“Many in my family have been on Medicaid. My children are grown now but, when they were small, they received Medicaid services,” Padilla said. “I know how important Medicaid is for families and children and I am so honored that daily I can make decisions about the services that our Medicaid members receive.”

A lifelong Dallas resident, Padilla and her husband have four children and nine grandchildren. She began her career in health care as a peer counselor in the Women, Infants and Children (WIC) Program, followed by 16 years at Parkland Health where she worked in many of the hospital’s community based programs. Along the way, she completed her bachelor’s and master’s degrees and became a Community Health Worker (CHW) and Community Health Instructor (CHI).

In July 2021, Padilla joined Cook Children’s Health Plan as manager of Community Marketing and was promoted to director of Member Experience within six months. Of all of her jobs in health care, her current leadership role is the one she is most proud to be doing. It’s allowed her to direct and manage programs and interventions that have truly impacted lives all across Texas, she says.

Padilla loves making a tangible difference where it matters most — on the ground in the community, where she says 80% of health care happens. It takes a keen understanding of the social determinants of health as well as the cultures within the service area to truly influence the health and well-being of those living there. Padilla believes no other organization does culturally competent, community centered health care management better than Cook Children’s Health Plan.

She’s concerned that boots-on-the-ground insight could all be lost If Texas’ Health and Human Services Commission (HHSC) is allowed to follow through with its decision to deny CCHP a new contract for managing the state’s Medicaid programs. Instead, HHSC seeks to award contracts to large, national insurance providers through an unfair and faulty contract review process. 

“I can tell you with my soul, that the biggest impact from going from this community based program to a national, for-profit payer is going to be the loss of the knowledge base and perspective that comes from the front lines,” she said. “We know the ins and outs here. We already know the partners we can and are working with to build services around food insecurity, housing and job readiness. We understand the cultures in the area and know how to effectively communicate with them. Any health insurance company can come in here and be a payer, but no one can come in and meet the people in the community where they are to make the most impact like we can.”

While CCHP waits for the Texas Legislature to weigh in on the issue and deliver a permanent solution for HHSC’s Medicaid contract procurement process, Padilla remains committed to her team and the members they serve. Her singular focus is and will always be on delivering impactful health care and services to members and their families.

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.”

What HIPP parents know. Even with private insurance and Medicaid, the cost of medicine and care for a child with a serious condition can still create a tight budget. For some of those families, there may be help from HIPP. HIPP is a state program that assists qualified families with private health insurance costs. Click here to learn more.

Don’t let out-of-pocket expenses stand for OOPs. Knowing what your deductibles and copays are can help you plan ahead for major illnesses, treatment and care. That way you protect your child’s health and your financial health, now and in the future. Learn more here.

You protect them from the rain, from the cold and even from pretend monsters. But did you know you can take that protection a step further by learning all you can about your insurance coverage? Understanding your health insurance coverage will protect you and your family from the unexpected. Find out what you should know, here.

Protect your most precious valuables…your kids! That’s exactly what a health insurance policy is supposed to do. But sometimes you get an unexpected bill because your policy didn’t cover a procedure, doctor or hospital stay. If you have an appointment, visit to the hospital or a procedure scheduled, know before you go. Learn more about understanding benefits here.

Is your newborn covered? Did you know that there is a limited time to get your precious bundle covered on your health insurance plan? Missing that deadline could mean waiting until the next open enrollment. Learn more now.