FAQ and Talking Points Regarding Denial of STAR & CHIP Managed Care Services Contract to the Cook Children's Health Plan
What happened?
The State of Texas denied the Cook Children's Health Plan (CCHP) application for a new STAR & CHIP Managed Care Services contract, along with Texas Children’s Health Plan and Driscoll Health Plan.
Why is this significant?
This decision directly impacts nearly 143,000 CCHP Members, many of whom are from lower-income families and neighborhoods, jeopardizing their access to vital health care and Providers.
Approximately half of CCHP Members will be a Cook Children’s patient in any given year. Losing this contract would be detrimental to our Health Plan operations, which employs nearly 400 individuals.
What makes CCHP different from other Managed Care Organizations (MCOs)?
The state’s scoring methodology overlooked the significant value Cook Children’s brings to the market. We have a long-standing history of serving our communities with impressive Member and Provider satisfaction and experience, and high-quality outcomes.
Moreover, as a non-profit, community-based health plan, we have a unique understanding of the needs of our community and our Members. That depth of knowledge informs the many programs and services we bring to those we serve in order to address barriers to health and well-being such as food security, transportation, access to behavioral health care, preventative health programs and much more.
This decision does not reflect our impact on the overall health and well-being of the community or the exceptional care the Health Plan and the Health Care System have both provided for more than 20 and 106 years respectively.
What’s the next step?
We have 10 business days from the initial notice (on March 7) to appeal the decision. We are actively pursuing this appeal now. We must file our appeal by March 21, 2024.
Has a health plan ever successfully protested a decision from the state?
Yes
Which MCO(s) was awarded the contract?
In the Tarrant service area, Aetna, Blue Cross, Molina, and United. This link shows all awards in Texas: Procurement Opportunities | Texas Health and Human Services
Who ultimately decides whether or not we get the contract? What group of people? Are they elected?
Texas Health and Human Services will decide whether to grant an appeal; they are not elected.
What prevented us from getting the contract?
The state’s scoring process favors the large, national for-profit companies, and disadvantages the regional, provider-sponsored plans. Despite scoring process 8th out of 18 plans with an overall score of 91.3%, we were not offered an award.
Are we banding together with other community health plans?
We must be mindful of the perception of collusion. Each health plan is responsible for their own appeal.
Is it fair to say that this decision by the state effectively puts three community health plans out of business long term?
If our appeal is not successful and because Medicaid and CHIP are the only lines of business we offer, it will be very difficult for CCHP to be sustainable or remain operational.
What does this mean for Star Kids?
We are moving forward with preparing our response to the request for proposal (RFP) for STAR Kids. If we are not successful with the STAR/CHIP appeal, we will consider not submitting a response to continue with the STAR Kids program. This would be unfortunate, as we believe we can provide better health outcomes for these Members/Patients as an integrated delivery system, which includes not just a health plan, but a home health care company, two medical centers and dozens of access points for families: primary care offices, neighborhood health centers, urgent care centers, surgery centers and more.
Yes, we still believe our STAR/CHIP proposal was sound, scored well and have no doubt our STAR Kids proposal will be even stronger given how well our current consulting team knows us. Our score ranked 8th among 18 plans that responded to the RFP.
Could we theoretically lose CHIP and STAR but keep STAR Kids?
If we lose our appeal of the STAR and CHIP decision, we will need to seriously consider the advisability of submitting a bid for the STAR Kids contract.
What can we do in our daily practice to support this effort to fight this decision?
Cook Children’s leadership is working with our public relations team, legal counsel and lobbyists to develop and quickly implement an appeal strategy. The most important thing you can do is support this great organization by continuing to provide the outstanding service we are known for to our Members and Providers.
Additionally, any employees who would like to share their experiences/comments with our health plan can send them to InternalCommunications@cookchildrens.org. This will help with our messaging.
If families find out the STAR/CHIP RFP was not awarded to CCHP, what can we share with families that ask what does this mean for them?
You can share that Cook Children’s is actively pursuing an appeal and exploring every avenue to overturn this decision. Our current STAR and CHIP contract is effective through August 31, 2025, and so there is no immediate impact to them or their coverage. They will receive direct communication from CCHP about our efforts.
Will there be communication or letters that will inform families about our appeal process with the State?
Yes, we are working on direct communication to CCHP Members who may be wondering how this decision impacts them and their families, and provides them information about our appeal.
What can staff communicate to families to reassure them if they find out CCHP was not awarded the RFP?
You can share that Cook Children’s is confident in our appeal and will fight this decision at every opportunity. We have the full support of our board and system leadership behind us, and we will engage our community and partners to advocate for us.
What is the time frame for appeal process?
While we must file our appeal by March 21, 2024, there is no set timetable for the State’s response.
What is the success rate when an MCO has protested a decision from the state?
Plans have successfully altered the outcomes of similar procurements in the past. The original 2018 STAR and CHIP contract procurement was voided because of various contracting problems and flaws.
Where can we send additional questions?
You can send questions/comments to InternalCommunications@cookchildrens.org.
Are there Cook Children’s policies we should review/share with our staff related to this issue?
Yes, now is a good time to remind your teams about our social media and media policies. We need to refrain from commenting about this topic online/in public mediums. If a reporter/member of the press approaches you, please reach out to the Public Relations Department at media@cookchildrens.org. They will handle all public comments.
· Social Media Policy: HR 670.pdf (cookchildrens.org)
· Media Policy: AD 220.pdf (cookchildrens.org)