State rejects health insurers' pleas to halt plan that will shake up coverage for 1.8 million Texans

Medicaid News

State rejects health insurers' pleas to halt plan that will shake up coverage for 1.8 million Texans
Texas Health And Human ServicesTexas Medicaid CrisisStarchip
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Affected Texans who receive Medicaid coverage would be shifted to new insurers next year if the state health and human services agency sticks to its plan. It’s now up to the executive commissioner to make a final decision.

* Attract new national plans to replace local managed care organizations, or MCOs, that historically served some regions “Don't let corporate greed take away outstanding and caring care for our children,” McAllen resident Angelica Mata wrote to lawmakers earlier this week. Mata was one of about 500 people who submitted written testimony decrying the plan during a Texas House hearing.

Young did not address what she plans to do about the current procurement and has declined to discuss it publicly, saying she is limited to what she can say until the process is over. Among those who would be affected by the proposed procurement are a collective 700,000 families, pregnant women and children covered by Cook Children’s Health Plan in the state’s Tarrant service area, Texas Children’s Health Plan in the Harris region, and Driscoll Health Plan in South Texas, all which formed when the state’s CHIP program was created two decades ago.

Murphy said the company would appeal the decision and “pursue all legal remedies necessary as HHS has violated the law during this process.” It would also trigger a massive effort by the state to inform all those families of the change, which would take effect late next year if the plan holds.The Medicaid contracts outlined in the procurement were awarded based on a process that scored plans on written questions and an oral exam, after the MCOs had proved that they could effectively serve the areas for which they had applied.

“It appears that the recent award considerations have overlooked crucial factors such as track record, community investment, and overall value provided,” the letter reads.The lawmakers asked Young to remove the limit on how many managed care organizations can serve in a particular region — a limit imposed by HHS at the start of the process and blamed in part for its outcome.

Under questioning from House members this week, Young and Molina, the agency’s procurement director, said the agency hears the concerns but is hamstrung by state laws that require the agency to create a process that is fair and competitive to all applicants.us to put something out that is fair to everyone, which makes it very hard to give extra points for someone who is already in the space doing something, because then it’s not fair and everyone is not judged the same way.

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