TEXAS — Nearly 2 million women and children will be forced to find a new health insurance plan if Texas Health and Human Services finalizes its current procurement plan that removes some long-standing providers from its Medicaid and children’s health insurance contracts.
Karen Love is the president for the Cook Children’s Health Plan, one of the providers that was not awarded a bid from the state.
“They’ll have to change providers because not all of the providers in my networks may not be in the networks of the new insurance companies. It could mean the need to get new prior authorizations or new paperwork filed with the new insurance companies so they can continue with their treatment. They may have people fall through the cracks,” said Love.
Cook Children’s, Texas Children’s Health Plan and Driscoll Children’s Hospital make up the largest three largest nonprofit children’s health plans in the state. They all are poised to not get a contract.
“We were able to lower NICU days and save the state of Texas a lot of money. I’m talking over a billion dollars over 10 years with a $10 million per year investment though the health plan. If the health plan goes away through this procurement, I worry about that whole program,” said Dr. Mary Dale Peterson, Driscoll Children’s Hospital executive vice president and COO.
TXHHS contracts with organizations to provide coverage for low-income woman and children through a Request for Proposals process. The agency says, “All proposals were evaluated in the same fashion, using the best value criteria that was advertised in the solicitation.”
“There is legislation that requires them to give contracts to health plans that are part of public hospital systems if they meet the quality and service parameters that are laid out in the contract,” said Ken Janda, founder of Wild Blue Solutions.
Although not finalized, providers not awarded a contract are protesting the Health and Human Services decision.
In a statement, Michael Murphy, president of the Texas Children’s Health Plans, said:
“As the largest children’s health system in the United States which has been providing care for the underserved since opening its doors in 1954, Texas Children’s is deeply disappointed that Texas Children’s Health Plan was not awarded a STAR (Medicaid) and CHIP contract and strongly disagrees with this outcome. For over 25 years, Texas Children’s Health Plan has illustrated its commitment to helping the state’s most vulnerable children and pregnant women receive the highest quality of care and remain healthy.
"As Harris County’s largest Medicaid and CHIP health plan, we are deeply concerned about the potential impact of this decision on the families who rely on Texas Children’s Health Plan for health coverage. Texas Children’s Health Plan challenged the decision and promptly filed a protest. As the only Medicaid and CHIP health plan affiliated with a children’s hospital serving the 20 counties in the Harris and Jefferson service areas, the decision not to award Texas Children’s Health Plan a Medicaid and CHIP contract is unnecessarily disruptive and jeopardizes the care of 450,000 of the state’s most vulnerable beneficiaries.
"We want to assure all Texas Children’s Health Plan members and their families that there will be no disruptions in coverage at this time and that the health of our members remains our top priority. Texas Children’s Health Plan has a long and storied history of serving the children and women of Texas and looks forward to continuing to support Texas’s Medicaid population.”
Some providers want lawmakers to weigh in on the process.
“The governor, the executive commissioner, the Legislature saying we’ve got some good solid plans that have been in the business for 20 years, let them stay,” said Love.
HHS can’t comment on the procurements until contracts are awarded. But currently only one contract is expected to go to a provider run by a children’s hospital.