The plan, owned by Fort Worth-based Cook Children’s Health Care System, was not awarded a contract to manage Texas’s STAR and CHIP programs. Cook Children’s executives have previously said the plan will likely shut down if it is denied a Medicaid contract from the state.
Texas’s Health and Human Services Commission rejected challenges from Cook Children’s Health Plan and seven other insurers disputing the contract award process.
Cook Children’s said it filed a lawsuit against the Health and Human Services Commission challenging the decision in a June 26 news release. In its statement, Cook Children’s Health Plan called the process “deeply flawed.”
The health plan alleged the state did not follow state law requiring preference be given to health plans with “long and successful track records of facilitating care for the children and mothers in our community.” The health plan also alleged the state’s scoring of bids submitted by plans was “riddled with mistakes.”
Texas’s Health and Human Services Commission sent documents to Aetna Health Plan of Texas in response to a public records request in error, according to The Texas Tribune. The state later asked Aetna to destroy the records “as a courtesy.”
The Health and Human Services Commission said the error did not affect the outcome of the procurement.
“The state got it wrong, and we are asking the courts to make it right,” Karen Love, president of Cook Children’s Health Plan said in the release. “We have taken such good care of our Members for so many years because we live here, and they are our neighbors.”
Texas’s STAR and CHIP contracts cover the majority of Medicaid beneficiaries in the state, including pregnant women, low-income children and their caretakers. The contract makes up the majority of Cook Children’s Health Plan’s business.
The state also declined to award plans to two other system-owned Medicaid plans in the state: Houston-based Texas Children’s Health Plan and Corpus Christi-based Driscoll Children’s Health Plan.
Executives from Cook Children’s and Driscoll Children’s previously told The Texas Tribune the plans will likely shut down without the Medicaid contracts. Hospital finances are not endangered by the contract award, the executives said.
Blue Cross Blue Shield of Texas, Molina Healthcare, Aetna and UnitedHealthcare were awarded the majority of the state’s tentative contracts. Just one of the state’s 13 Medicaid service areas will keep the four managed care organizations it currently has, meaning 1.8 million people could have to switch to a new plan.
