Health and Hospital Districts

Overview

Health/hospital districts and authorities (HHDs) provide a legal framework to create hospital systems to provide hospital and medical care facilities, emergency services, and mental health services to district residents.

HHD tax-supported and revenue debt is used to construct, acquire, and/or improve buildings for hospital, fire, emergency, and mental health facilities. HHDs can create conduit entities to issue debt on their behalf.

The BRB collects debt information on four types of hospital, health, and public safety districts: hospital districts (HD), hospital authorities (HA), emergency services districts (ESD), and mental health mental retardation centers (MHMR).

District Purpose Voter Approved / Taxing Authority Authorizing Texas Health and Safety Code Chapter
Hospital Districts Creates hospital systems to provide hospital and medical care facilities. HDs must be voter approved and have taxing authority Yes / Yes Chapters 281, 282 or 283
Hospital Authorities Creates hospital systems to provide hospital and medical care facilities. HAs are created by a municipality's governing board, do not require voter approval and do not have taxing authority No / No Chapter 262
Emergency Service Districts Provides rural fire prevention and emergency medical services. ESDs must be voter approved and have taxing authority Yes / Yes Chapter 775
Mental Health & Mental Retardation Provides child, adolescent, and adult mental health services; substance abuse recovery services; and skills training. MHMRs do not require voter approval, and do not have taxing authority No / No Chapter 534
Debt
Outstanding
- Fiscal Year 2025 -
Tax Supported:
$4,221,324,772
Revenue Supported:
$1,201,798,483
Total Outstanding:
$5,423,123,255
Debt
Issued
- Fiscal Year 2025 -
Tax Supported:
$1,076,285,000
Revenue Supported:
$106,345,000
Total Issued:
$1,182,630,000

Issuers of Texas Debt

Showing entries (filtered from total entries)

The fiscal year for the State of Texas runs from September 1 until August 31.

Unless otherwise stated, the data for each chart is as of the fiscal year stated above.

TIP: Click on the legend elements to focus the chart's display.

The chart above shows the purposes for which debt was issued for both tax-supported debt and revenue debt outstanding.

Click here to see a brief description of each purpose type.

Download CSV