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.

The day ahead was already filled with taking care of her daughter Winslow, who hadn't even taken her four medications during the day because of her medical condition. Plus, Shelly still had to breast pump and then feed her daughter through Winslow’s G-button. 

Shelly didn’t have time to be on hold, but she did know the one person she should call.

“Rebecca Melville. She’s amazing. Rebecca has always been there for me. She’ll call me or I’ll call her and with a snap of the fingers, she gets things done,” Shelly said. “I needed to speak to someone at Medicaid to update them on something. And it was just impossible. I called early in the morning and then I waited and waited. I called Rebecca and ‘Boom!’ everything was done.”

Rebecca Melville, RN, is a case manager and service coordinator for Cook Children’s Health Care Plan. The program is a local, non-profit company that provides health care for STAR (Medicaid) and CHIP members in a six-county service area in North Texas.

“It can be frustrating for parents, especially for someone like Shelly who does not have time to be on the phone all day. She needs to take care of her child,” Melville said. “I have one contact person who works with the state and I can talk to very quickly. If there’s a medication application or an eligibility issue, our contact is very quick to respond to us. Our role at the Health Plan is to intervene on the parent’s behalf and to be a liaison between them and the state.”

Melville has 42 patient families on her current caseload. She speaks to the families regularly. For instance, she speaks to Shelly once a month and then sees her every three months in person.

“And of course if Winslow gets sick, I go visit her in the hospital and when she gets out,” Melville said.

Each month, Melville calls to make sure that Shelly is receiving the services she’s authorized for and everything is working smoothly for her. Through the Health Plan, Winslow receives her formula and feeding supplies, as well as any private duty nursing she needs.

Shelly admits to being surprised that she and her husband, David, even qualified to be a part of the Health Plan and Medicaid. They both worked and had insurance.

“I thought when you were in a certain income or tax bracket, it disqualifies you for Medicaid,” Shelly said. “But after all we’ve been through and as much time as Winslow has spent in the hospital, I don’t care how much money you make, you are going to be broke after this. So I was pleasantly relieved that we not only qualified but continue to receive help today.”

As Shelly’s telling her story, you can hear Winslow, who is 5 years old, playing with her dog and urging her mom to get off the phone so they can go to the movie.

It all sounds so blissfully normal.

But that’s not how things started from the moment Winslow came into this world.

Winslow was born on Jan. 1, 2014, the first baby born in Wise County that year. Soon after her birth, the celebration ended.

Shelly and David Ogle’s little girl was born with a condition called heterotaxy syndrome. Though heterotaxy syndrome is extremely rare – in the U.S. about one in every 250,000 children are born with it --- it is the cause of some of the most complex and complicated heart defects.

Heterotaxy is a disorder that results in certain organs forming on the wrong side of the body, most typically the heart, lungs, kidneys, liver, stomach, intestines and spleen. Sometimes organs may be facing in the wrong direction, may be divided into multiple sections and even missing.

The result is that a child’s organs cannot function correctly, placing the child’s life at risk.

Vincent Tam, M.D., a thoracic surgeon at Cook Children’s, performed complex heart surgery to repair Winslow’s right ventricle that pumped backward.

The next big surgery was to repair her liver flow into the bowel of the child. Many times children who have Winslow’s condition need a liver transplant by the time they turn 2. Winslow is almost 5 and a half and is doing remarkably well and so far doesn’t need a transplant.

Because of her congenital condition, Winslow was born without a spleen and doctors removed her appendix, which was on the opposite side (the left side) of where it is supposed to be on the body.

By the time Winslow arrived home in August 2014, she was quarantined. After a couple of months, blood work came back to say Winslow was strong enough to go out in public for the first time.

With surgeries behind her, now it was time to begin life at home. That meant four doses of medicine a day, feeding tubes, breast pumping, cleaning supplies, and a G-button.

“Winslow is doing great,” Shelly said. “We think she can live a normal life, go to school, have children ... The only thing we think we will have to say no to is no high impact sports. I want her to be a band camp kind of kid.”

For Shelly to make jokes about her daughter’s condition shows how far she and her family have come. She credits the multiple doctors and nurses who looked after Winslow for saving her daughter’s life. And now she has people like Rebecca Melville taking care of Winslow’s needs.

“Rebecca has always been there for me. She’ll call me or I’ll call her and with a snap of the fingers, she gets things done,” Shelly said. “If I were going to refer anyone, it would be Cook across the board. They saved my daughter’s life. All the team members. The doctors, nurses, coordinators, the STAR Kids Program. You know that little say about it takes a village? Well, they are our village.”

Michael, who is 24 now, stopped moving his extremities at the age of 18 months and was diagnosed with a debilitating form of cerebral palsy.

Lynn describes her first few months after she learned Michael had cerebral palsy as “fuzzy.” She lived in a terrified blur of emotions and cried for the first year after learning of his diagnosis.

But through her tears Lynn kept her resolve, beginning with one decision – Michael would be transferred from the family home in Abilene to Fort Worth to be treated by Cook Children’s. They then moved to Fort Worth to stay closer to Cook Children’s.

“To see your baby crawling, trying to learn to walk and then all of a sudden he’s not moving, was horrible,” Lynn said. “We insisted he be transferred. If he had not gotten transferred Michael would not be alive. I believe that with all my heart. I would not go anywhere else.”

The first month he stayed in the Pediatric ICU. Since then Michael's been seen by a plethora of specialties at Cook Children's, including Infectious Disease, Neurosciences, the Heart Center, Radiology, Surgery and Rehabilitation Services for issues ranging from pneumonia to cerebral palsy.

Lynn stopped working to stay home with Michael and her early attempts to get her son on Medicaid were declined.

“We got a letter that said because Medicaid had turned us down he was automatically approved for CHIP. I believe we were waiting to get on [Medically Dependent Children Program (MDCP)]. Considering Michael’s extensive needs (medications, tube feeding supplies and everything else), CHIP saved us,” Lynn said. “There were prescription co-pays but they were very reasonable, and we were able to continue seeing doctors at Cook Children’s.”

Without CHIP, Michael may not have received the care he needed to cover the multiple specialties he required as a young child.

Currently, CHIP funding expired almost 100 days ago. While Congress recently provided temporary funding to the United States, many are likely to run out of funds and will send termination notices in the coming weeks to children’s hospital patients and others who have CHIP.

To learn more how you can help #SaveCHIP and “Speak Now For Kids”, visit this site to learn more.

“It was a long time ago when we needed CHIP,” Lynn said. “I do remember feeling so proud that Texas would never let a child go uninsured. Clearly things have changed. It took about five years for Michael to get on MDCP and then at that time, he became eligible for Medicaid. I am not sure I would have been able to keep Michael alive without CHIP.”

To learn more about Michael’s story, click here.

I’m always on the lookout for the latest news about developments in my field. In fact, I sometimes learn about the most up-to-date information by searching the news before I read about them in a medical journal.

A new diabetes technology under development caught my attention. The innovative technology developed at Stanford University uses a microchip for detection of type 1 diabetes.  A small sample of blood is placed on the microchip. The testing procedure detects auto-antibodies commonly found in those with Type 1 diabetes. The hope is that this new device can rapidly identify children who are at a high risk for developing Type 1 diabetes.

Illness symptoms of Type 1 diabetes, sometimes severe, are almost uniformly present at the time of diagnosis. It is frustrating both to me and parents that no easy screening is available to detect Type 1 diabetes earlier in its course when there are more possibilities of intervention. This new technology excites me as a way to overcome this barrier and expands intervention research opportunities in those in the early phase of type 1 diabetes. 

Screening for Type 1 diabetes is only currently done in large research studies such as the Trialnet Pathway to Prevention Study  and only in children who have a parent or sibling with Type 1 diabetes. It is possible that this new microchip will allow for wider, faster screening. The promise of an inexpensive, rapid test may help the growing number of children in countries with limited resources receive a prompt diagnosis and proper care for their Type 1 diabetes. 

The incidence of Type 1 diabetes continues to rise worldwide, and those of us in pediatric endocrine and other medical fields continue in efforts to better understand this mysterious condition. I believe a cure will come one day, but in the meantime, technology tools such as this microchip will form the new wave of innovation in Type 1 diabetes.