Forth Worth-based Cook Children’s Health Care System, one of Texas’s largest pediatric Medicaid managed care providers, is in a battle to retain its Medicaid contract with the state after being left out of the latest awards.
“We take our direction from our community,” Karen Love, president of Cook Children’s Health Plan, told Becker’s. “Provider-affiliated plans like ours, where you have the hospital and the doctors and the payer all working together for the benefit of these children, is a different model of care and a different model of coverage than the large national for profit companies.”
In March 2024, Texas awarded a majority of its Medicaid STAR and CHIP contracts to Blue Cross Blue Shield of Texas, Molina Healthcare, Aetna and UnitedHealthcare, which are collectively worth $116 billion. If the new contracts are implemented, nearly 1.8 million Medicaid beneficiaries in the state will have to move to new insurers.
Cook Children’s Health Plan, Houston-based Texas Children’s Health Plan and Corpus Christi-based Driscoll Children’s Health Plan were all denied contracts in the tentative award process. Collectively, the three plans serve more than 700,000 people.
In June, Cook Children’s took the Texas Health and Human Services agency to court, arguing that the procurement process violated state law. The court agreed and issued a temporary injunction in October that prevented the state from finalizing the Medicaid contract awards. While the state has appealed the ruling since then, the case has been put on pause to allow the Texas Legislature to weigh in.
“We’ve abated the legal proceedings while the legislature is in session, and we’re asking them to make it clear that the past performance of plans should be considered,” Ms. Love said. “This shouldn’t be just an essay contest about what plans might do in the future but should also include a 25-year track record of quality outcomes, high member satisfaction, high provider satisfaction, and strong financial performance.”
The Texas Legislature is in session until June 2. If lawmakers don’t act in Cook Children’s favor, Ms. Love said they’ll continue the fight in court.
“We’re advocating for a system that continues to offer an array of plans, including locally embedded nonprofit plans,” Ms. Love said. “It’s not just about the contract. It’s about continuing to provide the care that these families rely on.”
