Time Is Of Essence: Protect Children of Texas and Save Community Health Plans including Cook Children’s Health Plan

By: Rick W. Merrill, President & CEO, Cook Children’s Health Care System

Imagine being forced to forfeit a local, trusted resource that serves as your medically fragile child’s lifeline to out-of-state strangers for no good reason at all. That is exactly what Texas’ Health and Human Services Commission (HHSC) will do by cutting off access for Texas families to long-established, community-based health services.

Last year, HHSC, which oversees the contracts and funding for the state’s Medicaid STAR and CHIP programs denied Cook Children’s Health Plan renewed contracts to serve its membership through these programs. They did the same to two other non-profit community health plans in South Texas and the Houston area. Instead, HHSC chose to give those contracts to numerous for-profit health care companies, most of whom are not based in Texas. The decision would force 1.8 million children and pregnant women who qualify for the Medicaid STAR and CHIP programs to switch from the health plans they rely upon to unfamiliar, corporate insurers beholden to shareholders.

We are doing everything we can to protect North Texas families from this harmful decision. But we can’t do it without the support of Texas Legislators.

If lawmakers do not intervene, HHSC’s decision will upend the lives of Texas families, including 125,000 vulnerable North Texas children who rely on Cook Children’s Health Plan. They’ll have to start from scratch with a new health insurer and possibly new doctors after years of establishing a specialized medical team and complex care plans for their children. This could result in delayed or disrupted care, including for patients on a ventilator who are enrolled in Cook Children’s Health Plan.

Very soon, Texas Legislators are expected to consider several bills to protect the health care of vulnerable Texas children.

These bills would change the law on how HHSC awards contracts for the management of its STAR and CHIP programs. Simply put, they would give Texas families a choice in health insurers and protect their right to have their Medicaid-dependent child’s health care managed locally.

Needlessly foisting a change onto the most vulnerable in our community could be disastrous for Texas families. Change is hard even in the best of circumstances. When you have a medically fragile child, forced changes pile hardship onto an already heavy burden. Just ask Breanna Hernandez.

Her son, MJ, was born prematurely at 27 weeks. Now 10, MJ requires complex care from multiple specialties like neurology, pulmonology and gastroenterology, to name a few. All of MJ’s current doctors, along with many of his therapies and services, are part of the Cook Children’s Health Plan network. His family relies on the STAR Kids program through the health plan to cover most of MJ’s health care costs, like the supplies that allow him to receive nutrition safely through a port in his stomach.

“Losing the health plan would be like a tsunami or a tornado coming through our lives,” Hernandez said. “We never know what we’re going to get every morning when we wake up, but waking up with the knowledge that we have this established resource is a lifeline, a constant. It being taken away is something else that we would also have to worry about.”

Hernandez is on a first-name basis with MJ’s case manager at Cook Children’s Health Plan. That type of connection, where everyone feels like family, is central to Cook Children’s culture. Knowing the people who manage your child’s care also live and raise their families in the same area is another key benefit of a community-based health plan. They have first-hand knowledge of the local resources and how to help members navigate them. They understand the unique needs of local children and care deeply about the health of the community because it’s their community, too.

Private, out-of-state insurance companies can’t offer the same connection. The majority aren’t embedded in the communities they serve.

Cook Children’s Health Plan has been providing health care coverage for families and children with limited resources for more than 20 years, and Cook Children’s itself has been serving this community for more than 107 years. As a nonprofit organization, we use our resources to support our Promise of improving the well-being of every child in our care and in our communities.

This year, Cook Children’s will open two new neighborhood health centers, for a total of nine centers strategically located throughout Tarrant County in areas with little access to health services close to home. The majority of neighborhood health center patients are dependent on Medicaid. These centers offer basic, yet critical, health and wellness services, including behavioral health, for children who otherwise might go unserved. It’s your health care dollars in action, making a real difference in the lives of children in your community—a stark contrast from several out-of-state corporate insurers selected by HHSC whose profits flow to shareholders.

HHSC’s decision is flawed and wrong for Texas families. It’s the result of a subjective and unsound contract-renewal process that is not consistent with the law. Instead of considering past performance and quality when awarding these contracts, which HHSC was legally required to do, it ignored decades-long telling track records, like Cook Children’s Health Plan’s high member ratings and demonstrated quality of care, and chose untested promises made by many for-profit insurance companies.

The proposed bills would replace the current error-prone, subjective bidding process with a more modern and straightforward system. Most importantly, the bills would allow families enrolled in STAR, CHIP and other Medicaid programs to choose whether they want to remain on their current health plans or switch to the private insurers.

“I would ask lawmakers to spend one day, or a week, in our lives,” Hernandez said. “There are a lot of things that us parents go through daily with these kiddos’ lives, and seeing it from somebody else’s perspective, really digging in there and living that day-to-day, would change your mind on a lot of the decisions you make. Please, save Cook Children’s Health Plan.”

We urge the Legislature to join us in viewing the world through the eyes of the Hernandez family and the thousands of others like them. Support the proposed legislation, and give Texas families the power to choose. Focus on the well-being of the children in our communities, and not the countless out-of-state shareholders, by supporting nonprofit community-based health plans. Let’s protect our children and ensure they receive the quality health care they deserve.

To learn more and support our efforts, please visit SaveCookChildrensHealthPlan.com.