Cook Children’s sues state of Texas over Medicaid contracts

Fort Worth-based Cook Children’s is suing the state of Texas.

The action is against a plan that would exclude Cook's from certain much-needed healthcare programs.

Cook Children’s Medical Center says this very important issue could affect 125,000 North Texas families.

2-year-old Zachariah Sudolcan was born with a very rare and complex genetic disorder.

"From birth, we've seen him grow tremendously, and Cook’s has played a real big part in that," said Zachariah’s father, Samuel Sudolcan.

The small army of medical providers have cared for Zachariah since birth, according to his parents.

"His doctors, they have from the very beginning given us a lot of hope in his future," Samuel said. "And that encourages us so much. They are not willing to give up on him."

The family is not happy over a recent decision by Texas Health and Human Services Commission (HHSC) to no longer extend a Medicaid contract to Cook Children’s Health Plan and other local plans. 

Instead, HHSC awarded the funding worth billions of dollars for low-income patients to plans administered by United Healthcare, Aetna and Blue Cross Blue Shield.

Cook Children’s Health Plan President Karen Love said they are not going down without a fight. 

"The families and children covered by Cook Children’s Health Plan deserve the ability to choose us," she said. "That’s why we’ve decided to file litigation in court to stop the state from ending our Medicaid, STAR and CHIP-managed care."

In addition to the lawsuit, the hospital has filed an appeal to its initial 33-page protest which pointed out legal challenges to the decision. 

Thus far, the state in summation has said, "No violation of the specific statutory or regulatory provisions cited by [Cook Children’s] has occurred."

The hospital and families like the Sudolcans believe change could happen before the Texas Legislature convenes.

"I believe there’s some happy middle ground, and I think the Legislature wants to weigh in on what that middle ground should be," Love said. "So our hope is that we get them to recognize that there’s no reason to remove solid performers from the plan."

"If we lost the health plan, we have to get completely new doctors, completely new home health who don’t know him, don’t know his background, don’t know anything about him and his progress," Samuel said. "We’d have to learn all new therapists, doctors, and it would be extremely stressful for him."

Cook Children’s has asked for a temporary restraining order to block the state from moving forward with the changes.