In Texas, a significant shake-up is on the horizon for mothers and children regarding their health care coverage, following the state’s decision to overhaul Medicaid contracts.
The Texas Health and Human Services Commission (HHSC) recently announced plans to distribute $116 billion in Medicaid contracts, which has led to considerable pushback. The changes will phase out three major health plans managed by nonprofit children’s hospitals, including the Texas Children’s Hospital STAR (Medicaid) program, which serves around 450,000 vulnerable kids and expectant mothers.
Michael Murphy, president of Texas Children’s Health Plan, expressed concern about the disruption this will cause. “When you have a good working relationship that helps navigate the health care system, losing that connection and starting fresh is very unsettling for everyone involved,” he shared with Click2Houston. He raised alarm over how difficult this transition could be for families with children who have disabilities that require ongoing specialist care.
Murphy pointed out that maintaining consistent access to health specialists is crucial for children with high dependency needs, and any disruptions could lead to negative outcomes. “This is simply not acceptable,” he stated.
In defense of the changes, the Centers for Medicare & Medicaid Services (CMS) reassured that beneficiaries wouldn’t lose their coverage. The HHSC emphasized that switching managed care organizations (MCOs) won’t impact the services Medicaid recipients are entitled to. “MCOs must ensure continuity of care for both new and transferring members,” they stated.
“HHSC aims to make the shift to new MCOs as smooth as possible, and maintaining established relationships and treatment plans is critical during this transition,” they added, while noting that details remain under review due to ongoing protests and appeals.
Texas Children’s Hospital has formally challenged the decision and is exploring all legal options. Murphy affirmed their commitment, saying, “We will fight to protect our members and the families we support. We assure Texas Children’s Health Plan members that there will be no immediate disruptions in coverage, and our focus remains on their health and well-being.”