Cook Children’s Health Plan Continues to Mislead and Scare Medicaid Recipients
- TMCA
- 7 days ago
- 8 min read
If you have questions about your Medicaid coverage or feel like your health plan has given you false information you, can contact the HHSC Ombudsman Office online or call 866-566-8989 to get help or file a complaint.
The Problem Persists
Through recent articles, ads and websites, Cook Children’s continues to spread misinformation to the public, the Legislature and Medicaid recipients. In a recent article, Cook Children’s appears to be misleading Medicaid recipients for their own financial gain. Any health plan that knowingly misleads Medicaid recipients should have their contracts terminated. Taxpayer dollars should not be used to scare the most vulnerable Texans into thinking they will lose access to life saving Medicaid coverage. When the state moves forward with the new STAR and CHIP awards, or any managed care implementation, every Texan currently receiving Medicaid will continue to have access to their health care providers with uninterrupted coverage. Extensive federal and state protections ensure that Medicaid recipients do not experience any disruption in care during health plan transitions.
In addition to scaring Medicaid recipients, Cook Children’s Health Plan CEO, Karen Love, is now claiming in a May 2 Dallas Magazine article that a bill “being shepherded by State Senator Lois Kolkhorst, who chairs the Texas Senate Committee on Health & Human Services, is up for discussion next week.” While discussions about a potential new bill have taken place, nothing has been filed and no hearing has been set. Even though no legislation has been heard, Cook states, “There’s widespread consensus in the legislature that the children’s plans need to be put back in the program.”
All the plans that won a STAR and CHIP contract in the Tarrant Service Area have been a STAR and CHIP health plan in Texas for decades and have been providing STAR and CHIP care coordination. These health plan CEOs, staff and care coordinators live and work in Texas. These health plans invest in Texas and are a part of the communities they serve. Rhetoric saying otherwise is just another scare tactic to try to convince the Texas Legislature to give select plans taxpayer dollars and preserve market share.
Myth vs. Fact
The President of Cook Children’s Health Plan confirmed this on the record to the House DOGE committee on March 26, 2025: “I want to be clear. Cook Children's Physician Network and Cook Children's Medical Center will remain Medicaid providers in the Tarrant service area. The Medicaid [plans] that are offered in our service area — their patients will continue to be able to come to our facilities.”
When the state moves forward with the new STAR and CHIP awards, or any managed care implementation, every Texan currently receiving Medicaid will continue to have access to their health care providers with uninterrupted coverage. Extensive federal and state protections ensure that Medicaid recipients do not experience any disruption in care during health plan transitions.
Based on the characteristics of the client mentioned in the article and most of the patients in the Cook Children’s media, the children Cook claims would be harmed by the STAR/CHIP awards appear to be medically complex children likely enrolled in STAR Kids, not STAR/CHIP recipients. There are no impacts to the STAR Kids program due to the STAR/CHIP awards as these are separate and distinct programs.
Medicaid recipients will not be forced to pay for any covered services out of pocket and will continue to have access to all covered services.
Health plans that knowingly mislead or lie to Medicaid patients should not receive a contract.
HHSC reprocured the STAR and CHIP contracts, which serves pregnant women and children, not STAR Kids, which serves medically complex children. Cook Children’s Health Plan still has a STAR Kids contract — that RFP has not been completed or awarded due to the lawsuits brought on the state by Cook.
HHSC did not deny Cook Children’s a STAR and CHIP contract. Rather, Cook did not win the legal, transparent, and competitive procurement and scored lower than other health plans that bid on the Tarrant service area.
Dell Children’s Health Plan, also a regional provider-sponsored plan, won an award and is not claiming to have been disadvantaged.
The entire RFP process, including evaluation criteria, scoring examples and scoring matrix, was posted online.
HHSC revamped the procurement process, and two other contracts have been awarded and implemented under the new process. During the entire process to revamp the procurement, health plans and other stakeholders were given opportunities to weigh in. The health plans — including those opposed to the current STAR/CHIP awards — applauded HHSC on their new process via letters from both the Texas Association of Health Plans and the Texas Association of Community Health Plans.
The state affords bidders an administrative protest process to raise legitimate concerns with scoring or procurement irregularities.
Extensive federal and state protections ensure that Medicaid recipients do not experience any disruption in care during health plan transitions.
If someone selects a health plan that does not have their doctor in network, the health plan can offer a single case agreement and work with the provider to enter into a contract. Medicaid recipients retain the right to change health plans at any time without any disruption in care.
Health plans have very similar networks and Cook Children’s Hospital is in network with the other health plans in the service area. MJ will maintain access to Cook Children’s Hospital providers. This was even confirmed by Karen Love during the DOGE hearing on March 26.
Cook Children’s Health Plan and other Plaintiffs continue to infer that they are the only entities that provide community-based care coordination. The vast majority of the winning health plans have provided locally-based community care coordination for a lot longer than the children’s hospital-affiliated plans through the STAR+PLUS program, which was created in 1996, and offer it in their STAR/CHIP program. In fact, two health plans that tentatively won a contract for the Tarrant area (Molina and United) currently provide care coordination in the Tarrant service area in the STAR+PLUS program and have decades of experience providing community based Service Coordination in Texas, and Aetna has provided community based care coordination in Tarrant County through the STAR/CHIP program since 2006 and through the STAR Kids program since its inception in 2016.
Texas Medicaid programs require all health plans to have local, community-based Service Coordinators for complex recipients, including high risk pregnant women. This is not only a contractual requirement, but the main reason the state moved to managed care. These care coordination services were further enhanced in the new contract that Cook is blocking the state from implementing. All Medicaid health plans in Texas MUST have Service Coordinators to make visits in the home and help connect individuals to community resources.
In the Tarrant Service Area, Aetna, BCBSTX, Molina and United legally and competitively won a STAR and CHIP contract.
Aetna currently provides community-based care coordination through the STAR, CHIP and STAR Kids programs in the Tarrant Service area – a population much more complex than the STAR and CHIP programs.
United and Molina are currently providing local, community-based care coordination through STAR+PLUS in the Tarrant service area.
BCBSTX is a statewide customer-owned health insurer that has been in Texas for nearly 95 years and provides community-based care coordination through the STAR Kids program.
These health plans already have or will hire local care coordinators to serve the STAR and CHIP population. In fact, when health plans exit a market, the entering health plans work with them to hire their experienced staff so that the Medicaid recipients can keep their care coordinator.
These health plans had to demonstrate their ability to provide community-based care coordination to win a contract and must ensure their teams are imbedded in and have knowledge of the local communities to fulfill the terms of their contracts.
Additionally, health plans maintain community engagement staff within their local communities to connect families to local resources and address their needs.
During transitions, health plans work together for entering plans to hire exiting plans' current staff.
It is unclear why primary care providers and specialists would be impacted unless Cook Children’s Health Plan is saying they pay their own providers more than other providers.
Where are these providers going? They will still serve Medicaid recipients and still receive Medicaid reimbursement.