Cook Children's suing state after being denied Medicaid contract renewal
NORTH TEXAS — Cook Children's is suing the state of Texas over its decision to deny the hospital's health plan a new Medicaid contract.
The pediatric healthcare system announced the lawsuit Wednesday.
In March, the Texas Health and Human Services Commission said it planned to drop the Cook Children's Health Plan and award contracts to several national, for-profit insurance companies instead.
To stop the change, Cook Children's has filed multiple appeals with the agency itself.
"Our families and children are worth fighting for, and we'll continue to fight until the state does the right thing," said Karen Love, the president of the Cook Children's Health Plan. "The stakes are too high, and the consequences are too great, to let this flawed decision stand. We are determined to ensure it does not."
The healthcare system called the HHSC process "deeply flawed."
"There's simply no reason to remove Texas-based companies from the program," Love said. "These are just unnecessary hassles for these families that have enough struggles in their lives. They don't need the added stress of having to pick a new plan, potentially having to get a new primary care doctor, change medications."
Nearly 125,000 members of the Cook Children's Health Plan could lose healthcare coverage if HHSC stands by its decision, including Zechariah Sudolcan.
The two-year-old boy has relied on Cook Children's for his critical healthcare needs since he was born, seeing dozens of specialists.
"He means the world to us and he needs a lot of care," said his father, Samuel Sudolcan. "Take your experiences with setting up a dentist appointment, having to get it paid, having to get it authorized… magnify that by 35. But we don't struggle a lot with that with our health plan."
Cook Children's has managed Medicaid coverage for low-income families, pregnant women, and medically fragile children for more than 20 years.
"Having that local health plan that was already tied into the same umbrella company, just made it to where it was really painless," Suldocan said.
Now that the future of the plan is in jeopardy, he's concerned about the impact on Zechariah.
"My biggest fear is we have to figure out everything over again," he said. "We have to get completely new doctors."
Parents like Dr. Bethany Edwards also say being forced to switch plans could have catastrophic consequences. Her adopted son has multiple chronic disabilities and complex medical needs.
"I'm terrified to lose that continuity of care and lose that coverage, even if it's just for a little bit while we get it all straightened out," Edwards said. "It's really scary."
She's grateful to have the Cook Children's Health Plan for at least another year.
"I'm pretty confident in saying that Cook Children's has changed my son's lifetime trajectory and outcomes," said Edwards.
If the contract changes do go into effect, it won't be until September 2025.
HHSC told CBS News Texas it will not comment on pending litigation. The agency did say "A change in managed care organizations (MCOs) holding contracts with HHSC does not affect whether a Medicaid recipient receives services, nor does it affect the services that a recipient is eligible to receive. MCOs are contractually required to provide continuity of care for both newly enrolled recipients and recipients transferring from another MCO. HHSC requires that the transition to a new MCO be as seamless as possible for Medicaid recipients and their providers. Established recipients and provider relationships, existing treatment protocols and ongoing service plans are important parts of any transition."
