FORT WORTH, Texas — Ever since the age of 10, 14-year-old Vivienne Molen has been in and out of hospital emergency rooms. After suffering a series of health complications, she was diagnosed with Type 1 Diabetes.
Molen, who also suffers from serious mental health issues, is considered medically complex.
When her health journey became too difficult to navigate, her mother, Tricia Moon, had to resign from her job in order to focus on her daughter’s care full-time.
“It was confusing and scary and overwhelming,” Moon said.
Moon, a single parent, applied for Medicaid coverage in order to cover her daughter’s medical costs. Their coverage is under Cook Children’s Health Plan, which serves nearly 125,000 Tarrant-area families and their children.
Now, Texas Health and Human Services is considering an option that would dismantle her daughter’s current health plan.
Texas Health and Human Services is moving toward dropping the state’s three largest nonprofit children’s health plans from Medicaid and children’s health insurance contracts. While the decision has not been finalized, health providers are bracing for its far-reaching impact.
If Texas health officials move to dismantle health plans that cover 1.8 million low-income Texans, care providers say families would be forced to start over with new health plans, and they could face gaps in care.
In Tarrant County, nearly 125,000 families and their children under Cook Children’s STAR and CHIP health plans would lose healthcare. If the agency stands by the decision to redistribute contracts, nearly 125,000 Tarrant-area families and their children could be shifted to new insurers.
“It would be devastating,” Moon said. “It definitely is just an added stress that looms in the background that I don’t wish upon Vivienne or any family.”
Jami Jensen, a registered nurse and case manager at Cook Children’s Medical Center serves as an advocate for Molen and other families.
Jensen told WFAA that a loss of coverage could lead to gaps in care, including patients losing their doctors, and appointments, delayed procedures, and inability to afford prescription medications. ‘
“It’s just a lot on their plate already, and now having to start over with a health plan, maybe with somebody new, is just adding more stress to their life,” Jensen said.
HHS declined to comment on the matter, citing ongoing procurements the agency can’t discuss until contracts are awarded.
According to data from the Centers for Medicare & Medicaid Services, Texas leads the nation in the number of children kicked off Medicaid. In recent years, 1 million kids in Texas have lost coverage, according to data released by the Texas Health and Human Services Commission.
Karen Love, the President of Cook Children’s Health Plan is urging state health officials to reconsider who it awards its contracts to.
Love told WFAA that some members of the STAR and CHIP programs at Cook Children’s have been patients at the nonprofit hospital their entire lives. The hospital provides coverage for some of the most medically complex kids.
“It’s not right. It’s not what we need to be doing for these families,” Love said. “You’ve got a local nonprofit plan (Cook Children’s Health Plan) embedded in the community alongside a national for-profit plan. You can make the choice. This is unbelievable that families will no longer have a choice.”
Molen, who is only a freshman in High School, worries about the financial strain her medical condition would place on her mother if they lost Medicaid coverage.
“The healthcare we’re on right now has been a blessing,” Molen said. “I can’t imagine the stress it would put on my mom to have to pay for everything.”
Moon became emotional as she listened to her daughter’s words.
“She is so resilient, and she has faced so much… more than most adults,” Molen said. “She should never ever have to worry. To have her feel that pressure and that responsibility… it’s not hers to bear.”
Cook Children’s current contract for its Medicaid health plans are in place until next year.