Texas health officials are poised to drop the state’s three largest nonprofit children’s health plans from multibillion-dollar Medicaid and children’s health insurance contracts — threatening the future of plans run by legacy children’s hospitals in Fort Worth and South Texas and shaking up health care coverage for low-income families throughout the state.
That would leave Dell Children’s Health Plan in the Austin area as the only Medicaid plan in the state that is run by a children’s hospital. The change would force nearly half of the Medicaid STAR and CHIP enrollees in the state out of their current health plan, potentially causing changes in providers, pharmacies, mental health services and plans.
"This procurement rips out the investments made over two decades, and abandons 20 years of progress in the health of South Texas," said Craig Smith, CEO of Driscoll Health Plan, which covers 190,000 STAR/CHIP members in South Texas — and where the change would gut a critical maternal fetal medicine program.
Barring that, they want Texas HHS Executive Commissioner Cecile E. Young to cancel the procurement or delay the decision to allow lawmakers time to pass legislation more specifically governing and enforcing how the state picks its Medicaid insurers. All three of those plans have filed protests, along with five others. At least four have said that they are considering legal action if they aren’t successful with their administrative protests.
“There wouldn’t be an alternate path for that portion of the health plan,” Peterson said. “That's not to say that we couldn't potentially repurpose all the great work that our plan has done. We have a great claims system, we pay physicians timely and accurately, and we could go on the exchange and do that, but that's not really our core business or our mission. It really is about children and pregnant women.
They also ask that Young order the removal of limits on the number of managed care organizations that can be operating STAR/CHIP contracts in any one service area “to create more robust competition among MCOs across the state.” This investment has decreased preterm births, decreased maternal mortality, and resulted in about $100 million per year in health care savings, Smith said.
That investment includes over $10 million to build seven centers and then about $9 million per year to cover the losses they incur from seeing primarily Medicaid and CHIP patients. The plan’s eighth neighborhood health center is about to open, for example.
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