Six Tarrant County lawmakers are protesting the Texas Health and Human Services Commission’s $116 billion Medicaid procurement that would remove three hospital-affiliated children’s health plans, including Cook Children’s Health Plan, from STAR and CHIP contracts starting September 2025.
State Reps. Salman Bhojani, D-Euless, Nicole Collier, D-Fort Worth, David Cook, R-Mansfield, Charlie Geren, R-Fort Worth, Ramón Romero, Jr., D-Fort Worth, and Chris Turner, D-Arlington, signed a June 4 letter addressed to Cecile Young, executive commissioner with the Health and Human Services Commission, to express concerns about the decisions possible impact on more than 125,000 families with children in the Tarrant County area.
“The decision to potentially exclude Cook Children’s will disrupt essential healthcare services to our community’s most vulnerable populations. Such a change threatens to dismantle long-standing health care relationships and infrastructure, which have been integral to Cook Children’s significant public health achievements in Tarrant County,” the lawmakers wrote.
Tiffany Young, deputy chief press officer with Texas Health and Human Services, said the agency cannot comment on the procurement until contracts are awarded and protests and appeals have been resolved so as “to maintain the integrity of the process.”
Cook Children’s filed its protest March 21 in hopes Texas Health and Human Services overturns its decision.
During a June 4 public hearing, Kay Molina, deputy executive commissioner for procurement and contracting services for Health and Human Services Commission, said she is hoping to issue a decision on the contracts by the end of the week.
In their letter, the Tarrant lawmakers ask the Texas Human and Human Services Commission to reconsider the current procurement caps, which limit the number of managed care organizations per service area, and delay finalizing the contract awards until the Texas Legislature convenes in January 2025.
“This would allow for a thorough legislative review and the opportunity to address these critical issues more comprehensively,” the lawmakers wrote.
Cook Children’s expressed its gratitude to the legislators for their support.
“We appreciate the strong, bipartisan support of our local legislative officials,” a Cook Children’s spokesperson said in a statement. “It’s not too late for HHSC to change course and do the right thing. We will continue to urge them to do just that. And as we do that, we will work closely with our legislative officials.”
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. CHIP provides care to children in families who earn too much money to qualify for Medicaid, but cannot afford to buy private insurance.
Texas Health and Human Services contracts with 20 managed care organizations to provide, arrange and coordinate acute, preventive and primary care, behavioral health care, nonemergency medical transportation and pharmacy-covered services to people with limited income.
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 subsequently awards the new contracts.
When Texas Health and Human Services directed managed care organizations to start preparing proposals for new contracts in December 2022, the agency switched to a new scoring rubric. Among the changes was a new ranking system that placed more emphasis on numerical scores than on quality of health care, community preferences, market share and historical performance.
In its appeal, Cook Children’s argues the state’s rubric for contracts lacked transparency and was set up to work against regional, provider-based sponsored plans like theirs.
“(The state) wants to be sure that they are getting the best value for the taxpayer dollar, I totally understand that. But, when you use a new process that kicks out the three largest children’s health plans in a Medicaid program that is two-thirds children, something’s wrong,” Karen Love, president of Cook Children’s Health Plan, previously told the Report.
If the agency stands by the decision to redistribute contracts, Cook Children’s would likely shut down its health plan, but the hospital itself is not in danger.
Cook Children’s advises its health plan members to continue seeking care from doctors and other providers as coverage will remain active for at least the next year and a half.
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 on X.
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