Here’s why proposed changes to Medicaid procurement will hurt South Texas – Rio Grande Guardian

EDINBURG, Texas – Eric Hamon, president and CEO of Driscoll Health System, went off script at the end of a press conference held to celebrate the new Driscoll Children’s Hospital Rio Grande Valley.

While Lt. Gov. Dan Patrick was on stage with him, Hamon raised an issue regarding the Driscoll Health Plan. Although Hamon was addressing the audience, he may have wanted Patrick to hear his comments. He thanked Senator Juan Hinojosa for his involvement in the issue.

‘This is going to be very short. I want to let everyone know and I know he doesn’t want me to do this, but I will. I want to give a quick acknowledgment to Senator Hinojosa. A few weeks ago there was a problem… we have a care plan that we brought to Chuy’s attention. And it was very important to us, both to South Texas, and what I’m going to tell you is that Chuy listened, he took the proverbial bull by the horns and led the entire delegation from Port Lavaca to Eagle Pass, and the one in North Texas. , West Texas was watching. So Chuy, thank you for your leadership. Thank you for what you do for Driscoll. You knew how important that was to the children and mothers of this community. So thank you for doing that. We appreciate it,” said Hamon.

Hamon was talking about a proposed change to Texas Health & Human Services’ Medicaid procurement that would decimate the Driscoll Health Plan and leave tens of thousands of families scrambling for other plans.

“Seventy-five percent of children in South Texas would effectively need to change their health care plans, which could potentially require them to change providers as well, depending on the networks of the health plans involved,” Craig Smith, president and CEO of Driscoll Health Plan, told the Rio Grande Guardian International News Service.

Senator Hinojosa and the entire South Texas legislative delegation have written to Governor Abbott and HHS to try to stop the procurement changes.

After the press conference ended, the Guardian obtained exclusive interviews with Smith and Sean Pieri, vice president of development and marketing at Driscoll Children’s Hospital. Here’s the interview:

Q&A from Driscoll

Driscoll Health Plan has provided more information to news media about the proposed HHS changes to Medicaid procurement. Here are two of the questions Newsweek magazine and Driscoll’s answers:

Q. What has Texas Health and Human Services told you about the proposed new contracts and their possible termination?

On March 7, Texas’ Health and Human Services (HHSC) released the Medicaid Managed Care Organizations (MCO) preliminary tender prices for STAR and Children’s Health Insurance Program (CHIP) Managed Care Services for contracts beginning September 1, 2025. This announcement eliminated Driscoll Health Plan, a two-decade incumbent that provides services in both the Nueces and Hidalgo service areas. These two service areas consist of 23 counties in South Texas where the Driscoll Health Plan has provided coverage for more than twenty years.

HHSC has an established process through which we can challenge this decision, and we have done so. We requested a delay in the decision so that state lawmakers can pursue a more collaborative and open process for awarding these Medicaid contracts.

We have asked Governor Abbot to direct HHSC to remove the MCO-related limits within the existing procurement. Specifically, remove the maximum number of MCOs per service area and the maximum number of service areas per MCO. This action will allow any qualified health care plan to operate within a service area, creating greater competition to benefit members (children and pregnant mothers).

Such an approach offers members and their communities opportunities for better care and services; providers benefit because they have the opportunity to compete on a level playing field; and it avoids massive disruption to care for some of the most vulnerable in our communities.

At a minimum, we request that the current procurement process be postponed so that the Legislature can convene in January 2025 to develop a competitive, market-based approach to Managed Care that will ensure robust competition across the state.

Consistently recognized for the quality level of service and care provided to its members, Driscoll Health Plan currently insures more than 180,000 children and pregnant mothers, representing 54% of recipients in South Texas.

Q. What is your reaction to the proposed changes and how harmful could they be?

According to census data, about 30% of residents in Hidalgo’s service area lack health insurance, and median incomes in the region are lower than the state average, making access to health care difficult.

Compounding this challenge is the limited number of providers and specialists. The Robert Wood Johnson Foundation states that area residents have 33% less access to doctors than the state of Texas as a whole, and 55% less than the national average. Additionally, the Texas Department of State Health Services (DSHS) reports that the region currently owns only 53% of the healthcare market

the necessary pediatric support required for the population size and expects this figure to shrink to 39% over the next ten years.

These barriers often force a high percentage of patients to interrupt or discontinue their medical care due to both cost and access. As a result, South Texas children continue to experience significant health problems, some of which are largely preventable or treatable, such as obesity, diabetes and mental health.

Driscoll Health Plan has been extremely active in addressing these challenges, not only in the Rio Grande Valley but throughout South Texas. For example, Driscoll Health Plan facilitates access to care and directly ensures subspecialty care is available to children and pregnant women by investing more than $10 million annually in maternal-fetal medicine incentives to subsidize physician costs. This investment has helped improve overall birth outcomes and significantly reduce NICU costs, saving the state approximately $1.056 billion between 2008 and 2022.

This is just one example of an investment that will cease to exist if the Driscoll Health Plan is dissolved due to the HHSC’s procurement process.