State against denies Cook Children’s Health Plan Medicaid contract

Proposed shake-ups in pediatric Medicaid insurers could lead thousands of North Texans to change health plansThe state has once again denied Cook Children’s Health Plan’s bid to secure a major Medicaid contract, a decision the Fort Worth nonprofit health insurer plans to appeal.it will award the Medicaid STAR and CHIP contracts, which provide health coverage for low-income children and pregnant women in Tarrant County, to Molina, Blue Cross Blue Shield, Aetna and UnitedHealthcare.

Insurance companies and plans must periodically compete for different Medicaid contracts, like the STAR and CHIP contracts that will be officially awarded by the state. Cook Children’s currently has both a STAR and CHIP contract and a STAR Kids contract. The latest procurement window for STAR Kids, which offers insurance to children and young adults with disabilities, opened in early May.

A lengthy appeals process and even legal action is common during Medicaid procurement, said Daniel Karnuta, director of the Professional Program in Healthcare Management at UT Dallas’ Naveen Jindal School of Management.“Sometimes they win, sometimes they lose. If they win, either in a court or if their protest is accepted, then the bid needs to be redone and basically start over,” Karnuta said. “But a lot of times the response to the protest is just, ‘Well, that’s interesting.

Awarding Medicaid contracts to new insurers can be a heavy lift for everyone involved. Providing new cards and insurance information comes with administrative costs, Karnuta said. For insurance users, the switch can be a mental and logistical hurdle, especially if they’re comfortable navigating the plan they’ve had for years. Cook Children’s Health Plan has received Medicaid contracts for more than 20 years, Love said.. Marin Wolf is a health care reporter for the Dallas Morning News. She previously covered breaking business news for The News' business desk and race and diversity for Bloomberg News.

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