Save Cook Children's Health Plan

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October 4, 2024 - Cook Children’s Health Plan (CCHP) is grateful to announce that a Travis County court has granted a Temporary Injunction, preventing the Texas Health and Human Services Commission (HHSC) from awarding, signing or implementing any new contracts for the Medicaid STAR and CHIP managed care programs. This decision is a major win for the 125,000 children and families who rely on CCHP for their health care coverage.

For more than two decades, CCHP has been a trusted provider of high-quality health care coverage to low-income families, expectant mothers, and children with complex medical needs. We believe this ruling will help ensure that our Members continue to have access to the care they need, when they need it.

We would like to express our gratitude to the court for their careful consideration of this matter and for their decision in our favor. Cook Children’s will continue to monitor the situation closely and work with all stakeholders to ensure that our Members continue to receive the best possible care.

Read more about this court’s decision in the Dallas Morning News: https://www.cookchildrens.org/siteassets/documents/about/release/dallas-morning-news-texas-judge.pdf

Situation

The Texas Health and Human Services Commission recently announced it plans to deny Cook Children's Health Plan a new contract for the Medicaid STAR and CHIP managed care programs.

We believe there were flaws in the bidding process, and you can learn more about this issue below. More importantly, you can meet a few of the families who will be devastated by this decision.

For more than 20 years, Cook Children's has provided outstanding coverage to low-income families and children. And we've provided exceptional care to medically-complex children—these are kids with severe health needs, including 172 Members who require ventilators. We are proud of that work. And we are going to fight for our Members.

Spend some time exploring the media below to find out why the state's decision is so devastating ... and why the state needs to reverse course and make this right before our current contract expires in September 2025.

Welcome and thanks for visiting our page dedicated to protecting those served by Cook Children's Health Plan.

The Texas Health and Human Services Commission recently announced it plans to deny Cook Children's Health Plan a new contract for the Medicaid STAR and CHIP managed care programs.

We believe there were flaws in the bidding process, and you can learn more about this issue below. More importantly, you can meet a few of the families who will be devastated by this decision.

Health plan stories of hope and healing

Children in Jeopardy: MJ's Story

MJ is one of the more than 8,000 medically fragile children covered under Texas' STAR Kids program by Cook Children's Health Plan. His story illustrates the important role Cook Children's Health Plan plays in the lives of its Members and their families.

Read MJ's story

Children in Jeopardy: Pinon family

Liz’s triplets, born at 25 weeks, each have their own medical complexities requiring four or five specialty medications. The financial cost of medication, medical care and other specialty needs quickly added up.

Pinon family story

Children in Jeopardy: Vivienne's Story

14-year-old Vivenne Molen is one of nearly 125,000 Cook Children’s Health Plan (CCHP) members who could lose health care coverage if Texas Health and Human Services stands by its decision to exclude CCHP from the new STAR/CHIP contract starting in September 2025.

Impact of Potential Medicaid Contract Loss

The denial of a new STAR & CHIP Medicaid contract would signal a devastating disruption in care for vulnerable Texas children and families—and the potential loss of employment for their biggest advocates.

Jami Jensen's story

Zechariah’s Story

Children in Jeopardy: Zechariah’s Story

Zechariah is one of the more than 8,000 medically fragile children covered under Texas' STAR Kids program by Cook Children's Health Plan.

Children in Jeopardy: Rebekah Jones

Longtime Cook Children's nurse, Rebekah Jones, fears loss of Cook Children's Health Plan for her adopted children.

Rebekah Jones's story

In the media

August 1 - Becker's Healthcare: 'This is dire': Texas systems face losing their health plans (beckershospitalreview.com)
June 26 - Dallas Morning News: Cook Children’s takes legal action against state to save Medicaid contracts
June 26 - WFAA (ABC/TV): Cook Children's sues to stop insurance change that would affect 125,000 North Texans
June 26 - Fox 4 (TV): Cook Children’s sues state of Texas over Medicaid contracts
June 26 - CBS Texas (TV): Cook Children's suing state after being denied Medicaid contract renewal
June 26 - Fort Worth Star Telegram: Cook Children’s Health Plan sues the state of Texas over Medicaid contract dispute
June 12 - CBS Texas: Texas doubles down on plan to drop Cook Children's health plan
June 12 - Telemundo Dallas: Miles de familias podrían perder cobertura médica en el hospital Cook’s Children
June 11 - The Dallas Morning News: State doubles down on denying Cook Children's Health Plan Medicaid contract
June 6 - Texas Tribune: State rejects health insurers' pleas to halt plan that will shake up coverage for 1.8 million Texans
June 6 - Fort Worth Star-Telegram: Texas stands by its decision not to award major Medicaid contract to Cook Children's
June 5 - Fort Worth Report: 6 Tarrant lawmakers protest state Medicaid changes, show support for Cook Children's
June 2 - Fort Worth Star-Telegram: If you have Medicaid in Texas, a big change could be coming to your health insurance
May 17 - Houston Chronicle: Poised to lose major Medicaid contract, Texas Children's Health Plan faces uncertain future
May 10 - CBS 11: 125,000+ North Texas families could lose current health care coverage
May 2 - WFAA: 'It would be devastating': Proposed changes to Medicaid plans in Texas could dismantle coverage for 125,000 low-income families in North Texas
April 30 - Modern Healthcare: Medicaid disclosure unfairly benefits Aetna, rival insurers say
April 26 - Texas Tribune: State's premature release of bid proposal info touches off new battle over $116 billion in Medicaid contracts
April 24 - Fort Worth Report: Cook Children's Fort Worth health plan could be dropped from state Medicaid plans
April 24 - Spectrum News: Insurance providers petition possible changes to the state Medicaid plans
April 19 - Newsweek: Texas Medicaid Shake-up Risks Upending Nearly 2 Million People
April 18 - Becker's Payer Issues: Texas Medicaid shake-up could force 1.8 million to switch plans
April 18 - Texas Tribune: Proposed changes to state Medicaid plans could shake up health coverage for 1.8 million low-income Texans

Op-eds and editorials

June 5 - Fort Worth Star-Telegram (op-ed): Cook health plan serves Fort Worth children in need. Don't let Texas screw it up
May 10 - Dallas Morning News (letter to the editor): Letters to the Editor — John Cornyn replies, children's health care, Old City Park
May 9 - Dallas Morning News (commentary): Texas agency botched multibillion-dollar Medicaid bid (dallasnews.com)
May 8 - Dallas Morning News (op-ed): More than a million Texas children face health care chaos

Understanding the situation

For more than 20 years, Cook Children's Health Plan (CCHP) has provided outstanding service for hundreds of thousands of families as part of the STAR & CHIP Managed Care Services. However, on March 7, 2024, CCHP was denied a new contract starting Sept. 1, 2025, by the Texas Health and Human Services Commission (HHSC) due to a flawed methodology. This decision jeopardizes access to vital health care for nearly 125,000 CCHP Members from low-income families and children with complex medical needs. CCHP is appealing the decision, arguing that the state's scoring methodology lacked transparency, and disadvantaged regional, provider-sponsored plans like theirs. If not reversed, the result will be a serious disruption in care and potential for harm to the vulnerable children and families who depend on CCHP.

HHSC unilaterally made the decision, without any direction from the legislature, to depart from a community-based care model to provide Medicaid services across the state of Texas, to a for-profit national model. Their decision was flawed in many ways, including failing to follow statutory mandates requiring preference for health plans committed to providing charity care. HHSC was also required to give weight to health plans that provide care to special populations, such as children. They did not. Additionally, HHSC failed to consider how continuity of care would be impacted, as well as costs to the state.

HHSC did not go through the proper rulemaking process for making critical changes to the Request for Proposal (RFP) and their scoring was riddled with mistakes. As a result, 1.8 million of the 3.2 million children, pregnant women and adults enrolled in the STAR and CHIP plans will be forced to find a new plan. This disruption is a 56% turnover if this decision stands. (In Tarrant County, it is a 75.6% turnover.)

Impact: Nearly 125,000 CCHP members from low-income families could lose access to vital health care services and providers.

More than 8,000 fragile children who are medically complex will also be impacted.
Loss of the contract threatens the sustainability of the Cook Children's Health Plan potentially impacting 400 local employees and 1,455+ primary care providers and 2,550+ specialists.

Going into something as unknown and scary as Graham’s heart defect, one of our many stressors was the possibility of paying for three open heart surgeries in three years. Becoming a part of the Cook Children’s Health Plan took so much worry off our plate so that we could truly just be in the moment to support Graham during his recoveries. Also, having an insurance plan that all of Graham’s interconnected specialists accept really makes our lives so much easier when he has such frequent appointments and ER visits. The care that we’ve received from everyone at Cook Children’s is unmatched, and the fact that we never have to worry about him receiving care due to CCHP is priceless to us.

Zoe Maples

CCHP's Differentiators

As a non-profit, community based health plan, Cook Children's has a deep understanding of local needs.
The Health Care System provides more than $200 million every year in community benefit and uncompensated care to families in need.
We have a 20-year history of serving the community with our high health plan member, physician and provider satisfaction and top tier performance.
Cook Children's has impressive quality outcomes as we utilize health plan data to identify opportunities to reduce costs and improve the health of the communities we serve. As a community based health plan, we integrate our systems to better coordinate care and drive efficiencies. We also have a proven willingness to invest in services that are unreimbursable by the Medicaid programs and benefit vulnerable and medically complex children. Examples:
- Cook Children's Healthy Homes Asthma Program which involves funding the remediation and repair of homes. Results:
  - Emergency Department (ED) visits declined 80%
  - ED charges were reduced 78%
- Each of our seven Neighborhood Health Centers serve underserved communities and have a $1 million financial loss per center each year. (There are 125,000 visits per year across the centers.)
- Through close collaboration with Cook Children's physicians, we were able to reduce pharmacy expenses over a two-year period by 17%, while non-Cook Children's PCP costs went up by 10%.
Cook Children's also has the ability to address social determinants of health beyond just medical care (food security, transportation, etc.).
The Health Plan has saved the state of Texas millions of dollars in the last 20 years through proactive preventative health care outreach efforts for children from lower-income families and communities across the state. Examples of this include:
- Partnership with Tarrant Area Food Bank to provide free fresh fruits, vegetables and dairy items through the R.E.D. Market to underserved families in Denton, Wise and Cooke Counties. This effort reduces the risk of children experiencing problems in school and serious health conditions due to hunger.
- Providing COVID-19 vaccines to homebound children and their families to prevent unnecessary hospitalizations.
- Partnership with the United Way of Tarrant County to create a doula certification program to provide education, a birthing plan and recovery period for soon to be moms, combatting Texas' high maternal mortality rate.

Protest and next steps

CCHP filed a protest with the state on March 21, 2024.

CCHP was notified on June 6, 2024, that the protest was denied by HHSC. We will pursue every legal option available, including filing an immediate appeal. We are confident in the strength of our case and believe we will prevail.
Our protest argues the scoring process favors large, national for-profit companies and there are flaws in the scoring methodology.
It was recently learned that the process was so flawed that Aetna was emailed in advance copies of the proposals of other health plans competing for the same contract. We believe we were likely one of those plans whose proposal was released to Aetna, giving them a massive advantage. This alone is enough to warrant a correction from the state.
HHSC also failed to give preference for charity care, specialized care (pediatrics) and continuity of care, all of which are required by the state's “best value” statute.
This decision will result in 76% of Tarrant County and 56% of Texas Medicaid and CHIP Members losing their health plans.
If the appeal is unsuccessful, it will be challenging for CCHP to submit a bid for the STAR Kids program for medically complex children.
On June 26, CCHP announced it’s taking legal action to stop the flawed process that led to the HHSC taking away Cook Children’s longstanding contract administering Medicaid to local families. Cook Children’s filed a Petition for Declaratory Judgment and Injunctive Relief against HHSC Commissioner Cecile Erwin Young. This is the lawsuit to overturn the decision. In the meantime, Cook Children’s has also filed a Temporary Restraining Order request to stop HHSC from finalizing its procurement results. Both actions were filed in Travis County.
Cook Children’s also filed a protest of the STAR Kids RFP to stop HHSC from making the same mistakes it made in the STAR & CHIP RFP and from taking away options from the kids who need help the most.

I'm a wife, but most importantly I'm a mom of 2 little boys, both under the age of 4 years-old. In October of 2019, at the age of 20, I found out I was expecting my oldest, Weston W. James. At that time, I was working full-time at a childcare center and attending Tarrant County College as a full-time student. As any woman should feel, I was nervous but excited. I went to a free pregnancy testing center and was able to confirm my pregnancy. When I left the clinic, I sat in my car and felt lost. I knew that I needed an OBGYN, but I didn't have any insurance. I was able to do research and found Medicaid for pregnant women. I applied, received approval, and chose the CCHP- STAR/CHIP Program. This program paved the way for my pregnancy journey and after birth. I was happy with all the resources that were provided for my son and me. I was able to find the perfect pediatrician and dentist for Weston. After Weston was born, we had to make an appointment for him at Cook Children's for an x-ray due to him being breached. Thankfully, the x-ray showed no issues with his hips. Fast forward to a few years later, around the age of 3, Weston was showing severe symptoms of the beginning stages of asthma and had to be treated at Cook Children's Urgent Care in Mansfield. CCHP- STAR/CHIP Program has helped me and my son in many ways. We'll be forever grateful for this program because of all the doctors, nurses, and technicians at Cook Children’s. Other families should be able to get the assistance they need and witness the greatness that CCHP- STAR/CHIP Program has to offer. Thank you.

Allyson James

Community impact

Denial of the contract undermines Cook Children's commitment to serving all children in need.
Loss of the CCHP could negatively impact the overall health and well-being of the community.

You can support Cook Children's Health Plan

Information for Members Information for Providers Provider Update Sept. 2024

Have a story or a question?

If you'd like to share your experience with Cook Children's Health Plan, or submit questions, please email us at social@cookchildrens.org.

Faces of Cook Children's Health Plan

Cook Children's Health Plan social workers

Cook Children's Health Plan family and staff

Cook Children's Health Plan father with child