125,000+ North Texas families could lose current health care coverage
NORTH TEXAS – More than 125,000 North Texas families could lose their current healthcare coverage because of proposed changes to Medicaid.
The Texas Health and Human Services Commission has said it plans to drop the Cook Children's Health Plan and award contracts to several national, for-profit insurance companies instead.
"It would just be awful," said Breanna Hernandez, whose son MJ is covered by the Cook Children's Health Plan. "It would just be terrible taking it away."
MJ, who is 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 a variety of health issues.
"As a special needs mom, and being a single mom, it's a lot," Hernandez said. "It's a lot every day. It's never knowing, is today going to be a good day? We literally take life hour by hour."
Hernandez says being on the Cook Children's Health Plan makes it all a little easier.
"The plan just honestly puts you at ease, so you feel like you're able to parent and to have a healthy child," she said.
But now the future of the plan is in jeopardy after the HHSC announced it doesn't intend to renew the Cook Children's Medicaid contract, along with two other nonprofit children's hospitals 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 I try to stop from crying because it's disheartening, it really it," said Amber Castillo, a Cook Children's Health Plan service coordinator who helps children who have complex medical needs.
"They typically have trachs, ventilators, feeding tubes, they're wheelchair bound or bedbound and they require a lot of care, a lot of support," Castillo said. "Just the thought there could be a disruption in these care for them, that support – it breaks my heart."
That's why Cook Children's has appealed the change, which hasn't been finalized yet.
"I don't want anybody to think that this is about a fight over money or profits," said Karen Love, the president of the Cook Children's Health Plan. "This is a fight to be true to the Cook Children's promise to be there for the kids who need us."
The Cook Children's Health Plan has provided service for hundreds of thousands of families as part of the STAR and CHIP managed care services for more than 20 years. Loss of the contract means more than 75% of children and mothers on Medicaid in Tarrant County will be forced to find new health plans, according to Cook Children's.
Hernandez, the mom of one of those kids, says losing MJ's current coverage would be devastating.
"Go be with a special needs family for one day, whether it's a kiddo with autism or a kiddo with a lung disease," she said. "See what those parents do in a day. It might change your mind."
If the changes do go into effect, it won't be until September 2025.
When asked about the new contracts, a press officer with the HHSC sent this statement:
"HHSC allows recipients the opportunity to change their health plans throughout the year. An enrollment broker communicates with recipients on behalf of HHSC about managed care enrollment and is actively engaging with recipients. A recipient's eligibility to receive Medicaid or CHIP services is not impacted by a change in health plans.
The Request for Proposals (RFP) No. HHS0011152 STAR CHIP Managed Care Services was posted on the Electronic State Business Daily (ESBD) on 12/7/2022. Article III of the published RFP explains the proposal evaluation and award process.
HHSC announced contract awards (Notice of Intent) following a competitive solicitation where all respondents were scored using the same evaluation criteria. The resulting awards across all service areas were to those Managed Care Organizations (MCOs) that received the highest scores. This will provide the best value to the state and quality of care and service to all STAR & CHIP recipients. For more information on the protesting process, please visit the Texas Administrative Code website.
MCOs are contractually required to provide continuity of care for both newly enrolled recipients and recipients transferring from another MCO. HHSC expects that a recipient's transition to a new MCO be as seamless as possible for recipients and their providers. Established recipients 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 robust readiness review to ensure MCOs are operationally ready to fulfill obligations under the contract and can provide all contracted services. Readiness activities, performed by HHSC staff, include ongoing desk reviews, trainings, trading partner IT systems testing, review of MCO documented processes and workflows, interviews with key MCO staff, review of provider networks, claims payment testing and other activities. When the readiness activities are completed, HHSC determines if the MCO is operationally prepared to provide the contracted services. Operations are targeted to begin in the first quarter of state fiscal year 2025."