NPR for North Texas
Play Live Radio
Next Up:
0:00
0:00
0:00 0:00
Available On Air Stations

Texas judge halts state’s Medicaid plans. Here’s what that means for Cook Children’s

Rick W. Merrill, president and CEO of Cook Children’s Health Care System, speaks to guests during a Cook Children’s press conference on June 26, 2024.
Camilo Diaz
/
Fort Worth Report
Rick W. Merrill, president and CEO of Cook Children’s Health Care System, speaks to guests during a Cook Children’s press conference on June 26, 2024.

The fight over whether Cook Children’s can continue offering its health care plan to more than 125,000 families in the Tarrant County area has come to a halt.

District Judge Laurie Eiserloh of Travis County blocked Texas Health and Human Services from finalizing a set of contracts that would drop the Cook Children’s Health Plan, alongside the Driscoll Health Plan in South Texas and the Texas Children’s Health Plan in the Houston area, from Medicaid STAR and CHIP plans starting in September 2025.

The state’s $116 billion Medicaid contract proposal — which excludes the three hospital plans — would force over 1.8 million low-income Texans to change their children’s health coverage to other organizations: Aetna, Molina, UnitedHealthcare, and Blue Cross and Blue Shield of Texas.

Eiserloh granted the temporary restraining order to the children’s health plans, stating the state’s proposed changes could negatively impact the public.

“The intended contract awards will impose significant harm and confusion on millions of Texas’ STAR & CHIP members,” the judge wrote in a 10-page order.

Cook Children’s Health Care System celebrated the judge’s decision by stating that the ruling will “help to ensure that our members continue to have access to the care they need, when they need it.”

Launched in 2000, Cook Children’s Health Plan provides health coverage to Tarrant County-area families with Medicaid and CHIP. The Medicaid STAR and CHIP programs cover the cost of routine, acute and emergency medical visits.

STAR is primarily for pregnant women, low-income children and some adults who cannot afford health insurance, and STAR Kids is for children with disabilities. CHIP provides care to children in families that earn too much money to qualify for Medicaid, but cannot afford to buy private insurance.

“We would like to express our gratitude to the court for their careful consideration of this matter and for their decision in our favor,” a Cook Children’s spokesperson wrote in an Oct. 7 statement. “Cook Children’s will continue to monitor the situation closely and work with all stakeholders to ensure that our Members continue to receive the best possible care.”

A spokesperson for the Texas Health and Human Services Commission did not respond to the Report’s request for comment by publication time.

The judge’s temporary decision comes nearly four months after Cook Children’s filed a petition against Cecile Young, executive of the Health and Human Services Commission, to stop the state agency from finalizing its procurement results. The suit was filed in Travis County.

“Our families are worth fighting for, and we’re going to continue to fight until the state does the right thing,” Karen Love, president of Cook Children’s Health Plan, said during a June 26 press conference. “The stakes are too high and the consequences are too great to have this flawed decision set in stone. We are determined to ensure that it does not.”

Karen Love, president of Cook Children’s Health Plan, sits during a Cook Children’s press conference June 26, 2024. Love announced Cook Children’s will file a lawsuit against the Texas Health and Human Services Commission after the health system was dropped from state Medicaid plans.
Camilo Diaz
/
Fort Worth Report
Karen Love, president of Cook Children’s Health Plan, sits during a Cook Children’s press conference June 26, 2024. Love announced Cook Children’s will file a lawsuit against the Texas Health and Human Services Commission after the health system was dropped from state Medicaid plans.

In Texas, Medicaid STAR and CHIP contracts run for six years, with three two-year renewal options. After contracts have been in place for 12 years, the agency runs a new procurement. During that process, the agency issues requests for proposals, accepts bids, puts insurers through an evaluation process, and then awards the new contracts.

When the Health and Human Services Commission directed managed care organizations to start preparing proposals for new contracts in December 2022, it included new elements. Among the changes was a new scoring-and-ranking system that placed more emphasis on numerical scores rather than health care quality, community preferences, market share and historical performance.

Cook Children’s filed its original protest March 21 and said the state’s process was “deeply flawed” and failed to give preference to health plans with successful track records that provide care to special populations. The state’s decision didn’t consider how continuity of care would be impacted, according to the health system.

Representatives for Cook Children’s also allege the state agency did not go through the proper process for selecting providers and instead gave Aetna, one of the winning bidders, “an unfair advantage by prematurely disclosing copies of its competitors’ proposals.”

With its legal actions, Cook Children’s hopes to remain on the list of options for families in its network. If the health system does not win its legal challenge, Cook Children’s would likely shut down its health plan, but the hospital itself is not in danger.

The trial to determine whether Eiserloh will issue a permanent restraining order is scheduled for Nov. 3, 2025, according to the 10-page order. The ruling can be appealed before then or the Health and Human Services Commission could choose to change the state’s proposal.

If the procurement is dropped, it would be Texas Health and Human Services’ third unsuccessful attempt to procure new contracts for STAR and CHIP managed care organizations.

David Moreno is the health reporter for the Fort Worth Report. His position is supported by a grant from Texas Health Resources. Contact him at david.moreno@fortworthreport.org or @davidmreports.

At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

This article first appeared on Fort Worth Report and is republished here under a Creative Commons license.