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(Fort Worth, Texas – May 9, 2025)—Cook Children's expresses profound concern Today over a looming crisis that threatens health care access for Texas' most vulnerable children. A staggering 1.8 million children and expectant mothers statewide, including 125,000 within Cook Children’s Health Plan’s Tarrant County service area, face potential disruptions in their health coverage due to the current situation. 

This precarious situation will have devastating consequences for 10,000 children with complex medical conditions, including 170 relying on ventilators and 1,700 who use wheelchairs. Beyond the direct impact on these children and their families, the repercussions extend to our community's economic stability, potentially costing 400 jobs in Tarrant County and up to 2,000 jobs across the state within Texas-based children’s health plans if this issue is not resolved. 

Despite hopeful signs earlier this session, with bill language from Representative Charlie Geren and Senator Juan “Chuy” Hinojosa making its way to the Senate Committee on Health and Human Services, recent legislative inaction suggests a willingness not to address this critical matter during the current legislative session as intended by the courts. This is an urgent situation demanding immediate attention. June 2, 2025, is the critical deadline.

 At the heart of this crisis is a flawed procurement process by the Health and Human Services Commission (HHSC) that inexplicably favored large, for-profit, out-of-state national plans over established local children’s health plans like Cook Children's, Driscoll Children's Hospital, and Texas Children's Hospital in Houston. These Texas-based organizations possess a proven track record of delivering high-quality care while achieving positive patient outcomes and maintaining high member and physician, and provider satisfaction. HHSC’s process failed to adequately consider past performance, quality of care, and health plan member satisfaction, leading to this deeply concerning outcome. 

The potential consequences of inaction are dire, inevitably leading to further costly litigation and, more importantly, threatening to disrupt the vital health care services that countless Texas children and their families depend upon.

 The question remains: why has decisive action not been taken? 

For more than 107 years, Cook Children's mission has been unwavering: to do everything for the health and well-being of the children we serve. This commitment compels us to continue fighting tirelessly for these children and their families. The stakes are simply too high to do otherwise. Our state's leaders have a critical 24-day window to rectify this flawed procurement process. We urge them to prioritize Texas children by investing in their health care and ensuring local, proven children’s health care providers can continue serving our communities. Allowing the current HHSC contract awards to stand will drain millions of dollars from our state, benefiting out-of-state shareholders instead of Texas children and businesses. Cook Children’s alone reinvests $200 million annually in our community, demonstrating our commitment. We implore our leaders to choose Texas children and Texas-based, non-profit children’s health plans over out-of-state, for-profit interests. The exclusion of dedicated children's health plans from this process demands explanation, as the health and stability of our health care system are at stake. 

The time for action is now! Before it’s too late.

In March 2024, the Texas Health & Human Services Commission (HHSC) announced plans to deny contract renewals to several Medicaid providers, including three non-profit, Texas-based children’s hospital plans: Cook Children’s Health Plan (CCHP), Texas Children’s Health Plan, and Driscoll Children’s Health Plan. Despite their combined 60+ years of proven, high-quality care, HHSC intends to award the multi-billion-dollar Medicaid STAR/CHIP contracts primarily to publicly-traded insurers beholden to out-of-state shareholders.

On June 2, 2025, the clock will run out on the Texas Legislature to prevent the largest Medicaid upheaval in state history, costing Texans nearly 2,000 jobs and millions in tax dollars. Without immediate legislative action, at-risk families may lose access to pediatric specialists, leading to the loss of hundreds of local jobs. Furthermore, taxpayers might bear the burden of increased ER overcrowding and higher uncompensated care costs resulting from coverage gaps due to this disruption.

What’s at stake

•  1.8 million children and pregnant women across Texas would be forced to change health insurance plans if HHSC’s current award stands.
• 125,000 North Texas children, including as many as 10,000 medically complex kids who count on Cook Children’s Health Plan (CCHP) today. 
  •  Includes 170 children on ventilators who cannot afford a lapse in care and more than 1,700 children dependent on wheelchairs.
•  Texas stands to lose billions in taxpayers’ dollars if Medicaid and CHIP funding are redirected to out-of-state, for-profit corporations. This change will shift profits to shareholders across America, and away from reinvestments in local non-profit children's health plans based health care programs and access points throughout Texas. Don’t let these dollars leave Texas!
•  Three children’s hospital plans at risk: Cook Children’s, Texas Children’s, and Driscoll Children’s non-profit Health Plans swapped in favor of for-profit insurance companies, most of whom are out of state.

Economic Impact

Why non-profit children's health plans outperform for-profit insurance companies

• Texas-based, non-profit children's health plans pour their resources and earnings back into the communities they serve. These reinvestments build and strengthen communities across Texas.
• 107-year local legacy: Cook Children’s reinvests more than $200 million back into the community every year through community benefits and uncompensated care, not Wall Street dividends. 
• Nine neighborhood health centers (two opening this year) are placed in high-need ZIP codes at no additional cost to taxpayers. This keeps families out of emergency rooms for primary care needs. Cook Children’s funds $1 million annually for each center (total $9 million). Checkup Newsroom
•  Top-tier member satisfaction and quality metrics HHSC failed to consider in scoring the 2024 bids, prompting bipartisan criticism of a “subjective and unsound” procurement. AP News

The Solution:

Several bills have been filed in Austin, and officials are actively shepherding this cause.  We are hopeful there will be legislation finalized prior to June 2.

What’s the benefit of Texas-based, non-profit children's health plans?

• Local control of taxpayer dollars. Funds stay in Texas communities, not out-of-state shareholders.
• Free-market competition. Offers more consumer choice instead of narrowing it.
• Fiscal stewardship and ensures quality care. Maintains a proven, nonprofit plan with an integrated health system and a proven quality track record vs. paying corporate margins.
• Family values & self-reliance. Protects parents’ ability to choose trusted doctors and keeps medically fragile kids out of crisis care that drives up costs.

Additional Fast Fact:

• Cook Children’s Healthy Homes Asthma Program significantly improves the quality of life for families by remediating homes to eliminate asthma triggers and providing essential resources like cleaning supplies. To date, we have improved the home environments of 760 children living with asthma, including 314 health plan members.

SaveCookChildrensHealthPlan.com is a valuable resource packed with facts, articles, timelines, photos, member/patient stories, and more. Visit the website here.

“I knew about Cook Children’s, but I thought it was just for babies. I didn’t know they had a plan actually to prepare mothers,” Evans said. 

CCHP covers the health care of pregnant mothers and offers additional services. Chrystal Bryant, a high-risk maternity case manager at CCHP, calls Evans monthly to check in. Under the health plan, each high-risk pregnancy is assigned a case manager. 

“We ensure they have adequate prenatal care, that they’re going to their doctor’s appointments, and that they have their prenatal vitamins,” Bryant said. 

At four months pregnant, Evans was told her baby was measuring small. Doctors informed her that her daughter might need to spend time in the neonatal intensive care unit (NICU) at Cook Children’s Medical Center-Fort Worth. Although concerned, Bryant and her medical team helped put her at ease. 

“I have a whole dedicated team for her. It’s amazing,” Evans said. 

Maternal and infant mortality is a concern in Tarrant County. In 2024, the Tarrant County Maternal and Infant Health Coalition presented the city of Fort Worth with data showing Tarrant County had the second-highest maternal mortality rate among Black women in the state. 

“Cook Children’s Health Plan is committed to ensuring that all children in our community are safe and healthy, and that begins at conception,” Bryant said. 

CCHP understands this and focuses on ensuring mothers and children’s medical and essential needs are met. 

Members can earn gift cards, a car seat, and a portable crib by attending their prenatal and postpartum appointments and classes. 

“Cook Children’s Health Plan is unique because we are embedded in the community as a community plan,” Bryant explained. 

A former labor and delivery nurse, Bryant provides mothers with an added resource as she is able to answer questions and direct patients to the appropriate resources, such as transportation vouchers, rental assistance and food delivery. 

Evans said it makes a difference. 

“They make sure the baby has everything she needs to grow,” Evans said. As her nutritional needs increased, Bryant helped Evans get food boxes delivered to her home every two weeks. 

CCHP case managers are embedded in the community, enabling them to form relationships with organizations to help meet members’ needs. 

Meeting for the First Time 

Evans and Bryant, who had spoken on the phone for months, met in person for the first time in March. They shared a hug and began conversing as if they had known each other for years. 

Bryant asked Evans about her medical appointments and her mood. 

In December, Evans's mother died. Bryant became more than a caseworker; but a shoulder to lean on and encourage her. 

"Not only did she become my caseworker, but she also became my mental health caseworker," Evans said. Bryant helped her navigate her emotions. 

During the meeting, Evans shared that her daughter would be named Hazel, after her mother. She expressed her excitement about meeting her daughter. 

Evans showed Bryant a 3-D sonogram of Hazel, noting her resemblance to Evans’s fiancé. 

Bryant took notes as Evans discussed her recent doctor's appointment. Bryant accessed Evans's medical records to answer questions. 

They discussed nutrition, ensuring Evans was receiving nourishing foods. 

"She's concerned about the baby, but she's also concerned about me as well," Evans said. 

They also discussed baby items that Evans could get through classes.  

Chrystal let Evans know she could receive a bassinet for completing a Safe Sleep class hosted by Cook Children's Center for Community Health. 

Through other classes, she could earn a car seat and a gift card for other baby items. 

"They [CCHP] have a team of people willing to help me with a lot of things," Evans said. "They are helping me in the process of helping the baby grow." 

What’s at Stake 

CCHP helped Evans thrive during her pregnancy. She may not have received the support and resources under a different insurance plan, like the ones the state plans to fund instead.  

The current CCHP STAR and CHIP contracts will remain active through Aug. 31, 2025. At that time, families enrolled in CCHP will be forced to choose a new plan from four national, for-profit insurance companies – Aetna, Blue Cross Blue Shield of Texas, Molina, and UnitedHealthcare – three of which have no experience in our local market.  

Until then, CCHP will continue to appeal against the state’s flawed decision and work with all stakeholders to ensure that its members continue to receive the best possible care.  

For more information, including key facts, videos, photos, and recent media coverage, please visit SaveCookChildrensHealthPlan.com.  

Vivienne Molen, a 15-year-old with type 1 diabetes, is one of thousands of children who rely on the Cook Children’s Health Plan (CCHP) for life-saving treatment. Now, she is at risk of losing insurance coverage for the care she needs.

On March 7, 2024, CCHP was denied a new contract for STAR & CHIP Managed Care Services by the Texas Health and Human Services Commission (HHSC). Though CCHP’s initial protest to the state’s decision was rejected, the team has filed another appeal and continues to fight for a contract renewal.  

If not reversed, this ruling will result in a serious disruption in care for nearly 125,000 low-income families, pregnant women, and medically complex children like Vivienne. 

Vivienne's Story 

In December 2019, when Vivienne was 10 years old, she became critically ill with both the flu and strep throat. When she wasn’t responding to typical treatments, her mother, Tricia Moon, brought her to the emergency room. From there, Vivienne was rushed to the ICU, where she was diagnosed with type 1 diabetes. “It was confusing, scary and overwhelming,” Tricia said. “Vivienne’s care became quite complex.”

When Tricia went through a divorce, she and Vivienne lost their health insurance coverage. Since then, they have been members of the CCHP STAR Medicaid plan. 

“Insulin is so expensive and we are so grateful that it’s covered under the STAR plan,” Tricia said. “We’ve always felt supported. I think it would just be terrible [if the new contract is denied].”

For Vivienne, getting diagnosed with type 1 diabetes was life-altering. Her chronic health issues have robbed her of the opportunity to be a normal teenager, but she has found a safe space in Cook Children’s. 

“I always love coming to Cook Children’s and I look forward to coming to my appointments,” Vivienne said. “It is the one place where I feel like I can try to gain control of my diabetes.”

Vivienne’s robust care plan involves seeing numerous specialists and getting labs and scans on a regular basis. She also frequently visits the emergency room. 

“I couldn’t imagine the stress it would put on my family, my mom, to have to pay for everything,” Vivienne said. 

As Tricia reflects on Vivienne’s journey, she becomes overwhelmed with emotion. 

“Vivienne is so resilient,” Tricia said. “She should never ever have to worry about how the adults in her life are going to care for her. That responsibility is not hers to bear.” 

What's at Stake  

Vivienne and other STAR and CHIP members could not only lose their health coverage, but also the vital support of their case managers. 

The CCHP case management team helps members in countless ways, from connecting them to food and transportation resources, to coordinating appointments and follow-ups, to ensuring they receive the medications they need.  

“Our health plan staff is very knowledgeable about the programs and resources in this community. They know how to access those services and get things for families that they need,” said Vivienne’s case manager, Jami Jensen, RN, CCM. 

If the STAR and CHIP contract is ultimately denied, more than one hundred thousand members and children could be forced to switch health plans, find new in-network doctors, and undergo lengthy authorization processes for life-saving treatments. 

“There could be issues with getting the care they need in a timely manner,” Jami said. “It’s just added stress on them, trying to navigate something from the start when there were services already in place that they were happy with.”

Without the STAR and CHIP programs in place, CCHP would likely become unsustainable—and Jami, along with hundreds of other CCHP employees, could lose their jobs. 

“I want to make sure these families get the things they need for their health, and I have a lot of experience and skills doing that,” Jami said. “Not being able to continue to help would be hard.”

What's Next? 

The current CCHP STAR and CHIP contracts will remain active through Aug. 31, 2025. At that time, families currently enrolled in CCHP will be forced to choose a new plan from four national, for-profit insurance companies— Aetna, Blue Cross Blue Shield of Texas, Molina, and UnitedHealthcare—three of which have no experience in our local market. Until then, CCHP will continue to appeal the state’s flawed decision.

“We’re putting our money back into the community, and we feel like that is what makes us different from the national companies,” said CCHP president, Karen Love.

Love is ready and willing to compete with other plans in the area, as long as families continue to have meaningful options. 

“This is not about money for the system. This is because Cook Children’s Promise is to care for every child who needs us,” Love said. “This is a fight for the children in our community, to make sure they still have access to the high-quality care that we provide.” 

For more information, including key facts, videos, photos and recent media coverage, please visit SaveCookChildrensHealthPlan.com.  

Rebekah Jones, who has had four children on Cook Children’s Health Plan, knows too well how big of a difference consistent, quality medical care can make.

Rebekah, who has been a nurse at Cook Children’s for 20 years, is the mother of four children with medical complexities. In 2017, her adopted son, Danny, passed away. After he died, Rebekah decided to foster medically challenged kids and has since adopted three of those children.

As a staff member and mother of patients, Rebekah has seen every aspect of Cook Children’s care. For her, the key to the quality care at Cook Children’s is the relationships that Cook Children’s physicians and providers build with kids over time.

“I am a little biased because I love Cook (Children's) and I think it is the best hospital in the world. And Cook Children’s is our home,” she said. “Part of it is just building that relationship, having doctors that trust you, listen to you, that you can call and say, ‘Hey, like something's not right,’ and you know they would just listen to you and believe you.”

Those relationships are not easily replicated. Rebekah worries if Cook Children’s Health Plan loses essential state funding, her children will have to start all over with new physicians, providers and therapists. She has some experience with having to coordinate with a new medical facility; in 2013 she had to transfer some of Danny’s care to another hospital to be put on the list for a heart transplant. The providers there did not know her or Danny, and in a way, it felt like starting over. Anytime you move medical care, she said, you face the headache of paperwork and trying to find new providers and schedule with all of them. Even the testing and data in a patients’ medical file might need to be repeated at the new medical facility.

For Rebekah’s three children, the relationships built at Cook Children’s under Cook Children’s Health Plan are essential to their quality of life. Because of the Texas Health and Human Services Commission plans to deny Cook Children’s that funding, Rebekah and her kids are in a sort of medical care limbo, wondering what will happen next.

On March 7, 2024, Cook Children’s Health Plan (CCHP) was denied a new contract for STAR & CHIP Managed Care Services by the Texas Health and Human Services Commission (HHSC). Though CCHP’s initial protest to this decision has been denied, the team refuses to back down and is currently fighting for a reversal in the courts.

If not reversed, this decision will result in a serious disruption in care for nearly 125,000 low-income CCHP Members , pregnant women and medically complex children. It could also leave hundreds of CCHP employees—who work tirelessly to serve their community—in search of a job.

CCHP Complex Case Manager, Jami Jensen, RN, CCM, shared some of the crucial ways she helps patients navigate the complex health care system daily—and the potentially devastating consequences of a STAR & CHIP contract denial.

ABOUT CCHP CASE MANAGEMENT

CCHP case managers advocate for vulnerable families and children in our community all day, every day, through three vital areas of focus:

• Social determinants of health
• Coordination of care
• Education

These services have been proven to increase preventive care, decrease ER visits, and empower low-income local residents as they navigate health care.

THE CCHP DIFFERENCE

Unlike national health plans, CCHP is intertwined with Cook Children’s Health Care System and the local community.

“Some of us have worked within the Cook Children's Health Care System, and some of us have children of our own who have been through the system as a patient,” Jensen said. 

Because of their close proximity, case managers can communicate with providers seamlessly, get Members answers quickly, and even offer occasional on-site support. 

“I have gone to clinic appointments with patients before, and we’ll sometimes even meet complex patients at the hospital or in their home,” Jensen said.

CCHP case managers maintain an open-door policy—even for Members who have left the health plan.

“Even if they just have a simple medication issue, they know who to call,” Jensen said. “It’s so easy for them to reach out to us if they need something.”

SOCIAL DETERMINANTS OF HEALTH

Social determinants of health are the non-medical factors that influence health outcomes, such as socioeconomic status and access to basic needs. Before concentrating on health care issues, people must have their basic needs met.

Many CCHP Members lack reliable transportation, access to consistent food sources, and knowledge of community resources. That’s where CCHP case managers step in—to help families acquire all of the local benefits they qualify for. The knowledge and resources that come from building relationships between case managers and Member families are invaluable.

COORDINATION OF CARE

Case managers constantly collaborate with nurses, social workers, and providers within the Cook Children’s Health Care System to communicate Members’ needs, coordinate appointments and follow-ups, and close gaps in care.   

Oftentimes, when families are overwhelmed with a child being in the hospital, crucial steps for care get overlooked during discharge. Case managers bridge those gaps by reviewing each patient’s record, following up after their admission, and ensuring the family has all necessary next steps and appointments in order.

EDUCATION

Case managers go above and beyond to solve any and all types of Member needs. From helping families apply for state programs for children with special needs, to helping new moms find Medicaid-covered formulas, there’s nothing CCHP won’t do to make Members’ lives easier. 

With the help of staff members, who have extensive nursing backgrounds, CCHP has also been able to implement preventative programs and services for high-risk populations, including members with diabetes, asthma, and pregnancy risks.

CONSEQUENCES OF STAR & CHIP CONTRACT DENIAL

If the STAR & CHIP contract is ultimately denied, approximately 125,000 Members and children could be forced to switch providers and find new, in-network doctors.

Patients relying on life-saving treatments and medical equipment, such as ventilators, might have to find new suppliers and undergo lengthy authorization processes. These delays could cause serious harm to their health.

The loss of on-the-ground support from CCHP would force Members to navigate national call centers for support through these disruptive transitions—and there’s no guarantee that their new plans will offer knowledge of local resources.

“These families already have so much on their plates and it’s a lot of new information they might not understand,” Jensen said. “It’s so awful thinking how much stress this will add for them.”

WHAT’S NEXT?

Though Health Plan case managers continue to work tirelessly to support their Member families, they are also battling the anxiety of potential unemployment. A denial of the contract would more than likely threaten the sustainability of CCHP as a whole.

The CCHP team laments the potential loss of the heart, soul, and hard work they have poured into making health care more accessible for the most vulnerable Members of our community. National, for-profit insurers—favored over CCHP by the HHSC—cannot match the exceptional commitment and dedication that CCHP has demonstrated for over 20 years.

“We're not in this line of business for the profit,” Jensen said. “We are doing, and have always done what's best for the children in our community.”

By Kaley Johnson

Cook Children’s operates seven Neighborhood Health Centers around the Fort Worth area, with two more set to open in the next 18 months. The centers provide unique services in the community, particularly for underserved children and families.

The main mission of the Neighborhood Health Centers is to provide holistic health care and primary medical care to underserved communities, explained Vida Amin, M.D., Medical Advisor for the Neighborhood Health Centers. The centers are strategically placed in areas where residents have less access to health care due to lack of transportation, low socioeconomic status or other factors.

In 2023, the Neighborhood Health Centers saw 125,761 patient visits across the seven locations; over 50% of those patients were on Cook Children’s Health Plan and the rest were on a variety of other government insurance plans.

“Health care should be available to children across the board,” Dr. Amin said. “We are ensuring that we are not only taking care of the child's health but also ensuring that we’re helping the families as well, to support their child.”

That support extends beyond basic medical care. Christina Reed, LMSW, has been the Neighborhood Health Centers’ Operations Director for five years. She explained the vast support system the Neighborhood Health Centers provide for families in each area. Patients of the Neighborhood Health Centers have access to dieticians, referral coordinators, speech therapists, behavioral health therapists, community health workers and even dental services, all within their medical home. These teams work seamlessly with the community and Cook Children’s partners to assess and address patient needs in a timely and holistic manner.

“Whether it’s transportation needs or maneuvering through school issues, the NHC providers and staff are part of the child’s support system, working to help the child and their family be successful beyond basic medical care,” said Veronica Tolley, Vice President of Primary and Specialty Services. 

This holistic approach to care emphasizes the importance of going beyond “basic” medical care to set families up for healthy lives. Dr. Amin understands the significance of health care access firsthand; she and her family visited health centers after her family immigrated to the U.S. when she was young.

“For children, if you can intervene in health, it can make such a massive impact on the trajectory of a child’s life,” she said. “It’s not just with the patient, but with the family and how to support their child.”

In order to set patients up for better health in the future, the Neighborhood Health Centers emphasize health care education and health screenings for patients. Staff members screen patients for adolescent depression, postpartum depression, cholesterol levels, food insecurity and common illnesses to identify areas where families might need more support. Immunization is also an important piece of the centers’ care; in 2021 to 2023, nearly half of the visits at the health centers were for patients receiving vaccines.

Staff also work with families to overcome barriers to future health care access. A large part of that support system involves partnerships. For example, the Neighborhood Health Centers collaborate with the Cook Children’s Homeless Initiative to provide primary care services to children staying in local shelters.

“It brings me a tremendous amount of pride in what we do,” Christina said. “The way we collaborate with the Cook Children's system and our communities; it is absolutely the most impactful work that I’ve been a part of.”

We look forward to sharing more future stories about the special people working in the Neighborhood Health Centers who live the mission every day in keeping our Cook Children’s Promise!

Where Are Cook Children’s Neighborhood Health Centers?

Cook Children's Neighborhood Health Centers provide a pediatric medical home for children's health care needs, including well-child checkups, sick care, dental, immunizations, behavioral health services, nutrition services and speech therapy. Learn more.

• Arlington: 1525 S. Cooper, St. Arlington 
• McCart: 6421 McCart Ave., Fort Worth 
• Miller: 2755 Miller Ave., Fort Worth 
• The Morris Foundation Center for Innovation in Children's Health: 1729 8th Ave., Fort Worth 
• Northside: 4405 River Oaks Blvd., Fort Worth 
• Renaissance: 2600 East Berry St., Fort Worth 
• Richland Hills: 7120 Blvd. 26, Richland Hills