does Texas spend more on parks than on its most vulnerable citizens? Part of the answer lies in how park funding is structured. The SGST ensures a dedicated and consistent stream of revenue for parks and historical sites. It’s politically neutral and draws bipartisan support because everyone benefits from parks — families, tourists, and businesses alike. Parks are easy to sell because they’re public-facing, aesthetically pleasing, and offer economic opportunities.

Contrast that with IDD services, which rely on a mix of state and federal Medicaid funding. This system is a political landmine, involving complex bureaucracies and requiring constant oversight. It’s easy for lawmakers to ignore or underfund these services because the people affected are often out of sight, out of mind. For most Texans, Medicaid waiver waitlists are an abstract concept. But a new park? That’s something everyone can rally around.

A System Already Failing: The IDD Waitlist Crisis

While lawmakers celebrate the expansion of state parks, Texas’s Medicaid waiver system is crumbling under the weight of its own failures. As of December 2022, the state had 156,000 unduplicated individuals on waitlists for Medicaid waiver programs. These programs are critical for people with IDD, offering them the services they need to live in their communities rather than in institutions.

But these services are out of reach for most. Families apply for Medicaid waivers when their children are young, knowing that it will take years — sometimes decades — before they receive any help. The waitlists are so long that many individuals age out of the services they need before they ever reach the top of the list. This isn’t just a bureaucratic failure; it’s a human tragedy that plays out in real time, year after year, as thousands of Texans with IDD go without the care they need.

The Economic Myth: Why Texas Thinks Parks Are an Economic Boon

One of the arguments used to justify the $1 billion park budget is that parks are good for the economy. They boost tourism, drive local development, and provide recreational spaces that contribute to a higher quality of life. And while all of this is true to some extent, the economic benefits of parks are often overstated. Yes, parks can bring in revenue, but they won’t fix the systemic issues plaguing Texas’s social services infrastructure.

In contrast, investing in IDD services would provide a long-term economic benefit that far outweighs any gains from park tourism. Families would be able to continue working if they had access to respite care. Healthcare costs would decrease as fewer people with IDD end up in emergency rooms or long-term care facilities due to lack of support. And the state’s Direct Support Professional workforce, which currently faces high turnover due to low wages, would stabilize, providing more consistent and reliable care for those in need.

But this kind of investment doesn’t come with the immediate, visible returns that parks do. It’s not something lawmakers can point to on a map or tout in campaign ads. It’s the quiet, behind-the-scenes work of taking care of the state’s most vulnerable citizens, and in Texas, that kind of work simply doesn’t get funded.

The Real Human Cost: Stories from the IDD Community

For the families caught in Texas’s Medicaid waiver nightmare, every day is a battle against a system that has forgotten them. Take the story of Juanita, a mother in Austin whose son, diagnosed with severe autism, has been on the waitlist for services for nearly 14 years. Juanita’s son is now 22, and without support, she’s been forced to quit her job to provide around-the-clock care. Her family is barely scraping by, and the emotional toll is unbearable. But for the state of Texas, Juanita and her son are just numbers on a spreadsheet.

There’s also the case of Michael, a 34-year-old man with Down syndrome who’s been waiting for services since he was a teenager. His parents, now in their 60s, are exhausted. They’ve spent years advocating, filling out paperwork, and navigating the labyrinthine Medicaid system, only to be met with endless delays and excuses. As Michael ages, the likelihood that he’ll ever receive the services he needs dwindles, leaving his parents to wonder what will happen when they’re no longer able to care for him.

These aren’t isolated incidents — they’re emblematic of the broader crisis facing the IDD community in Texas. For these families, the state’s decision to prioritize parks over people isn’t just frustrating; it’s a betrayal.

Workforce Crisis: The Consequences of Underpaying Care Workers

The lack of funding for IDD services has created a workforce crisis that is spiraling out of control. Direct Support Professionals (DSPs) are the backbone of care for individuals with IDD, yet they’re paid less than most fast-food workers. The average DSP in Texas makes $10.60 an hour, a wage so low that many are forced to take on second jobs just to make ends meet. It’s no wonder, then, that turnover in this field is astronomical.

Without adequate pay, it’s impossible to retain skilled and compassionate care workers. As a result, people with IDD are often left with inconsistent or substandard care. High turnover also means that families must constantly train new caregivers, adding to their already overwhelming burden.

By refusing to invest in the DSP workforce, Texas is ensuring that the quality of care for people with IDD remains abysmal. This is the direct result of underfunding — a problem that $1 billion could have gone a long way toward solving.

Misaligned Priorities: Parks Get Visibility, IDD Services Remain Invisible

The disparity between park funding and IDD services comes down to one thing: visibility. Parks are tangible, photogenic, and popular. IDD services, on the other hand, are invisible to most people. They exist in the private homes of struggling families, behind the walls of institutions, and in the paperwork of Medicaid offices.

It’s easier for lawmakers to justify a massive investment in parks because the benefits are obvious. People use parks. They see the trails, the trees, the lakes. They can point to a park and say, “This is where our tax dollars went.” But with IDD services, the benefits are harder to see. They’re hidden behind layers of bureaucracy, and the people who rely on them aren’t in a position to advocate for themselves.

Moral Failure: What This Says About Texas’s Values

The $1 billion park budget and the paltry $75 million for IDD services speak volumes about Texas’s values. The state has chosen to prioritize recreation over the basic needs of its most vulnerable citizens. It’s a moral failure on an epic scale, one that reflects a deep-seated indifference to the lives of people with disabilities.

The contrast between these two budget items raises serious questions about equity and justice in Texas. By spending more on parks than on services for people with disabilities, the state is effectively saying that some lives matter more than others. It’s a stark reminder that, in Texas, those who can’t advocate for themselves are left to fall through the cracks.

What Needs to Change: Real Solutions for the IDD Funding Crisis

The solutions to Texas’s IDD funding crisis are not difficult to identify — they’re just difficult to enact because they require a shift in priorities. First, Texas needs to significantly increase its investment in Medicaid waiver programs. The $75 million currently allocated is nowhere near enough to meet the needs of the 156,000 people on the waitlist.

Second, the state must address the DSP wage crisis. Raising wages for care workers would not only improve the quality of care for individuals with IDD, but it would also help stabilize the workforce and reduce turnover. A living wage for DSPs would go a long way toward ensuring that people with IDD receive consistent, compassionate care.

Finally, Texas must confront its legislative and moral failures head-on. Lawmakers need to acknowledge that parks, while valuable, cannot come at the expense of human lives. It’s time for a balanced budget that reflects the state’s commitment to all of its citizens, not just the ones who enjoy a hike in the park.

A State That Prioritizes Parks Over People

Texas’s decision to allocate $1 billion to state parks while only budgeting $75 million for IDD services is more than just a budgetary oversight — it’s a reflection of the state’s values. It’s a statement that parks and recreation are more important than the dignity and well-being of individuals with intellectual and developmental disabilities.

As long as this disparity exists, families like Juanita’s and Michael’s will continue to struggle in silence, while politicians pat themselves on the back for expanding Texas’s parks. Until Texas decides to prioritize its most vulnerable citizens, the waitlists will grow, the workforce will collapse, and the state will remain a place where it’s easier to build a park than to care for a person.

View our citations and sources in our research document here. 

Texas’s State-Sponsored Hell: The Corrupt, Abusive, and Politically-Protected Disaster of State Supported Living Centers

View the Texas Watchdog article Texas’s State-Sponsored Hell: The Corrupt, Abusive, and Politically-Protected Disaster of State Supported Living Centers here. 

In Texas, they like to say everything’s bigger. Bigger trucks, bigger steaks, bigger ego. But what they don’t talk about are the bigger scandals, the bigger failures, and the bigger, uglier bureaucratic monstrosities that exist just under the surface. Take, for example, the State Supported Living Centers (SSLCs), a chain of facilities ostensibly designed to care for people with intellectual and developmental disabilities (IDD). They should be bastions of compassionate care, but instead, they’ve become the embodiment of Texas’s worst attributes: cruelty, corruption, and cover-ups.

What Texas has built here is nothing short of a state-sponsored hell. It’s a place where the most vulnerable are subjected to unimaginable abuse, where staff members — paid by the taxpayer — are free to run their own Fight Club, and where neglect leads to death, all while the government looks the other way. And why wouldn’t they? Protecting the SSLC system is easier than reforming it, and no politician wants to risk losing votes by shutting down a local institution, no matter how rotten it is inside.

So here we are, in the great state of Texas, where oil flows and the money’s green, but if you happen to be disabled and in need of care, well, God help you. Because the Texas government sure won’t.

Fight Club and Abuse: The Texas Tradition of Institutional Cruelty

You’ve probably heard of Fight Club, that Brad Pitt movie where disillusioned men punch each other into oblivion for sport. Well, Texas’s SSLCs decided to make their own version — except the participants weren’t movie characters; they were real people, many of them non-verbal and severely autistic. And instead of it being a voluntary activity, it was coerced by the very people hired to care for them. The Corpus Christi SSLC Fight Club scandal in 2009 wasn’t just some isolated incident, either. It was a snapshot of the systemic abuse rotting away at these centers.

You see, staff members at Corpus Christi didn’t just take advantage of their vulnerable charges; they made a game of it. They forced residents to fight each other for their own twisted entertainment, treating human beings like pit bulls in an underground fight ring. Non-verbal individuals, incapable of reporting the abuse, were pitted against one another while staff members watched and, in some cases, filmed. It’s a scandal so grotesque that it sounds like fiction — but it’s real, and it’s just the tip of the iceberg.

Physical abuse, sexual abuse, neglect — you name it, SSLC residents have suffered it. Sean Yates, a non-verbal man with Asperger’s syndrome, died after escaping from the Corpus Christi SSLC. The staff didn’t even bother to inform his family of the abuse he endured in the Fight Club. He wasn’t the first, and he certainly won’t be the last, to meet a tragic end while under state “care.” The Lubbock SSLC saw 17 deaths in one year — 17! — under suspicious circumstances. Imagine if 17 people died mysteriously in a single high school or a corporate office. There would be public outcry, investigations, accountability. But here, in the state-run nightmare that is SSLCs, silence reigns.

The Texas Legislature’s Complicity: A System Built to Fail

So why does this system persist? Why, after multiple investigations, lawsuits, and even a $112 million settlement with the Department of Justice in 2009, do these atrocities continue? The answer lies in the Texas Legislature — those fine, upstanding politicians who love to beat their chests about “freedom” and “justice” while ignoring the rampant human rights violations happening under their noses.

You’d think the people responsible for crafting laws would have some interest in stopping the abuse, but you’d be wrong. Instead, they’ve built a system designed to protect itself. SSLCs provide jobs, and politicians — ever mindful of their reelection prospects — aren’t about to shutter a major employer in their district. That’s all that matters. Forget about the 3,000 abuse, neglect, and exploitation allegations reported annually in the SSLCs. Forget about the deaths, the beatings, the sexual assaults. No politician in Texas wants to be the one to cut jobs, especially not in rural districts where SSLCs are often the largest employer.

And then there’s the Texas Health and Human Services Commission (HHSC), the agency responsible for overseeing these institutions. HHSC has repeatedly failed to enforce any meaningful oversight. Year after year, the commission lets things slide. Instead of closing these facilities or holding staff accountable, they respond with cosmetic reforms, like increasing fines for violations — a Band-Aid on a bullet wound.

Let’s face it: the Texas government doesn’t give a damn about the disabled people suffering inside these walls. What they care about is money, power, and political expediency. It’s easier to let the SSLC system continue to rot than to fix it, easier to defend the status quo than to risk a political backlash by shutting them down.

Institutionalized Hell: The Persistence of Abuse

Now, you might think the 2009 DOJ settlement would’ve fixed things. After all, $112 million and a commitment to reform sound like a pretty big deal, right? Wrong. Nearly 15 years later, SSLCs are still riddled with the same issues — understaffing, underfunding, and unrelenting abuse. In 2024, SSLCs are complying with only 42.9% of the provisions laid out in the DOJ settlement. Think about that for a second. Nearly 60% of the reforms promised haven’t even been touched.

And if you ask the politicians, they’ll say the problem is too complex to solve overnight. Complex? Really? Let’s break this down: stop the beatings, stop the sexual abuse, stop the neglect. Hire enough qualified staff, fire the abusers, and close the worst institutions. How is this complex? It’s not — it’s a choice. A choice to prioritize jobs and lobbyists over human lives, a choice to sweep abuse under the rug rather than face the political consequences of real reform.

Meanwhile, staffing shortages have reached crisis levels. SSLC employees are overworked and underpaid, forced to work shifts that stretch over 70 hours a week. It’s no wonder abuse happens; the system is designed to break people. And break them it does. At least 600 caregivers were injured between 2017 and 2022. Some were attacked by residents, but let’s be real — if you cage people in an abusive, neglectful environment, violence is inevitable.

Cost Over Care: Texas’s Budgetary Insanity

What makes this even more infuriating is the sheer waste of taxpayer dollars. Texas spends $661.9 million a year on these institutions, with per-resident costs exceeding $120,000. That’s more than twice the cost of community-based care, which averages $50,000 per year. So not only is Texas locking people up in abusive institutions, it’s paying extra to do it. This is fiscal conservatism, Texas-style: waste more money to do a worse job.

The Texas Legislature’s answer to this mess? Keep the SSLCs open, ignore the systemic abuse, and keep funneling taxpayer dollars into a system that doesn’t work. Meanwhile, the state’s community-based care programs — which could actually provide a better, more humane solution — are woefully underfunded. The waitlist for these programs is seven years long. Seven years! That’s longer than most Texans serve in elected office. So families, left with no options, send their loved ones into SSLCs, knowing full well what could happen. It’s a devil’s bargain, forced on them by a system that treats people with disabilities as disposable.

Families Trapped by a Corrupt System

It’s easy to look at this situation from a distance and wonder why families haven’t rebelled en masse. Why, after all these years, do families still send their loved ones to SSLCs, knowing the horrors inside? The answer is brutally simple: they don’t have a choice.

Texas’s community-based services are a joke. The waitlists are longer than a Texas summer, and families are left with few alternatives. And when families do speak out — when they sue for wrongful deaths, for abuse, for the negligence that led to their loved one’s death — they run into a brick wall of bureaucratic red tape and judicial indifference.

Take the case of David Paul Taylor, whose parents sued after he died while in the care of the Richmond SSLC. They alleged that the facility refused to provide necessary care because of his disabilities, and that refusal led to his death. The case went to court, but like so many others, it was swallowed up in the endless legal wrangling that defines the SSLC system.

Even whistleblowers, people inside the system who try to expose the corruption, face retaliation. Linda Moore, a former employee of the Lubbock SSLC, filed a lawsuit under the Texas Whistleblower Act after she was fired for reporting violations. What happened? The state fought her tooth and nail in court. That’s the Texas way: protect the institution, punish the truth-teller.

SSLCs: Political Lifelines, Not Care Institutions

When you look at the systemic abuses rampant in Texas’s State Supported Living Centers (SSLCs) — the beatings, the deaths, the criminal neglect — the question everyone asks is, why? Why do these places, which are little more than state-run warehouses for the disabled, stay open? If they cost more than community care, if they’re as dangerous as the data and lawsuits suggest, why are they still allowed to exist? The answer, like most things in Texas politics, is simple: power, money, and political survival.

Here’s the dirty secret about SSLCs: they’re not kept open for the benefit of the residents. They’re kept open for the benefit of politicians, their donors, and the local economies that rely on these institutions for jobs. If you think Texas politicians are going to risk upsetting their voters by shutting down a major employer in a rural district, you clearly don’t know how Texas works.

SSLCs are political lifelines. They’re job engines, and those jobs — however dysfunctional the work environment might be — translate into votes. In districts where these facilities are often among the largest employers, shutting them down would be political suicide. It’s not about protecting the people inside, it’s about protecting the political careers of those on the outside.

Let’s break it down: Texas’s rural economies are fragile. Many of these areas rely heavily on a few major employers — hospitals, schools, prisons, and yes, SSLCs. These institutions pump money into local economies, providing stable jobs in places where those are in short supply. In some towns, the SSLC is the only major employer, meaning that if it were to close, there’d be an economic collapse. Politicians know this, and they know that a vote to close one of these facilities is a vote to destroy jobs, alienate voters, and, ultimately, lose elections.

The Political Power of Local Interests

This is where it gets really twisted: the people fighting to keep SSLCs open aren’t the families of residents or even disability rights advocates — they’re local politicians, lobbyists, and contractors. These are the people who benefit from the status quo. They’re the ones who secure lucrative state contracts to provide services to the SSLCs, the ones who campaign on promises of keeping local jobs intact, and the ones who funnel money back into their political campaigns from grateful donors who work at these facilities.

It’s a closed loop: SSLCs employ hundreds of workers in rural districts. These workers, in turn, form the backbone of local economies. Politicians, knowing they need to maintain employment rates to stay in power, defend these institutions, even when reports of abuse and neglect surface. It’s not that they’re unaware of the problems; they’re very aware. But political expediency demands that the system remains untouched.

In fact, several Texas lawmakers have gone so far as to champion the SSLCs as essential parts of the state’s infrastructure. In public hearings, they’ll talk about how these institutions are critical for providing care to the “most severely disabled.” Behind closed doors, though, they’re protecting their political futures and keeping a steady stream of contracts flowing to local contractors.

And if you’re waiting for Governor Greg Abbott or Lieutenant Governor Dan Patrick to step in and demand reform, don’t hold your breath. Abbott has shown little interest in challenging the powerful rural interests that keep the SSLCs alive. He’s built his political career on catering to local business interests, and those interests — whether they involve prisons, oil, or state-run institutions like SSLCs — come before the residents suffering inside. Abbott isn’t a reformer; he’s a protector of the status quo, and that means SSLCs will keep operating no matter how many reports of abuse surface.

SSLCs and the Texas Political Machine

If you want to see the Texas political machine in action, look no further than the Sunset Advisory Commission’s 2020 recommendation to close six of the worst-performing SSLCs. That report should’ve been the nail in the coffin. It laid out the clear evidence: these facilities were not only abusive but also hemorrhaging money. Closing them would save taxpayer dollars and improve care for residents by shifting resources to community-based services.

What happened? Nothing. Absolutely nothing.

The proposal was shot down faster than you could say “reelection campaign.” Local politicians, bolstered by lobbyists representing the institutions and their contractors, fought tooth and nail to keep the SSLCs open. They rallied voters with scare tactics, claiming that closing the SSLCs would leave disabled residents with nowhere to go (conveniently ignoring the fact that better care options exist). They cried about job losses, about the importance of “keeping our communities strong.” And they won. The recommendation was shelved, and the SSLCs continued business as usual — abuse, neglect, and all.

This is the core of the problem: Texas politics isn’t driven by what’s best for the people; it’s driven by what’s best for the people in power. The SSLCs are allowed to remain open, despite the overwhelming evidence of their failures, because shutting them down would create short-term political pain for the lawmakers who represent the areas where they’re located. And if there’s one thing Texas politicians hate more than accountability, it’s the idea of losing power.

Why the Legislature Won’t Reform the System

Every few years, someone in the Texas Legislature proposes reforming the SSLC system. They’ll suggest increasing oversight, raising pay for staff, or improving conditions for residents. These proposals are always dead on arrival. Why? Because reform threatens the entire political ecosystem that keeps SSLCs running.

Closing or reforming SSLCs would mean upending a system that benefits far too many powerful people. It would mean cutting off state contracts for private companies that provide food, medical supplies, and other services to these institutions. It would mean firing staff, many of whom are politically connected. It would mean challenging the local economies that depend on these institutions for survival. And Texas politicians simply aren’t willing to take that risk.

Instead, they choose to double down on a system that everyone knows is broken. They’ll pass some cosmetic reforms — maybe increase funding by a few million dollars here or there — but the core of the system remains untouched. The SSLCs continue to operate as little more than taxpayer-funded abuse factories, all while politicians pat themselves on the back for “addressing the problem.”

The Texas Legislature, with all its tough talk about fiscal responsibility and justice, has chosen to maintain a system that abuses the very people it’s supposed to protect, all because closing these institutions would threaten their political careers.

The True Cost of Texas’s SSLC System

The real cost of Texas’s SSLC system isn’t measured in dollars — it’s measured in human lives. Lives destroyed by abuse, neglect, and systemic indifference. It’s measured in the deaths of people like Sean Yates, the broken families left behind, and the generations of disabled Texans abandoned by the state that’s supposed to protect them.

There’s no political will to fix this because there’s no political benefit to doing so. The SSLCs will continue to operate, funneling money into a corrupt system, while the Texas government pats itself on the back for being fiscally responsible. But behind that facade lies a brutal, unforgivable truth: the state of Texas is failing its most vulnerable citizens, and no one in power cares enough to stop it.

You can view our research, sources and citations at our research document here.

The Shield of Corruption: How the Texas Legislature Protects Borris Miles and Enables Misconduct

Read the original texas Watchdog article Silence in the Senate: The Texas Legislature’s Refusal to Address Borris Miles here.

You’d think that in a state as loud and proud as Texas, where independence and justice supposedly reign supreme, elected officials would be held to the highest standards. After all, the Lone Star State’s political brand is built on hardline accountability — tough on crime, zero tolerance for corruption, and a refusal to back down from a fight. But behind the flag-waving and chest-pounding, there’s a different story playing out in the halls of the Texas Capitol. It’s the story of Borris Miles, a state senator with a decade-long record of serious allegations, from sexual harassment to financial mismanagement, and the Texas Legislature’s cowardly refusal to do anything about it.

Instead of justice, what we’ve seen is protection — an institutional cover-up that’s left victims without recourse, as the state’s politicians prioritize party loyalty and political expediency over integrity. Miles, a walking catalog of scandal, remains in power, untouchable, shielded by a corrupt legislative system that lets him off the hook time and time again. This is Texas politics in 2024: where accusations of sexual misconduct are swept under the rug, and the accused not only evade consequences but thrive, bolstered by the very system that’s supposed to hold them accountable.

The Allegations: A Decade of Misconduct

Let’s start with the facts. Over the past decade, Borris Miles has been the subject of numerous allegations, ranging from sexual harassment to legal and financial troubles. It’s not just one or two isolated incidents — it’s a pattern. The accusations against Miles first gained serious attention in 2017, when multiple women came forward with stories of sexual harassment and assault. According to The Daily Beast, the allegations included claims that Miles forcibly kissed women and made inappropriate sexual advances. Not just a one-off drunk incident — a repeated offense.

You’d think that kind of scandal would end a political career. But this is Texas, where the powerful protect their own. Instead of being investigated thoroughly and held to account, Miles carried on with his political career almost as if nothing had happened. No formal disciplinary action. No resignation. No accountability at all.

In 2024, more allegations surfaced, reported by Texas Monthly. A Houston-based political consultant, Tayhlor Coleman, accused Miles of groping her at a party. She described the senator as pulling her in for a hug, then sliding his hand down to grope her. This wasn’t the first time Miles was accused of inappropriate touching — nor would it be the last. And yet, despite mounting accusations, Miles continued to sidestep consequences.

His office has been described by staffers as a place where misogyny and inappropriate behavior were tolerated, if not encouraged. Staffers left, citing an environment they found hostile and demeaning. Meanwhile, Miles’ response to all of this has been classic deflection — calling the accusations politically motivated attacks by “powerful enemies.” It’s a strategy that’s worked because of the Texas Legislature’s deeply flawed approach to dealing with sexual misconduct among its members.

The Texas Legislature’s Silent Complicity

In most workplaces, if you’re accused of sexual harassment, there’s a process. There’s an investigation, disciplinary action, and, in serious cases, termination. But in the Texas Senate, there’s no such thing. Instead, senators are free to handle these allegations “internally,” meaning they can choose to deal with them as they see fit — without any oversight, transparency, or accountability. In Miles’ case, that’s meant sweeping accusations under the rug and continuing on as if nothing happened.

According to Texas Monthly, under the leadership of Lt. Governor Dan Patrick, the Texas Senate has repeatedly failed to take action against senators accused of sexual misconduct. In fact, the Senate has actively buried and dismissed complaints. It’s a culture of silence and complicity, where powerful men are protected, and victims are left voiceless.

The Senate’s policy requires official complaints to be filed with the Director of Human Resources or the Secretary of the Senate to trigger an investigation. But how can you expect victims — many of whom are young staffers or interns — to feel safe filing a complaint when the system is so clearly stacked against them? The fear of retaliation is real. Miles, for example, has remained defiant throughout, denying all wrongdoing and painting himself as the victim of a smear campaign.

Even more absurd is that there’s no investigative committee in the Senate to handle these cases. Unlike the Texas House, which at least has a committee dedicated to investigating ethical violations, the Senate is operating in the dark ages. The lack of a formal investigative process means that allegations against senators like Miles can be ignored indefinitely, leaving victims without justice and the accused free to continue their behavior.

Political Expediency Over Morality

You might be wondering: why hasn’t there been more pressure from fellow Democrats to remove Miles? Why isn’t there more outrage? The truth is, Texas politics is an incestuous cesspool where loyalty to the party trumps loyalty to the truth. The Texas Democratic Party, afraid of losing political ground, has largely turned a blind eye to the allegations against Miles. There have been a few voices, like State Senator José Rodríguez, who have spoken out against the alleged behavior. But most Democrats have remained silent, unwilling to publicly condemn a fellow party member.

It’s not just about maintaining political power; it’s about maintaining political image. To push Miles out would be to admit failure — to admit that the Texas Democratic Party has a sexual harassment problem within its own ranks. And so, they’ve chosen the easy route: silence. The few calls for resignation — like those from Annie’s List, a group dedicated to electing women to office — have been easily dismissed by Miles and ignored by his colleagues.

Republicans, of course, have their own reasons for staying quiet. For them, the longer Miles remains in office, the longer they can point to him as an example of Democratic corruption. It’s a win-win for both sides: the Democrats avoid a messy internal fight, and the Republicans get a free punching bag.

Miles’ Financial and Legal Troubles: A Pattern of Poor Judgment

Beyond the sexual harassment allegations, Miles’ record of financial mismanagement and legal troubles is staggering. In 2007, he was indicted on two counts of deadly conduct for brandishing a firearm and making threats at two separate parties. This kind of behavior would have ended most political careers, but not in Texas. Miles managed to dodge any serious consequences, and the incident was quietly swept away as just another scandal in a state that’s become desensitized to political corruption.

But the legal issues didn’t stop there. Over the years, Miles has faced multiple tax delinquency cases in Harris County, racking up unpaid taxes and financial obligations. For a senator entrusted with managing public funds, this kind of financial irresponsibility should be disqualifying. Yet, like everything else in Miles’ career, it was brushed aside.

The question is, why? Why does Miles get a pass for behavior that would sink anyone else? The answer lies in the Texas political machine — a machine that protects its own, as long as they continue to serve the interests of the party and the system. Miles’ ability to survive scandal after scandal is a testament to just how broken Texas politics has become. It’s not about serving the people. It’s about serving the system.

A Culture of Corruption

The allegations against Miles aren’t just an indictment of one man. They’re an indictment of the entire political culture in Texas — a culture where sexual harassment is tolerated, legal and financial misconduct is overlooked, and accountability is nonexistent.

Miles is still in office because the system allows him to be. The Texas Legislature has built an impenetrable shield around its members, protecting them from consequences, no matter how serious the allegations. This isn’t just about one man’s bad behavior — it’s about a corrupt system that enables that behavior.

The real victims here are the people — both the individuals who’ve been directly harmed by Miles and the constituents who deserve better from their elected officials. Every day that Miles remains in office is another day that the Texas Legislature proves that it cares more about protecting its own than about serving the people.

The Shield of Corruption

The case of Borris Miles is not just a story of one politician’s misconduct. It’s a story of systemic failure — a failure of leadership, accountability, and integrity. The Texas Legislature has allowed a culture of corruption to flourish, where powerful men can act with impunity and victims are left without recourse.

If there’s any hope for Texas politics, it lies in reform — real reform that holds elected officials accountable for their actions, protects victims of harassment, and ensures that the people of Texas are represented by individuals worthy of the office. Until then, the state’s political system will remain as corrupt and broken as ever.

You can see our sources and citations in our research document here.

 

Waiting for a Miracle: The Cruelty of Texas’s IDD Support System

View the Texas Watchdog article Waiting for a Miracle: The Cruelty of Texas’s IDD Support System here. 

Texas has always prided itself on being big. Big skies, big oil, big trucks, and a big ego when it comes to rejecting anything that smells like federal overreach. But what happens when that brash independence comes at the expense of the most vulnerable citizens? What happens when political ideologies trump the basic human need for care, compassion, and dignity? In the Lone Star State, the answer is playing out in real-time: people with intellectual and developmental disabilities (IDD) are paying the price for Texas’s political games, and it’s a price many cannot afford.

The failure of Texas to provide for its IDD population — people who require assistance with daily activities, medical care, and emotional support to lead lives with a semblance of dignity — is not a fluke or a mistake. It’s not an unintended consequence of a bureaucratic tangle. No, this is a deliberate, calculated decision made by the state’s leadership, a cynical refusal to expand Medicaid and adequately fund community-based services that leaves over 113,000 Texans stranded on an ever-growing waitlist for essential services. This isn’t just mismanagement. This is policy, and the human cost is staggering.

A State Built on Contradiction: Booming Economy, But Barren Social Services

It’s hard to square Texas’s booming economy with the desolate landscape of its social services. The state is flush with money. In the 2024–2025 biennium, Texas boasted a surplus of $32 billion. That’s right — billion. Texas is one of the wealthiest states in the nation, with industries from technology to oil thriving. Yet for people with IDD, this wealth means nothing. They’re stuck in a system that actively chooses to leave them behind, a system where waitlists stretch for decades and services are patchy at best. It’s not because Texas can’t afford to help them — it’s because the state’s political leaders simply don’t want to.

You see, Texas isn’t interested in expanding Medicaid, which could bring in billions of federal dollars to support services for low-income residents, including those with IDD. The refusal to expand Medicaid under the Affordable Care Act (ACA) has left an estimated 1.5 million Texans without coverage, but no group feels the effects of this more than those with IDD. Medicaid expansion would have provided a lifeline — access to healthcare, housing, and community-based support for thousands who currently get nothing but a place on a waitlist.

The state’s leadership — people like Governor Greg Abbott and Lieutenant Governor Dan Patrick — have made their disdain for the ACA well known. For them, expanding Medicaid is a nonstarter. It’s seen as an affront to Texas’s independence and a violation of their anti-government principles. But this ideological crusade has very real consequences. It’s not just abstract political theater; it’s a denial of care that leaves families shattered, caregivers overwhelmed, and lives lost.

The Myth of Fiscal Conservatism: Texas’s False Economy

The absurdity of Texas’s IDD support system lies in the fact that it’s not even a good fiscal decision. In fact, Texas’s refusal to invest in Medicaid expansion and community-based services is costing the state more in the long run. Take the State Supported Living Centers (SSLCs), Texas’s institutions where IDD individuals are effectively warehoused. They are 13 outdated facilities that house around 3,000 people, and they cost the state around $700 million annually — $230,000 per person per year. Compare that to the cost of supporting someone in a community-based setting under a Medicaid waiver, which is around $70,000 per year, and you start to see the twisted logic of Texas’s priorities.

Why the obsession with funding institutions over community-based services? The answer, as always, is politics. The SSLCs have powerful allies — namely contractors, suppliers, and local economies that rely on these institutions to survive. They’ve got a built-in constituency of people with vested interests in keeping the SSLCs open, regardless of whether it’s in the best interests of the residents. Politicians, particularly in rural districts where these centers are often located, know better than to mess with that.

What you end up with is a system where it’s easier to institutionalize people than to support them in the community, where people with IDD are treated as problems to be warehoused rather than individuals deserving of care, dignity, and independence.

The Human Toll: Families Trapped by Bureaucratic Indifference

Imagine this: you’re the parent of a child with severe intellectual or developmental disabilities. Your child needs constant care — help with eating, bathing, dressing, and moving around. You can’t work because you have to be a full-time caregiver. You hear about the Medicaid waiver program, which could give you access to home care services, therapies, and equipment that would make life manageable for both you and your child.

But when you apply, you’re told there’s a 15-year waitlist. Fifteen years. In a state with an annual surplus in the tens of billions, that’s the best they can offer you. So, what do you do? You become another cog in Texas’s brutal machine of neglect. You sell your house, spend your life savings, and sacrifice your own health and well-being to provide care because the state has abandoned you.

This is the story of thousands of families across Texas. Parents who should be retiring are instead working themselves into an early grave, providing 24/7 care for adult children because there is no other option. Siblings are forced to step in as caregivers when their parents can no longer cope. And when the caregivers die, the state finally steps in — by sending their loved ones to an institution.

One particularly heartbreaking story comes from Connie Henson, whose adult son has autism. He has been on the waiver list for 16 years. Connie was told he would be eligible for services “soon,” but soon came and went long ago. Now, she’s exhausted, living off her savings, and wondering what will happen when she’s no longer able to care for him. “What happens when I die?” she asks. “Who will take care of my son?”

The state of Texas has no good answer for that.

The Workforce Crisis: Starving the Front Line of Care

If you think things are bad for families, wait until you hear about the people who actually provide care — the Direct Support Professionals (DSPs). These are the folks who work with IDD individuals every day, providing the care that keeps them safe, healthy, and able to live as independently as possible. DSPs do the work that most of us wouldn’t even consider — feeding, bathing, dressing, administering medication, and managing behavioral issues. And what does Texas pay them for this life-sustaining work? A whopping $10.60 an hour.

That’s right. The people doing some of the hardest, most important work in the state are being paid poverty wages. It’s no wonder the turnover rate is astronomical. Why would anyone stick around in a job that’s emotionally and physically draining, only to get paid less than they would at a fast-food joint?

But Texas isn’t interested in raising wages for DSPs. Instead, it has created a two-tiered system where SSLC workers — who are doing essentially the same job in an institutional setting — are paid up to $17.50 an hour. Why the disparity? Because SSLCs are part of the state’s budgetary priorities. Community-based care is not.

This pay gap has real consequences. As more DSPs leave the profession, community-based care providers are left understaffed, overworked, and unable to meet the needs of the people they’re supposed to serve. This creates a vicious cycle: understaffed facilities provide lower-quality care, leading to more people being institutionalized, which in turn strengthens the argument for funding SSLCs over community services.

A Political System Rigged Against the Vulnerable

At the root of all this suffering is a political system that has no interest in addressing the needs of the most vulnerable Texans. The state’s leadership views people with intellectual and developmental disabilities as little more than a line item on a budget spreadsheet — an expense to be minimized rather than a population to be cared for.

Governor Greg Abbott, a man who rarely misses an opportunity to trumpet Texas’s booming economy and low taxes, has steadfastly refused to expand Medicaid, even though doing so would bring billions of dollars in federal funding into the state. His rationale? Expanding Medicaid would “grow a broken system.” But the real reason is simple: Texas Republicans have built their brand on resisting anything that smacks of “big government,” and they’d rather let people suffer than be seen as giving in to Washington.

The refusal to expand Medicaid is the purest distillation of the state’s priorities. It’s not about saving money; it’s about political theater. Texas has the resources to provide care for everyone on the waiver list, to raise DSP wages, to ensure that every person with IDD gets the support they need. But it won’t, because that would require acknowledging that the current system is broken and that the state has a moral obligation to fix it.

In Texas, that kind of acknowledgment is seen as weakness. And so, the suffering continues.

Bottom Line: Abandoned in the Name of Ideology

For people with intellectual and developmental disabilities in Texas, there is no “Lone Star miracle.” There is only waiting, neglect, and abandonment. Families are left to fend for themselves, caregivers are paid starvation wages, and the most vulnerable Texans are shuffled off to institutions where they are forgotten.

This is not an accident. It is a deliberate choice, made by politicians who value ideology over human life. Until Texas’s leaders stop treating IDD services as a political pawn and start recognizing the basic humanity of the people they’ve abandoned, nothing will change.

And in the meantime, more Texans will suffer, more families will break under the strain, and more lives will be lost to a system that’s as broken as the politicians who created it.

You can view our sources and citations in our research document found here.

 

 

Death by Ideology: How Texas’s Refusal to Expand Medicaid Is Killing Rural Texans and Destroying Healthcare

View the Texas Watchdog article Death by Ideology: How Texas’s Refusal to Expand Medicaid Is Killing Rural Texans and Destroying Healthcare here. 

The refusal to expand Medicaid in Texas has left hundreds of thousands of low-income Texans, particularly in rural areas, without access to affordable healthcare. This decision, led by the state's conservative political leadership, has had catastrophic consequences for healthcare facilities, patients, and communities across the state. With Texas leading the nation in the number of uninsured residents, the absence of Medicaid expansion has worsened the already precarious situation for rural hospitals, working-class families, and healthcare providers. Rural Texans, who are disproportionately affected by this policy, find themselves trapped in a broken system that seems to care more about ideology than human lives.

This investigation examines the impact of Texas's Medicaid non-expansion policy on rural communities, based on the reporting by KERA News, Texas Tribune, and ruralhealthinfo.org, and will delve into the political motivations behind this decision, the devastating economic and health outcomes, and the preventable deaths that have resulted from this ongoing healthcare crisis.

The Political Ideology That Abandoned Rural Texans

The heart of this crisis lies in the refusal of Texas’s political leaders, spearheaded by Governor Greg Abbott and Lieutenant Governor Dan Patrick, to expand Medicaid under the Affordable Care Act (ACA). Despite overwhelming evidence of the benefits Medicaid expansion could provide—including a $5.4 billion influx of federal funds annually—Texas Republicans have doubled down on their ideological opposition to the ACA, often branding it as “Obamacare” to stoke political resentment among their conservative base.

Abbott has called Medicaid expansion a “massive expansion of an already broken and bloated Medicaid program,” choosing instead to stick with the status quo. This rhetoric may play well with conservative voters who fear government overreach, but it leaves nearly 800,000 Texans in a coverage gap—earning too much to qualify for Medicaid but too little to afford private insurance. This ideological grandstanding leaves rural Texans, who often don’t have access to the same wealth of healthcare options as urban areas, struggling to access even basic medical care.

The irony here is palpable. Texas, with its reputation for self-reliance and independence, is sacrificing the health and well-being of its residents, especially in rural areas, on the altar of political ideology. And it’s not just a few people suffering—nearly 15% of Texas’s population lives in rural areas, and many of them are uninsured.

Rural Hospitals on the Brink of Collapse: Closing Doors on Care

If there’s one visible consequence of Texas’s refusal to expand Medicaid, it’s the closure of rural hospitals. In the last decade, 21 rural hospitals in Texas have closed, and another 26% are at risk of closure, according to a 2022 report from Kaufman Hall. These hospitals serve as lifelines for communities spread out over large distances, often with no other healthcare options for miles. Without them, routine medical care, emergency services, and life-saving treatments are out of reach for many rural Texans.

This isn't just a healthcare problem; it's an economic disaster. Rural hospitals are often some of the largest employers in their communities. When a hospital closes, the economic ripple effects are devastating. Jobs are lost, families leave, and local businesses that relied on the hospital’s staff and patients for revenue also suffer. It’s a downward spiral that pushes already struggling rural economies even closer to collapse.

But why are these hospitals closing? One of the biggest reasons is the amount of uncompensated care they provide. Without Medicaid expansion, many rural Texans remain uninsured and cannot afford to pay for medical services. As a result, hospitals are forced to provide care for free, but they still have to cover the costs of staff, equipment, and supplies. In 2019, rural hospitals in Texas faced uncompensated care costs of 3.81% of their operating expenses, compared to 3.12% for urban hospitals. In Medicaid expansion states, this figure is even lower—2.55%—which highlights just how much Texas is losing out on by refusing to expand coverage.

Texas hospitals are hemorrhaging money because the state refuses to take federal funds that would help cover these uninsured patients. It’s as simple as that. And as these hospitals continue to close, more rural Texans are left without access to the care they desperately need.

The Working Poor: Caught in the Coverage Gap

Texas’s Medicaid eligibility criteria are among the most restrictive in the nation. To qualify for Medicaid as a parent in Texas, your income must be less than 17% of the federal poverty level—around $3,733 annually for a family of three. Childless adults, regardless of income, don’t qualify for Medicaid at all. This leaves a huge number of working Texans—people in low-wage jobs, many of whom are essential workers—without access to affordable healthcare.

In industries like construction, food services, and home healthcare, workers often make too much to qualify for Medicaid but not enough to afford private insurance. These are people who are vital to Texas’s economy, yet they are being left behind. Around 77% of those in the coverage gap are in families where at least one person works, and 42% are women of reproductive age.

Without Medicaid expansion, these workers are less likely to have a regular source of healthcare, more likely to delay or avoid necessary treatment, and at higher risk of medical debt and bankruptcy. For them, an unexpected illness or injury can be financially ruinous, pushing them further into poverty.

The fact that Texas’s leaders continue to deny these people healthcare while they work for low wages is not just a policy failure—it’s a moral one. These are the people who keep Texas’s economy running, and they are being abandoned by a state government that values ideological purity over human lives.

Community Health Centers: The Last Line of Defense

With rural hospitals closing and Medicaid expansion off the table, Federally Qualified Health Centers (FQHCs) have become the safety net for many uninsured Texans. These centers provide care for underserved populations, but they are also stretched to their limits. About a third of patients at FQHCs in Texas have Medicaid, while nearly a quarter are uninsured. The demand for services far exceeds the capacity, and with limited resources, these health centers are struggling to keep up.

For uninsured patients, the cost of care is often prohibitive. A visit to an FQHC might cost $350, but an uninsured patient might only be able to pay $30-$40, leaving the center to absorb the rest. This means fewer resources for expanding services, fewer staff to handle the growing number of patients, and longer wait times for care. As a result, uninsured Texans often don’t seek care until their condition becomes severe, which leads to more expensive and complicated treatments down the line.

The lack of Medicaid expansion also impacts the ability of these centers to recruit healthcare providers. Working in a community health center can be financially unstable, and providers may prefer to work in urban settings where salaries are higher and there are more opportunities for career advancement. This staffing shortage exacerbates the already limited access to care in rural areas.

The Health Toll: Preventable Deaths and Poorer Outcomes

The consequences of Texas’s refusal to expand Medicaid are not just financial—they are fatal. Between 2014 and 2017, an estimated 2,920 Texans aged 55-64 died prematurely because the state refused to expand Medicaid. These are deaths that could have been prevented if these individuals had access to regular healthcare.

Chronic conditions like diabetes, hypertension, and heart disease go untreated or poorly managed when people don’t have access to care. Without insurance, people are less likely to take medications regularly, less likely to see a doctor for check-ups, and more likely to end up in the emergency room when their condition worsens. The result is a healthcare system that spends far more on emergency care and hospitalizations than it would on preventive care, but with far worse outcomes for patients.

Maternal and infant health in Texas is also a significant concern. The state has one of the highest maternal mortality rates in the country, and uninsured women are at significantly higher risk. Expanding Medicaid would provide prenatal care and reduce the risk of complications for both mothers and babies. Yet, Texas’s leaders continue to deny this coverage, putting the lives of women and children at risk.

What Could Medicaid Expansion Do?

The refusal to expand Medicaid is costing Texas billions of dollars in federal funding—money that could be used to improve healthcare access, keep rural hospitals open, and provide insurance for hundreds of thousands of Texans. Expanding Medicaid would bring in an estimated $5.4 billion per year in federal funds, money that could cover the cost of care for low-income Texans and reduce the financial strain on healthcare providers.

The economic benefits of Medicaid expansion are clear. It would create jobs, strengthen rural economies, and ensure that more Texans have access to the care they need. States that have expanded Medicaid have seen significant improvements in health outcomes, including lower mortality rates, earlier detection of cancer, and better management of chronic diseases. Yet, Texas continues to reject these benefits, leaving its most vulnerable residents to fend for themselves.

Conclusion: Ideology Over People

At the heart of Texas’s Medicaid crisis is a simple truth: the state’s leaders care more about maintaining their ideological opposition to “Obamacare” than they do about the lives of rural Texans. The decision not to expand Medicaid is not based on sound economic reasoning or concern for the state’s healthcare system—it is a political stance that sacrifices the well-being of millions of Texans for the sake of partisan purity.

Rural Texans, the backbone of the state’s economy, are the ones paying the price. They are losing their hospitals, their access to care, and, in many cases, their lives. Until Texas’s leaders put people over politics, this crisis will only continue to worsen.

Bought and Sold: Soros Cash and DA Jose Garza’s Progressive Agenda Leave Austin in Crisis

View Texas Watchdog's original article Bought and Sold: Soros Cash and DA Jose Garza’s Progressive Agenda Leave Austin in Crisis here. 

The Travis County District Attorney, José Garza, has been one of the most controversial figures in Texas politics since taking office in 2021. Backed by substantial funding from George Soros, Garza has implemented a wave of progressive policies that he claims will address systemic inequalities in the criminal justice system. However, critics argue that his reforms have directly led to a significant surge in crime across Austin, damaging public safety and creating a deep divide between law enforcement and the DA’s office.

With Austin experiencing a rise in violent crime rates and the local police force undermanned and demoralized, Garza’s critics—including members of law enforcement, victims' advocates, and even some local Democrats—believe that his policies are contributing to a chaotic breakdown of public order. They accuse him of being too lenient on criminals, prioritizing a political agenda over the safety of Austin’s citizens, and prosecuting police officers more aggressively than criminals.

This investigative piece will delve deep into the impact of Garza’s policies, drawing from data, public records, and interviews to explore whether Austin’s crime wave is a result of his tenure, or simply a convenient scapegoat for deeper societal issues.

The Soros Connection: How Big Money is Reshaping Local Politics

Let’s start with the money—because in politics, that’s always where the story begins. José Garza’s 2020 campaign was fueled by over $1 million from the Texas Justice & Public Safety PAC, a group funded almost entirely by George Soros. Soros has made it his mission to reform America’s criminal justice system by backing progressive prosecutors, believing that these officials can enact the kind of systemic change that national politicians either can’t or won’t.

But Soros’s strategy, while effective in electing reform-minded district attorneys, has drawn sharp criticism—especially in Texas, a state that prides itself on tough-on-crime policies. Critics accuse Soros-backed DAs of pushing lenient policies that make communities less safe. Garza, with his deep ties to Soros’s funding, has become the poster child for these accusations in Texas.

The Texas Tribune and Fox News have reported extensively on the political controversy surrounding Garza’s policies. With funding pouring in from outside the state, many Texans feel that Garza’s priorities are more aligned with progressive think tanks in New York and California than with the citizens of Travis County. This criticism has only intensified as crime rates in Austin have skyrocketed since Garza took office.

Policies That Sparked a Crime Wave?

When José Garza was elected, he made it clear that he intended to overhaul Travis County’s approach to criminal justice. Among his most significant reforms was his decision to deprioritize the prosecution of nonviolent drug offenses and eliminate cash bail for low-level offenses. Garza argued that criminalizing poverty and addiction does nothing to solve the root causes of crime, and that the justice system should focus on violent offenders rather than clogging jails with people arrested for petty crimes.

In theory, these reforms sound humane. In practice, critics argue, they have emboldened criminals and led to a surge in crime.

According to FBI crime statistics, violent crime in Austin rose nearly 40% above the national average in 2023. These statistics are not isolated incidents. Robberies, aggravated assaults, and auto thefts have all spiked dramatically. Auto theft alone surged by 44%, reaching a record high of 14,700 cases in 2023. Local businesses and residents have expressed growing concerns about their safety, and many point the finger directly at Garza’s policies.

But the most glaring issue is Garza’s handling of violent offenders. In several high-profile cases, his office has been criticized for allowing violent criminals to walk free on probation or plea deals. Take the case of Cordero Rios, a man convicted of multiple assaults against women, who was given 10 years of probation instead of prison time. The backlash to this case was swift and severe, with victims' advocates accusing Garza of prioritizing leniency for criminals over justice for victims.

A Dismantled Police Force: Targeting Cops Instead of Criminals?

One of the most contentious aspects of Garza’s tenure has been his aggressive prosecution of Austin police officers. From the beginning, Garza made it clear that he intended to hold law enforcement accountable for instances of police misconduct. Following the 2020 Black Lives Matter protests, Garza’s office indicted 19 officers for their handling of the protests, accusing them of using excessive force.

Garza’s critics claim that this relentless focus on prosecuting police officers has demoralized the Austin Police Department (APD), leading to a mass exodus of officers. The Austin Police Retired Officers Association has stated that the department is now short by at least 500 officers, a significant gap that has crippled the force’s ability to maintain public safety. Officers feel unsupported by the district attorney’s office and many have either resigned or retired early, leaving the department understaffed and struggling to cope with rising crime rates.

Former officers have publicly spoken out about their frustrations, accusing Garza of selectively prosecuting police officers to fulfill a political agenda rather than focusing on reducing crime. This rift between law enforcement and the DA’s office has only grown wider, leading to less proactive policing and fewer patrols in high-crime areas.

Critics argue that Garza’s decision to prioritize the prosecution of police officers has led to a breakdown in public safety. As officers leave the force, crime goes unaddressed, and those who remain are often hesitant to act for fear of being targeted by the DA’s office.

Public Safety Eroded: Victims Left Behind

Perhaps the most tragic aspect of Garza’s tenure is the way in which victims have been neglected. Since taking office, Garza has faced multiple accusations of mishandling cases involving sexual assault, domestic violence, and violent crimes.

One such case involved Conny Branham, whose son was murdered in 2020. Branham was devastated when Garza’s office reduced the charges against all five suspects involved in her son’s murder, with none being charged with capital murder. This case, which was widely reported by local media, exemplifies the deep frustration felt by many victims' families who believe Garza’s office is more concerned with protecting criminals than securing justice for those they’ve harmed.

Moreover, the backlog of criminal cases in Travis County has reached an astounding 7,000, with many cases delayed or dismissed altogether. This has left victims waiting for months—sometimes years—for their day in court, only to find that the DA’s office has offered lenient plea deals that leave them feeling ignored and unsupported by the justice system.

The Austin American-Statesman has chronicled numerous examples of cases where violent offenders were released on probation or reduced charges, only to reoffend. One particularly egregious case involved a convicted sexual predator who was released on 10 years probation after brutally assaulting a woman. Shortly after his release, he was arrested again for a similar offense.

For the victims of these crimes, Garza’s policies have not only failed to deliver justice—they have actively put them at greater risk. The DA’s office, critics argue, is so focused on reform that it has lost sight of its most basic responsibility: protecting the public from dangerous criminals.

The Exodus from Austin: A City in Decline?

Austin has long been one of the fastest-growing cities in the country, attracting new residents with its vibrant culture, booming tech industry, and reputation as a relatively safe and livable city. But under Garza’s tenure, many Austinites are deciding it’s time to leave.

The combination of rising crime, deteriorating public safety, and a perception that the DA’s office is failing to hold criminals accountable has led to an exodus of residents from Austin. According to census data, Austin experienced a net loss in population for the first time in over a decade in 2023. Many residents, particularly families, are citing safety concerns as their primary reason for leaving.

Real estate data shows that more homes are being listed for sale in traditionally desirable Austin neighborhoods, while the surrounding suburbs and smaller towns in the greater Austin area are seeing an influx of new residents. Downtown businesses have also reported a decline in foot traffic, with many owners pointing to public safety concerns as a major factor.

This trend is particularly troubling for a city that has long prided itself on its growth and economic vibrancy. As more residents and businesses leave the city, Austin risks losing not only its reputation as a safe and livable city but also its economic stability.

Conclusion: A City in Crisis

As José Garza prepares to run for re-election, Austin is at a crossroads. His supporters argue that he is fulfilling his promise to reform a broken justice system, but the reality on the ground tells a different story. Rising crime rates, a demoralized police force, and a public increasingly fearful for its safety all point to a city in decline.

Garza’s critics, who now include a broad coalition of law enforcement, victims' advocates, business owners, and even some Democrats, believe that his policies have directly contributed to this crisis. They accuse him of prioritizing a political agenda over the safety of Austin’s citizens and warn that unless there is a dramatic course correction, the situation will only get worse.

Austin was once a city on the rise—a beacon of growth, opportunity, and progress in the heart of Texas. But under Garza’s tenure, it risks becoming a cautionary tale of what happens when ideology trumps public safety.

The Soros Playbook: Inside the Billionaire’s Plan to Rewire Texas Law Enforcement

View the original Texas Watchdog article The Soros Playbook: Inside the Billionaire’s Plan to Rewire Texas Law Enforcement here. 

Texas has always been a state where the battles for power are fought on the most local, gritty, and personal of levels. It’s a place where gun rights and property rights are sacrosanct, and where government intervention is seen with the same suspicion as an outsider at a Friday night football game. Yet in recent years, a new player has entered this political stage — one who couldn’t be more removed from Texas’s boots-on-the-ground, spit-on-the-sidewalk culture. His name? George Soros, the Hungarian-born billionaire philanthropist whose influence now stretches deep into Texas’s judicial system.

Yes, you read that right. George Soros — the bogeyman of every far-right conspiracy theory, the villain in every “deep state” fever dream — is heavily bankrolling the campaigns of district attorneys (DAs) across Texas. And it’s setting off a political firefight that makes your average Lone Star political squabble look like a Sunday barbecue. What we’re talking about here isn’t just a clash of ideologies; it’s an all-out war over the future of law and order in Texas, where district attorneys funded by Soros are pushing criminal justice reforms that their critics say are turning the state’s cities into anarchic hellscapes.

Let’s dive into the world of Soros-backed DAs in Texas — their rise to power, the policies they’re pushing, and the backlash they’re facing in a state that likes its law enforcement tough and its jail cells full.

The Soros Strategy: District Attorneys as Gatekeepers

For Soros, it’s not about winning flashy gubernatorial or senatorial races. No, Soros is smarter than that. He knows that the real gatekeepers of criminal justice aren’t the politicians you see on TV; they’re the district attorneys — the local prosecutors who decide who gets charged with a crime and who walks free. These are the people who can decriminalize entire categories of offenses with the stroke of a pen or redirect prosecutorial resources toward holding police accountable. In other words, DAs are the perfect vehicle for Soros’s larger project of overhauling the American justice system.

So, starting around 2016, Soros began to funnel millions of dollars into district attorney races across the country, focusing particularly on urban areas where he could elect progressive candidates with a mandate to “reform” the criminal justice system. Texas, home to some of the largest urban centers in the country, quickly became a focal point of this strategy. Soros used his Texas Justice & Public Safety PAC to fund the campaigns of DA candidates in Harris County (Houston), Travis County (Austin), Bexar County (San Antonio), and Dallas County. These candidates, often underfunded in traditional races, suddenly found themselves flush with cash and the ability to launch expensive media campaigns. And it worked. The Soros-backed DAs swept into office, promising to bring a new era of criminal justice reform.

The Rise of Reform DAs: Justice or Chaos?

Once in office, the Soros-backed DAs wasted no time in implementing reforms that they claimed would address the “mass incarceration crisis” and reduce systemic inequities. On paper, it all sounds great — who wouldn’t want a justice system that’s more just? But in practice, the results have been far more divisive.

Take John Creuzot in Dallas County, for example. After being elected with nearly $1 million in Soros funding, Creuzot immediately set about reforming the county’s approach to low-level crimes. He decriminalized thefts under $750, as long as they were considered “crimes of necessity.” In other words, if someone steals from a store because they say they need to feed their family, it’s not a crime. Critics, of course, immediately seized on this as an open invitation for shoplifting sprees — and crime data in the months after Creuzot’s policy shift seemed to back them up. Theft rates in Dallas County spiked, and local businesses were left to deal with the consequences.

Meanwhile, in Harris County, Kim Ogg initially came into office with Soros backing in 2016, although she later fell out of favor with the billionaire’s political apparatus. Under her tenure, Houston’s crime rates fluctuated, with a noticeable rise in violent crime during the pandemic. Ogg faced backlash for appearing soft on crime, particularly from conservative groups and police unions. But by the time she was ousted in 2024 by another Soros-backed DA, Sean Teare, the reformist agenda was back in full force.

Teare, who took over with a hefty $1.5 million war chest from the Soros PAC, has vowed to continue pushing policies that many in law enforcement argue are contributing to Houston’s crime problem. Like other Soros-backed DAs, Teare is focused on reducing incarceration rates for nonviolent offenders and prioritizing police accountability cases — a stance that has put him at odds with local law enforcement.

Crime Rates and the Backlash: A Convenient Scapegoat?

The argument over the impact of these Soros-backed DAs on crime rates is where things get really contentious. On the one hand, proponents argue that crime rates have fluctuated nationwide due to a wide array of factors — the pandemic, economic instability, rising mental health crises — none of which can be pinned directly on prosecutorial policy. On the other hand, critics argue that the rise in crime in cities like Dallas, Austin, and Houston is no coincidence. They point to a string of high-profile violent crimes, committed by individuals who were released or never charged under the more lenient policies of these Soros-backed DAs.

In Austin, José Garza — perhaps the most aggressively progressive of the Soros-backed DAs — has been criticized for creating a revolving door of justice. Garza’s office has repeatedly declined to prosecute cases involving low-level drug offenses and certain nonviolent property crimes. This has led to growing complaints from both law enforcement and community members who feel that Austin is becoming lawless. Garza has also taken heat for his focus on prosecuting police officers, which he argues is necessary to build public trust but which has alienated him from local law enforcement.

Then there’s Joe Gonzalez in Bexar County, where San Antonio has seen similar crime spikes under his tenure. Like his peers, Gonzalez has moved to decriminalize nonviolent offenses and has dramatically cut back on pre-trial detention, arguing that the cash bail system disproportionately punishes poor and minority defendants. But critics, including Texas Governor Greg Abbott, argue that the policies of DAs like Gonzalez are emboldening criminals. Abbott himself has vowed to take action against what he calls “rogue prosecutors,” and Texas lawmakers are already exploring ways to rein in the power of district attorneys who refuse to enforce certain laws.

Law Enforcement at War: Police vs. Prosecutors

One of the most striking features of the Soros-backed DA experiment is the way it has pitted local prosecutors against the very law enforcement agencies they’re supposed to work with. Police unions across Texas have come out swinging against these new DAs, accusing them of undermining public safety and making it harder for officers to do their jobs.

In Harris County, the relationship between the district attorney’s office and local police has deteriorated to the point where it’s openly hostile. Police officers complain that they arrest individuals for crimes, only to have the DA’s office refuse to prosecute or offer plea deals that amount to slaps on the wrist. The tension boiled over in 2023 when Sean Teare publicly criticized Houston’s police department for a series of officer-involved shootings, leading to a fiery response from the Houston Police Officers’ Union, which accused Teare of “politicizing” criminal justice.

Meanwhile, in Dallas, John Creuzot has faced similar pushback from law enforcement, particularly over his refusal to prosecute certain drug cases and property crimes. The Dallas Police Association has repeatedly clashed with Creuzot, arguing that his policies are making it impossible to maintain public safety. And yet, despite the tensions, these DAs remain committed to their reformist agendas, arguing that the old system of over-policing and mass incarceration was a failed experiment.

Big Money, Big Influence: The Ethics of Outsized Donations

For all the debate about criminal justice reform, there’s an even bigger elephant in the room — money. Soros’s influence in Texas’s DA races has led to growing concerns about the ethics of outsized campaign donations and whether one man’s millions should have this much sway over local politics.

Texas, of course, has long been a political Wild West when it comes to campaign finance. Thanks to Citizens United, there are essentially no limits on how much wealthy donors can spend to influence elections through PACs and Super PACs. And Soros has taken full advantage of this, spending millions to elect DAs who align with his vision of justice reform. Critics argue that this outsized influence is distorting the democratic process, particularly in local races where candidates typically don’t have access to the kind of funding that national candidates enjoy.

In some cases, Soros-funded PACs have been responsible for 80–90% of a candidate’s total campaign war chest. This has led to accusations that these DAs are beholden not to their constituents, but to their out-of-state benefactor. And it’s not just conservatives raising these concerns. Some local community leaders have questioned whether Soros’s influence is actually undermining trust in the justice system, particularly when the policies enacted by these DAs lead to rising crime and public outcry.

The Fight for the Future: Is Texas Ready for More Soros?

As Texas gears up for another round of local elections, the battle over the role of Soros-backed DAs is only heating up. The state’s political landscape is deeply polarized, and criminal justice reform has become a flashpoint in the broader culture war playing out across the country. On one side, you have the progressive DAs, armed with Soros’s millions and determined to implement reforms that they argue will create a fairer, more just system. On the other side, you have a growing coalition of law enforcement officials, conservative politicians, and concerned citizens who view these reforms as a dangerous experiment that’s making Texas less safe.

What’s clear is that the debate over Soros-backed DAs isn’t going away anytime soon. As crime rates fluctuate and political tensions rise, the future of criminal justice in Texas hangs in the balance. For now, the question is whether the reforms being pushed by these DAs will prove to be the change the system needs — or whether they’ll ultimately lead to a backlash that sweeps them out of office.

One thing’s for sure: the battle for the soul of Texas’s justice system is far from over. And in a state where everything’s bigger, the stakes couldn’t be higher.