Cook’s Children’s Health Plan ‘Won’t Go Down Without a Fight’

Cook Children’s Health Plan is suing the Texas Health and Human Services Commission to overturn HHS’s decision not to renew the health plan’s Medicaid contract with the state. But after more than 20 years of administering Medicaid’s STAR and CHIP programs to provide coverage to low-income families in Texas, the nonprofit health system isn’t letting the reversal get the better of it.

Cook Children’s Health Plan (CCHP) insures 125,000 low-income families, pregnant women and children in Tarrant County and surrounding areas. Approximately 8,000 of the children insured by the plan are considered to have complex health conditions. The plan administers the CHIP and STAR programs to provide health coverage to low-income children and families.

Earlier this year, HHS announced it would not renew Cook Children’s Plan, and the remaining options would be four national or state plans from Blue Cross Blue Shield of Texas, Aetna, Molina and United Healthcare. Also in the hot seat after HHS’s decision are Driscoll Children’s Health Plan in Corpus Christi and Texas Children’s Health Plan in Houston. Together, the health plans serve 700,000 families statewide.

Cook Children’s Hospital filed a lawsuit against the decision, but HHS dismissed it in June. Cook Children’s Hospital appealed the decision and said it intends to use all options available to it, including legal action, to ensure its health insurance plan remains an option for North Texas families.

Since HHS announced the contract would not be renewed, Cook Children’s has launched a public relations campaign to denounce the decision. The health system launched a Save Cook Children’s Health Plan website and held a news conference where a family was interviewed about how the plan helped them care for their medically complex child. “We will not go down without a fight,” a CCHP spokesperson said at last week’s news conference. “For more than 20 years, the health plan has made a name for itself by making a difference in our community.”

Most protests by Cook Children’s Health Plan center on the possibility that families will lose coverage or access to their doctors. However, a change in the organization that manages care does not change a patient’s insurance status or the patient’s ability to continue receiving services. Health insurance plans must provide continuity of care to new beneficiaries and their providers, so it is unlikely (but not impossible) that a Cook Children’s Health Plan patient will lose coverage or access to their doctors.

“HHSC requires that the transition to a new MCO be as seamless as possible for Medicaid beneficiaries and their providers,” an HHSC spokesperson wrote in response to questions about the lawsuit. “Established beneficiary-provider relationships, existing treatment protocols, and ongoing service plans are important elements of any transition.”

According to the list of STARKids insurance plans accepted for Cook Children’s, the hospital already accepts many national plans that will be the remaining options for families currently insured by Cook’s health plan, including Aetna, Blue Cross Blue Shield of Texas and UnitedHealthcare.

Still, CCHP says it is fighting on behalf of families and the health plan’s 400 employees. Cook called HHS’s process “deeply flawed” and said it failed to take into account Cook’s long history of patient care and caring for children, without considering continuity of care or costs to the state.

CCHP also claims that Aetna received copies of 17 competing health insurance plans, giving it an advantage when developing its own proposal. It believes Cook’s plan was likely one of those plans, which it says warrants a correction by the state.

Due to a process that Cook calls “riddled with errors,” the health insurance plan filed a motion for declaratory judgment and an injunction to vacate the decision to terminate Cook Children’s Medicaid contract and a temporary restraining order to prevent HHS from moving forward with its decision.

HHS said it used the same process to evaluate all plans that responded to the RFP and awarded contracts to the top scorers. Before managed care organizations begin providing services, HHS reviews each one to ensure it is operationally ready to provide the services under the contract. The new contracts will begin in the first quarter of next year.

Yet CCHP leaders and passionate Cook Children’s CEO Rick Merrill argued that the plan’s track record, care for medically complex children, and nonprofit status should have resulted in a contract. Merrill addressed the audience and called on state leaders to step in and reconsider HHS’s decision. “Who has the unwavering commitment to our most vulnerable patients? Not faceless corporations driven by profit,” he said. “Let’s find a path forward that prioritizes the well-being of our most precious commodity: our children.”

If all goes as planned, the loss of services and doctors that Cook officials have discussed could be avoided, and Medicaid-eligible families could choose a new plan and maintain continuity of care. However, errors and omissions are certainly possible with any major administrative change. Cook wants to avoid the headache of choosing a new plan and will continue to fight the state’s decision.

“The state made a mistake and we are asking the courts to correct it,” said Karen Love, president of Cook Children’s Health Plan. “We have taken great care of our members for so many years because we live here and they are our neighbors. We truly care about them. And our providers know them by name. Now, because of a flawed process that did not follow the guidelines set by Texas law, these families will be at the mercy of the nation’s for-profit insurance companies.”