FORT WORTH – Cook Children’s Health Plan has filed a lawsuit against the Texas Health and Human Services Commission (HHSC) in response to the state’s decision to terminate its long-standing Medicaid contracts.
HHSC announced earlier this year that it would discontinue STAR and CHIP contracts — which provide Medicaid health insurance coverage for low-income children and pregnant women — with Cook Children’s Health Plan and other nonprofit providers in favor of national for-profit companies such as Aetna, UnitedHealthcare, Blue Cross Blue Shield and Molina. Cook Children’s Health Plan’s lawsuit alleges that HHSC failed to follow protocol in selecting providers for STAR and CHIP contracts and neglected the Fort Worth-based nonprofit health insurer’s track record in administering health care, according to a news release.
“Texas Health and Human Services’ decision to deny us a renewal of our contract will not hurt Cook Children’s nearly as much as it will hurt the families we serve, while denying them meaningful plan choice and the right to choose us,” Cook Children’s Health Plan President Karen Love said at a press conference Wednesday.
Earlier this year, the HHSC conducted one of its regular “re-awarding processes” to evaluate provider performance, awarding billions of dollars’ worth of STAR and CHIP contracts to plans and insurers that performed well, Love said. That’s where Cook Children’s Health Plan made a mistake, according to the report.
“HHSC announced the contract award (letter of intent) following a competitive bidding process in which all participants were evaluated using the same evaluation criteria,” an HHSC spokesperson wrote in an email. “The resulting contracts in all service areas went to MCOs (managed care organizations) that received the highest ratings. This will provide the best value to the state and the best quality of care and service to all STAR & CHIP recipients.”
The nonprofit then filed two lawsuits in Travis County: a petition for declaratory judgment and injunctive relief against HHSC Commissioner Cecile Erwin Young and a preliminary injunction to “prevent HHSC from completing its procurement results.”
The HHSC spokesperson said in the email that the procurement will remain open “until all protests and appeals filed by respondents have been resolved and contracts executed.” They declined to comment on “pending litigation.”
More than 125,000 low-income people in the Fort Worth area could be left without health insurance, Love said, and many families simply cannot afford the time and resources to find a new provider if they are forced out of their current plans.
“These are just unnecessary problems for these families who already have enough problems in their lives,” Love said. “They can’t afford the added stress of having to complete a new plan.”
“A change in managed care organizations that contract with HHSC does not affect whether a Medicaid recipient receives services, nor does it affect the services a recipient may receive,” the HHSC spokesperson said. “MCOs are contractually obligated to provide continuity of care for both newly enrolled recipients and recipients who transfer from another MCO. HHSC requires that the transition to a new MCO be as smooth as possible for Medicaid recipients and their providers.”
The decision to terminate contracts with Cook Children’s Health Plan is the latest development in a growing nationwide health insurance problem: Since March 2023, more than two million Texans have lost their Medicaid coverage.
Love said nearly half of all children in Texas — those from families with incomes at or below 200 percent of the poverty level — are eligible for Medicaid and CHIP. In six counties around Fort Worth, that number is 300,000. About 40 to 46 percent of children in the region are covered by the Cook Children’s Health Plan, as are about 80 percent of children with serious illnesses requiring intensive care.
Cook Children’s Health Care System, which primarily operates a children’s hospital, set up its health insurance arm specifically to provide local families with access to Medicaid benefits through CHIP and STAR contracts. The nonprofit has received Medicaid contracts from the state for nearly 20 years.
Demand for Plan B contraceptives and pills falls in Texas and other states with abortion bans
In Texas and other states that imposed strict abortion restrictions after overturning the Roe v. Wade ruling, prescriptions for oral contraceptives, particularly emergency contraceptives such as Plan B, have declined, according to a study published Wednesday in the American Medical Association’s journal JAMA Network Open.
New study finds rising infant mortality in Texas after implementation of SB 8
The study found that both infant and newborn mortality rates increased following the implementation of the 2021 Abortion Act, which bans abortions when a fetal heartbeat is detectable.
