Cook Children’s Health Plan has filed a lawsuit against the Texas Health and Human Services Commission, trying to block HHS’s decision not to renew its Medicaid contract with the state. But the nonprofit health system, which has run Medicaid’s STAR and CHIP programs to help insure low-income Texas families for more than two decades, isn’t going to sit back and accept the cancellation of its contract.
Cook Children’s Health Plan (CCHP) provides coverage to 125,000 low-income families, pregnant women, and children in Tarrant County and the surrounding area. Approximately 8,000 of the children covered by this plan are considered to have medically complex conditions. The plan administers the CHIP and STAR programs to provide health insurance to low-income children and families.
Earlier this year, HHS announced it would not renew Cook Children’s Healthcare, leaving the options to four state or national plans: Blue Cross Blue Shield of Texas, Aetna, Molina and UnitedHealthcare. Driscoll Children’s Healthcare in Corpus Christi and Texas Children’s Healthcare in Houston also face elimination as a result of the HHS decision. The plans serve 700,000 families across the state.
Cook Children’s filed an appeal of the decision, but HHS denied the appeal in June. Cook Children’s is appealing the decision and says it will use all options, including legal action, to keep its health plan an option for North Texas families.
Since HHS announced it would not renew its contract, Cook Children’s Hospital has launched a public relations campaign against the decision. The health system launched a Save Cook Children’s Health Plan website, held a press conference, and interviewed a family to ask them how the plan has helped them care for their child with complex medical conditions. “We are not going to go down without a fight,” a CCHP spokesperson said at a press conference last week. “For more than 20 years, the health plan has built a reputation for serving the community.”
Much of the outcry from Cook Children’s focuses on the possibility that families could lose their insurance or access to doctors. However, a change in the organization that manages health care does not change a patient’s insurance status or whether they can continue to receive services. Because health plans must provide continuity of care to new beneficiaries and their providers, it is unlikely (though not impossible) that Cook Children’s patients would lose their insurance or access to doctors.
“HHSC wants the transition to a new MCO to be as seamless as possible for Medicaid beneficiaries and their providers,” an HHSC spokesperson wrote in response to questions about the lawsuit. “Established beneficiary and provider relationships, existing treatment protocols and ongoing service plans are an important part of any transition.”
According to a list of STARKids insurance plans accepted by Cook Children’s Hospital, the hospital already accepts many of the national plans that provide remaining options for families currently covered by Cook health insurance, including Aetna, Blue Cross Blue Shield of Texas and UnitedHealthcare.
Still, CCHP says it’s fighting for the family and the health plan’s 400 employees. Cook called the HHS process “deeply flawed” and said it doesn’t take into account Cook’s long track record of successfully caring for patients, the care he provides to children, continuity of care or the cost to the state.
CCHP also alleges that Aetna received copies of 17 competing health plans, likely including Cook’s, giving it an advantage in creating its own plans, which it believes need to be amended by the state.
Because of a process that Cook says was “riddled with error,” the health plan has filed a petition seeking declaratory judgment and injunction to overturn the decision to terminate Cook Children’s Healthcare, as well as a petition for a temporary restraining order to block HHS from proceeding with the decision.
HHS said it used the same process to evaluate all plans that responded to the request for proposals and awarded the contract to the plan with the highest score. Before the managed care organizations begin providing services, HHS reviews each organization to ensure they are operationally ready to deliver the services outlined in the contract. The new contracts will begin in the first quarter of next year.
Still, CCHP leaders and fiery Cook Children’s CEO Rick Merrill maintained that the plan’s track record, care of medically complex children and status as a nonprofit meant the contract should have been awarded. Merrill addressed the public, pleading with state leaders to step in and reconsider HHS’ decision. “Who has an unwavering commitment to our most vulnerable patients? Not faceless corporations driven by profits,” he said. “Let’s find a path forward that prioritizes the well-being of our most precious asset: our children.”
If all goes according to plan, Cook State officials will avoid the losses of services and doctors they discussed, and Medicaid-eligible families will be able to choose new plans and maintain continuity of care. But any major administrative change can lead to errors and omissions, and Cook State wants to avoid the hassle of choosing a new plan and will likely continue to fight the state’s decision.
“The state got it wrong, and we’re asking the court to set it right,” said Karen Love, president of Cook Children’s Health Plan. “We’ve taken good care of our members for many years because we live here and they’re our neighbors. We care about them at heart, and our providers know them by name. Now, because of a flawed process that doesn’t follow the guidelines set forth in Texas law, these families will be at the mercy of for-profit national insurers.”
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![Will Maddox](https://i0.wp.com/assets.dmagstatic.com/wp-content/uploads/2020/04/Will-Maddox-150x150.jpg?resize=150%2C150&ssl=1)
Will is a senior writer. CEO Editor of the magazine “D CEO Healthcare” and writer of articles on healthcare.