More than 125,000 families in North Texas could lose their current health insurance coverage

NORTH TEXAS – More than 125,000 families in North Texas could lose their current health insurance because of proposed changes to Medicaid.

The Texas Health and Human Services Commission has announced it will abandon Cook Children's Health Plan and instead award contracts to several national for-profit insurance companies.

“It would just be terrible,” said Breanna Hernandez, whose son MJ is covered by Cook Children's Health Plan. “It would just be terrible to take it away.”

MJ, now nine years old, was born at 27.5 weeks and spent 190 days in the NICU. He still sees several specialists at Cook Children's Medical Center for various health issues.

“As a special needs mom and a single mom, it’s a lot,” Hernandez said. “It’s a lot every day. You never know if today will be a good day? We literally take life hour by hour.”

Hernandez says joining the Cook Children's Health Plan makes everything a little easier.

“The plan just puts your mind at ease so that you feel like you are capable of raising and having a healthy child,” she said.

But now the plan's future is in jeopardy after the HHSC announced that it does not intend to renew the Cook Children's Medicaid contract along with two other nonprofit children's hospital plans in the state. The decision would force 125,000 low-income families in North Texas and 1.8 million across the state to switch plans.

“There are days when I try to stop crying because it's discouraging, it really is,” said Amber Castillo, a service coordinator at Cook Children's Health Plan, who helps children with complex medical needs.

“They typically have trachs, ventilators, feeding tubes, are confined to a wheelchair or bed, and require a lot of care and support,” Castillo said. “Just the thought that there could be an interruption to that care and support – that breaks my heart.”

For this reason, Cook Children's has filed an appeal against the change, which has not yet been finalized.

“I don't want anyone to think this is a fight for money or profits,” said Karen Love, president of Cook Children's Health Plan. “This is a fight to stay true to Cook Children’s promise of being there for the children who need us.”

Cook Children's Health Plan has been providing STAR and CHIP managed care services to hundreds of thousands of families for more than 20 years. Cook Children's says the loss of the contract means more than 75% of children and mothers on Medicaid in Tarrant County will be forced to find new health insurance plans.

Hernandez, the mother of one of those children, says it would be devastating to lose MJ's current coverage.

“Stay with a family with special needs for a day, whether it’s a child with autism or a child with lung disease,” she said. “Look what these parents do in a day. It might change your mind.”

If the changes actually come into force, this will not be the case until September 2025.

When asked about the new contracts, an HHSC press spokesperson responded:

“HHSC offers recipients the opportunity to change their health insurance plans throughout the year. An enrollment broker communicates with recipients on behalf of HHSC about managed care enrollment and actively engages with recipients. A recipient's eligibility to receive Medicaid or CHIP services is not affected by a change in health plans.

Request for Proposal (RFP) No. HHS0011152 STAR CHIP Managed Care Services was published in the Electronic State Business Daily (ESBD) on December 7, 2022. Article III of the published call for proposals explains the evaluation and award process for proposals.

HHSC announced the contract award (letter of intent) following a request for proposals in which all respondents were evaluated using the same evaluation criteria. The resulting awards went to the managed care organizations (MCOs) that received the highest ratings in all performance areas. This will provide all STAR & CHIP recipients with the best benefit to the state and the best quality of care and service. For more information about the protest process, visit the Texas Administrative Code website.

MCOs are contractually obligated to ensure continuity of care for both newly enrolled recipients and recipients transferring from another MCO. HHSC expects a recipient's transition to a new MCO to be as smooth as possible for recipients and their providers. Established recipient and provider relationships, existing treatment protocols, and ongoing service plans are important parts of any transition.

Once final contracts are awarded and before MCOs begin serving recipients, HHSC conducts a thorough readiness review to ensure that MCOs are operationally ready to meet contract obligations and provide all contracted services. Readiness activities conducted by HHSC staff include ongoing desk reviews, training, testing of trading partner IT systems, review of the MCO's documented processes and workflows, interviews with key MCO personnel, review of provider networks, claims payment testing, and other activities. When preparedness activities are completed, HHSC determines whether the MCO is operationally prepared to provide the contracted services. Operations are expected to begin in the first quarter of the state fiscal year 2025.”