The Texas Medical Association is monitoring a court injunction that – for now – prevents the Texas Health and Human Services Commission (HHSC) from entering into contracts with certain Medicaid and Children’s Health Insurance Plan (CHIP) managed care organizations (MCOs) named in HHSC’s notice of award for managed care contracts for the State of Texas Access Reform (STAR) Medicaid program and CHIP.
The Oct. 4 decision by Travis County District Judge Laurie Eiserloh comes after four health plans (Cook Children’s Health Plan, affiliated with Cook’s Children Health Care System in Fort Worth; Texas Children’s Health Plan, affiliated with Texas Children’s Hospital in Houston; Austin-based Superior HealthPlan, Inc.; and Wellpoint Insurance Company, formerly Amerigroup) sued to block HHSC.
“The intended contract awards will impose significant harm and confusion on millions of Texas’s STAR and CHIP members,” Judge Eiserloh wrote in her decision, adding that HHSC’s intended contract awards would affect 43% of the state’s total STAR and CHIP population.
While the injunction is in effect, HHSC cannot award any new contracts connected to CHIP or STAR procurements or take any action to effectuate or perform any contracts connected to HHSC’s CHIP or STAR requests for proposals.
Additionally, while the injunction is in effect, HHSC cannot proceed with the procurement of, or award any contracts under, HHSC’s recent STAR Kids request for proposals, which was posted on May 10, 2024. The STAR Kids program is designed to meet the unique needs of youth and children with disabilities.
Sheila Magoon, MD, a member of TMA’s Committee on Medicaid, CHIP, and the Uninsured, is among many Texas physicians TMA is hearing from who are impacted by the state process. The executive director for South Texas Physician Alliance says HHSC’s plan would have required 75% of Medicaid patients in the Rio Grande Valley, where she practices, to enroll in a different MCO.
“We were gravely concerned about 75% of our patients having to change [MCOs],” she said. The injunction “gives us time to take a look at the situation.”
“The state actually does a good job on giving patients choice,” Dr. Magoon added. “If patients are choosing certain health plans over others ... that [should] be taken into consideration.”
In June, the Texas Medical Association filed written testimony to the House Committee on Human Services regarding Medicaid and CHIP procurements, emphasizing the need for “continuing efforts to ensure a transparent, inclusive, and effective process.”
“Physicians and other stakeholders support greater transparency in the procurement process,” TMA wrote. “It is essential for HHSC to provide clear and accessible information regarding the criteria and decision-making processes used to award contracts. This will help ensure that the selection of managed care organizations is based on comprehensive and fair assessments of their ability to deliver efficient, high-quality care.”
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.