A battle over whether Cook Children’s can continue to provide health care plans to more than 125,000 families in the Tarrant County area has ended.
Travis County District Judge Laurie Iserrow has finalized a series of agreements in which the Texas Department of Health and Human Services will exclude Cook Children’s Health Plan from Medicaid STAR, along with Driscoll Health Plan in South Texas and Texas Children’s Health Plan in the Houston area. prevented from making a decision. And CHIP planning will begin in September 2025.
The state’s $116 billion Medicaid contract proposal (excluding the three hospital plans) would allow more than 1.8 million low-income Texans to purchase their children’s health insurance from other organizations (Aetna, Molina, United Healthcare, Blue Texas, Texas). Cross and Blue Shield).
Iserrow granted a temporary restraining order against the children’s health plan, saying the state’s proposed changes could harm the public.
“The intended contract award would cause significant harm and disruption to millions of Texas STAR & CHIP members,” the judge wrote in a 10-page order.
Cook Children’s Health Care System praised the judge’s decision, saying the ruling “will help ensure our members get the care they need, when they need it.”
Launched in 2000, Cook Children’s Health Plan provides Medicaid and CHIP health insurance to families in the Tarrant County area. The Medicaid STAR and CHIP programs cover the cost of routine, acute, and emergency medical visits.
STAR primarily targets pregnant women, low-income children, and some adults who cannot afford health insurance, while STAR Kids targets children with disabilities. CHIP provides care to children from families who earn too much to qualify for Medicaid but cannot afford private insurance.
“We would like to express our gratitude to the court for considering this matter carefully and for making a decision in our favor,” a spokesperson for Cook Children’s said in an Oct. 7 statement. Ta. “Cook Children’s will continue to closely monitor the situation and work with all stakeholders to ensure our members continue to receive the best possible care.”
A spokesperson for the Texas Health and Human Services Commission did not respond to a request for comment by the time the report was published.
The judge’s preliminary ruling comes nearly four months after Cook Children’s filed a petition against Health and Human Services Commissioner Cecil Young to prevent the state agency from finalizing the procurement results. The lawsuit was filed in Travis County.
“Our families are worth fighting for, and we will continue to fight until the state takes the right steps,” Karen Love, president of Cook Children’s Health Plan, said at a June 26 press conference. “The stakes are too high and the consequences too high to allow this flawed decision to stand. We are determined to prevent that from happening.”
In Texas, Medicaid STAR and CHIP contracts last six years with three two-year renewal options. After the contract lasts 12 years, the agency will execute a new procurement. During that process, the agency issues a request for proposal, accepts bids, goes through an evaluation process with the insurance company, and awards a new contract.
When the Health and Human Services Commission directed managed care organizations to begin preparing proposals for new contracts in December 2022, it included a new element. Some of the changes include a new scoring and ranking system that emphasizes numerical scores over quality of care, community preferences, market share and past performance.
Cook Children’s filed its first protest on March 21, saying the state’s process was “seriously flawed” and failed to prioritize health plans with a proven track record of providing care to special populations. said. The health system says the state’s decision did not take into account how it would affect continuity of care.
Cook Children’s representatives also said state officials failed to go through the proper provider selection process and instead told one of the winning bidders, Aetna, to “prematurely disclose a copy of a competitor’s proposal.” “This gave them an unfair advantage.”
By taking legal action, Cook Children’s hopes to remain on the list of options for families in its network. If the health system doesn’t win the legal challenge, Cook Children’s will likely shut down its health plan, but the hospital itself is not at risk.
A trial to determine whether Iserrow will receive a permanent restraining order is scheduled for Nov. 3, 2025, according to the 10-page order. The ruling could be appealed by then, or the Health and Human Services Commission could choose to change the state’s proposal.
If the procurement is canceled, it would be the third failure in the Texas Department of Health and Human Services’ attempt to procure new contracts for STAR and CHIP managed care organizations.
David Moreno is a health reporter for The Fort Worth Report. His position is supported by a grant from Texas Health Resources. Contact david.moreno@fortworthreport.org or @davidmreports.
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