Mothers and children in Texas must prepare for fundamental changes in their health insurance after the state decided to reorganize Medicaid contracts.
The Texas Health and Human Services Commission (HHSC) has faced criticism since announcing its plan to award $116 billion in Medicaid contracts earlier this year for eliminating three major health insurance plans run by the state’s nonprofit children’s hospitals. One of those plans is Texas Children’s Hospital STAR (Medicaid), which covers a total of 450,000 vulnerable children and pregnant women.
“We are obviously very concerned about the potential outcome,” Michael Murphy, president of Texas Children’s Health Plan, told Click2Houston. “When you find someone that you work well with to navigate the health care system and then have to break that bond to find someone new and start the process over again, it’s very, very disruptive to everyone’s personal lives.”
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He went on to talk about how disruptive the changes could be for families with disabled children who have assembled an entire medical team.
“If you need so many patients that you have to see a specialist at regular intervals, it’s very, very difficult to manage,” he said. “The children will suffer and that is certainly not acceptable.”
The Centers for Medicare & Medicaid Services (CMS) stressed that people would not lose their insurance coverage.
“A change in managed care organizations (MCOs) that contract with HHSC will not affect whether a Medicaid recipient receives benefits, nor will it affect the benefits a recipient may receive,” HHSC said in a statement. “MCOs are contractually obligated to provide continuity of care for both newly enrolled recipients and recipients transferring from another MCO.”
“HHSC requires that the transition to a new MCO be as smooth as possible for Medicaid beneficiaries and their providers. Established recipient-provider relationships, existing treatment protocols, and ongoing service plans are important components of any transition.”
It was further stated that it was only possible to comment on the matter to a limited extent as there were still unresolved protests and appeals.
Texas Children’s Hospital has appealed the decision and is “pursuing all legal remedies.”
“We will also leave no stone unturned to protect and advocate for our members and the families we serve,” Murphy said. “We want to reassure all Texas Children’s Health Plan members and their families that there will be no interruptions in care at this time and that the health of our members remains our top priority.”
