CORPUS CHRISTI, Tx. — A health plan that serves nearly 200,000 low-income pregnant mothers and children in South Texas may be shut down by September 2025.
"Despite being one of the very top health plans in clinical quality, we were shocked to learn recently that the Texas Health and Human Services Commission (HHSC) is looking to exclude Driscoll from serving the state's Medicaid population starting in September of 2025," said Craig Smith, CEO of Driscoll Health Plan. "It's a decision by the agency that, if not reversed, could effectively mean the end of the Driscoll Health Plan."
Driscoll Health Plan leadership decried the process by which HHSC selected providers for Medicaid STAR and the Children's Health Insurance Program (CHIP)and said that its first appeal of the decision had been denied.
It is one of three nonprofit children's health plans to be impacted by the state's decision. Driscoll Health Plan currently provides Medicaid coverage to members in a 24-county area.
A spokesperson for HHSC told KRIS 6 News Wednesday that a change in managed care organizations (MCOs) does not affect whether a Medicaid recipient receives services, nor does it affect the services that a recipient is eligible to receive.
These MCOs are also contractually required to provide continuity of care for new patients and patients 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," a spokesperson wrote.
However, Driscoll Health Plan leaders said that while this is a contractual requirement the process will not be seamless.
"A lot of times the new entity has not created their full network and so it's very difficult sometimes for them to actually honor that (continuity)," said Dr. Mary Dale Peterson, Executive VP and COO of Driscoll Health System.
Leaders said Wednesday that the procurement process was flawed and violated state law, including a statute that requires the state to give an existing health plan preference for quality initiatives.
Since 2008, Driscoll Health Plan has invested $10 million annually in maternal-fetal medicine. Leaders say this investment has saved the state over $1 billion in reduced neonatal intensive care unit costs.
"Within Nueces, in particular the Nueces service delivery area, another organization actually won the award that is not even presently operating in the State of Texas," Smith said. "It's almost absurd to think that they gave it to someone not even operating in the state when they have one doing it now."
"More than 500 jobs in our part of the state could be eliminated and access to pediatric care and maternal care will be reduced for a generation of individuals in need," Smith said.
The process to select Medicaid providers in the state is flawed, resulting in the possibility of Driscoll Health Plan ceasing to exist 18 months from now. So we're here today as a call to action to inform our communities about what is happening. We're here to share information and we hope you will continue to share with your friends, family, and other community members and explain that we're more than just an insurance company or health plan.
In response, HHSC said that "all respondents were scored using the same evaluation criteria" with awards given to MCOs that received the highest scores.
"This will provide the best value to the state and quality of care and service to all STAR & CHIP recipients," HHSC wrote in a statement.
Driscoll Health Plan leaders said that a second appeal would be submitted by the end of this week, and if denied, it intends to file suit.
"I'm here to assure you, our friends, and families at Driscoll, that we will fight until the very end to continue to service our members and our communities because South Texas is our home," Smith said.
