Legislative Push to Preserve Cook Children's Health Plan

This past week, I had the opportunity to visit the State Capitol in Austin and talk about our continued fight for thousands of families and children who rely on Cook Children’s Health Plan (CCHP).

As you know, last year, the Texas Health and Human Services Commission denied CCHP  -- and other major Medicaid children’s health plans --- a renewed contract. If this decision goes through, it would leave millions of Texans stranded without their long-standing, familiar health care plans.

On Wednesday (March 26, 2025), I spoke before Texas’ Delivery of Government Efficiency about the amazing work you, the CCPH staff, do for our families. Below are my full remarks that I shared with our elected officials. You can also watch the address at this link from timestamp 5:17 to 5:26.

Thank you for all that you do!

P.S. Feel free to leave any comments in the comment section below this post. We always welcome your thoughts, questions and observations. 

Transcript of what I said during my testimony:

"Thank you Chairman Capriglione for the invitation today and thank you all of you for your attention.

My name is Karen Love, and I have the distinct honor and privilege of serving as the President of Cook Children’s Health Plan, where we serve more than 120,000 children and pregnant women who live in the Tarrant County Service Area and who have chosen our plan for their coverage.

Just last week, Cook Children’s celebrated its 107^th year of serving North Texas families and Cook Children's Health Plan has been providing Medicaid and CHIP coverage to families for more than 25 years.

We have been a trusted partner to HHSC throughout those 25 years. And we have earned their trust through transparent and ethical business practices, high quality of care and excellent member and provider satisfaction.

As you’ve heard today, in the latest in a series of failed attempts to procure these contracts, HSSC has, in this latest process, used a process that essentially valued promises over performance. And it’s going to result in more than half of the Medicaid and CHIP enrollees in the state of Texas - 1.8 children and pregnant women - having to change their health plans. That’s a lot of disruption. In our service area, 76% of members will have to change to a new health plan.

The three plans that are represented here today, we are the #1 plan of choice in our service areas. We are the plans that families with children on Medicaid and CHIP chose above the other competitors in our market.

And we’ve earned that trust from our members because we authorize and arrange for the services that they need, we timely pay the doctors and hospitals who provide those services and we help them address the other non-medical needs that they have, like transportation or access to food or other kinds of social services.

You’ve heard that two of us are part of a lawsuit. We have exhausted those administrative remedies available to us through the agency, as is required. And we did seek to file a lawsuit. And you’ve also heard that that lawsuit has to do with the fact not that we’re unhappy with the results, but that the state failed to follow the law.

That’s the standard that we have to prove in this lawsuit. Not that we're just unhappy or we should have scored better, it's that the state didn’t follow the law.

Hopefully you’ve all seen a copy of that court order. That court order outlines 13 different failures (of the agency). The one that I find to be most grievous is the fact that performance wasn’t taken into consideration. You heard, for example, that we knew the best value criteria in advance. Yes we did. You heard that maybe one of those best valued criteria was about timely access to care. They asked us to answer a question about how we would best ensure timely access to care.

But who would have thought that the data that the state collects on its own -- they have mystery shoppers who call our doctors’ offices and ask “When can I get the next appointment with Dr. So and So” -- that they wouldn’t take those results that they have in their possession and use that as part of the analysis of the question of whether or not we provide timely access to care. Not just simply what we promise to do in the future, but actual data that shows whether we have been able to do that in the past.

The timing of the lawsuit does in fact give the legislature an opportunity to weigh in and potentially give the additional direction that HHSC thinks that it needs. The agency has testified that they can’t do anything differently unless they get different direction from the legislature.

We think the law is clear. We think those preferences and considerations that are in the law already give them the ability to take the performance into consideration. But if they need you to tell them that again, then I hope you will do that.

That things like high rates of well-child visits and immunizations and prenatal care, that that’s us doing the right thing for our members. That high member satisfaction, members actively choosing us at high rates when they have the opportunity to pick between the plans, that market share. Again, those are indications that we are doing the right things by members and our members are happy with our services. And that high provider satisfaction, which, while we all measure it, is not taken into consideration by the state. And it should be. That high provider satisfaction indicates we are collaborating with these providers to do what’s right for these members.

Had the agency taken performance into account, there would have been a very different set of results announced last year. And we would not be here talking about this failed process and the time that’s been wasted and the dollars that have been wasted in an inefficient process and defending that flawed process.

The proposals that are solicited through the current procurement process amount in nothing more than an essay contest; tell us how you will do things in the future. And plans like ourselves are competing against national plans that have whole departments that do nothing but gin out cookie cutter proposals across all the states that they participate in. And they’re not tailored to the community that they serve like the way we are because we work and we live in those communities. We speak to what the needs of the Fort Worth service area are. We don’t talk in generalities about what’s needed in Texas because what’s needed in Weatherford, Texas is very different than what is needed in Galveston or down in the valley.

We also think that it's important for the state to consider the investment that our institutions make in our communities. Our earnings from the Cook Children’s Health System and CCHP do not go back into the pockets of shareholders. They go back into our communities. They go back into investments like our seven, soon to be nine, Neighborhood Health Centers that are specifically built in low-income neighborhoods to serve Medicaid and CHIP patients. Those centers, because they only serve government-funded patients, they operate at a loss of roughly $1M per year per center.

That’s the kind of investment that you get when you have community-invested plans in the program and that’s the kind of investment that may not be there in the future if we don’t continue to participate in this program.

Somebody said earlier that the only differentiator between the plans is really the value added service that we offer. I would tell you there is a very significant differentiation in the plans that we represent because we are integrated with the doctors and the hospitals that we are affiliated with.

We, together, sit at the same side of the table. ["We" being hospital, doctor/provider and CCHP as the payer.] We’re all on the same side of the table trying to find out what is the best thing for each and every child in front of us.

We are not sitting across the table from a provider arguing about what services the child needs or what we are willing to pay for.

Medicaid has been a tremendous success in Texas over the past 25 years. We are part of that success. Our plans raise the bar on quality performance and we raise the level of competition.

Our children deserve the best that we can offer. And that’s a process that delivers health plans that perform, not health plans who promise.

To watch Karen's full testimony, click here: Texas House of Representatives.

To learn more, please visit Save Cook Children's Health Plan.