MY
PROTECT
HEALTH CARE
TEXAS
“Quote from Texas official about Quality or Member Choice.”
3,200,000
The number of Texans who have health coverage through STAR or CHIP.
94%
The percentage of counties where a lower-quality plan was awarded a contract.
56%
The number of Texans – 1.8 million – that could lose their current plan with the proposed contracts.
How Texas HHSC is Disrupting Medicaid
On March 7th, 2024, the Texas Health and Human Services Commission issued a Notice of Intent to Award STAR & CHIP contracts. STAR & CHIP contracts cover the majority of low income families living in Texas.
If the new HHSC Contract Awards do not change, they will cause the LARGEST DISRUPTION TO MEMBER CARE IN TEXAS HISTORY.
Proposed HHSC Contracts
Nearly 1,800,000 children & families will lose their health plan.
Plans with lower-quality ratings rewarded.
Plans with high-quality ratings and member choice ignored.
The largest disruption to member care in Texas Medicaid history.
The state ignored quality ratings and member choice, the most important aspects of what makes Medicaid managed care work.
HHSC is IGNORING QUALITY RANKINGS. Quality Rankings are an important aspects of what makes Medicaid managed care work.
HHSC is REMOVING MEMBER CHOICE. This could lead to millions of members losing their STAR and CHIP plans.
HHSC proposed contracts fail to address regional and demographic differences within Service Delivery Areas, as well as provider care capacity in those regions. The HHSC is planning to award contracts to low ranking Managed Care Organizations, MCOs that are unprepared to properly attend to the needs of additional members. The proposed contracts are unfair and will disrupt the lives of millions of Texans.
MANAGED CARE: The term “managed care” describes a type of health care focused on helping reduce costs while keeping quality of care high. Managed care was introduced in Texas in 1993 and is now the primary mode of care for people who have Medicaid or CHIP coverage.
MANAGED CARE ORGANIZATIONS: Managed Care Organizations, or MCOs, are health insurers that contracts with the state to deliver Medicaid health benefits and additional services. These MCOs accept a set per member per month payment for these services. In Texas, there are currently 16 MCOs.
MEMBER CHOICE: Allowing members to choose their health plan is an integral part of managed care. In fact, 70% of members actively choose their plan instead of being automatically assigned to a health plan by the state.
STAR: Most people who have Medicaid in Texas get their coverage through the STAR program. STAR covers low-income children, pregnant women and families.
CHIP: The Children's Health Insurance Program (CHIP) covers children in families that earn too much money to qualify for Medicaid but cannot afford to buy private insurance.
SDA: A Service Delivery Area, or SDA, is a select group of counties, defined by HHSC, where different health insurance plans provide Medicaid and CHIP coverage. There are 13 SDAs in Texas.
RFP: A request for proposal, or RFP, is a business document that announces a project, describes it, and solicits bids from qualified contractors to complete it. Texas uses the RFP model for managed care organizations to bid and secure Medicaid and CHIP contracts.
Quality Care Matters Fact Sheet (link to non-branded fact sheet)
Want to help? It’s EASY!
Contact the HHSC Procurement Office and tell them how these contract awards will hurt Texans.