Mega Doctor News
By Roberto Hugo González
In a significant victory for Driscoll Health Plan and its members, a Travis County Court issued a temporary injunction on October 4, 2024, blocking the Texas Health and Human Services Commission (HHSC) from signing a managed care contract that would have disrupted healthcare services for over a million children and families across Texas. The ruling is a significant step in a legal battle that began earlier this year when Driscoll Health Plan was denied the opportunity to continue providing Medicaid STAR and Children’s Health Insurance Program (CHIP) coverage.
The legal conflict dates back to March 2024, when Driscoll Health Plan, a leading provider of Medicaid and CHIP services in South Texas, was excluded from participating in the latest round of managed care contracts issued by the HHSC. The exclusion sparked concerns about the future of care for Driscoll’s 193,000 members and the broader healthcare network for Medicaid recipients in Texas.
Driscoll quickly challenged the decision, arguing that the procurement process lacked transparency and overlooked critical performance-based quality measures. The temporary injunction issued by the Travis County Court affirms these concerns, citing 13 separate violations of law and regulation in the state’s procurement process. The court’s decision casts a spotlight on a process that healthcare providers, including Driscoll, have long argued prioritizes cost over quality, jeopardizing the care of vulnerable populations.
The court ruling highlighted the absence of essential quality-based performance metrics in the HHSC’s decision-making process. Court testimony revealed that the proposed contract would have allowed specific untested and underperforming health plans to benefit, while well-established, community-based plans like Driscoll—recognized for their high-quality ratings—were at risk of being displaced. This, in turn, raised alarm among healthcare advocates, who feared the negative impact of such changes on patient care.
The ruling validated Driscoll Health Plan’s concerns and underscored the broader issues within the state’s procurement process. The lack of scrutiny and the potential for low-performing plans to gain a foothold in the market were key factors in the court’s decision.
“From the beginning, we have been clear with our community about the risks posed by this process,” said Craig Smith, CEO of Driscoll Health Plan. “This ruling is a validation of the concerns we’ve shared, and we are relieved that our members will still have access to the high-quality care they expect from Driscoll.”
Driscoll Health Plan has deep roots in South Texas. Established in 1998, it has grown to serve a 14-county area surrounding Nueces County and a 10-county area in the Rio Grande Valley. The plan provides Medicaid-managed and low-cost coverage options, focusing on children, young adults, and expecting mothers. With its strong ties to the local community, Driscoll has been recognized for delivering quality care tailored to the unique needs of its members.
This connection to the community has been a defining factor in the ongoing legal battle. Driscoll’s high-quality ratings and established presence in the region have made it the preferred choice for many families. The potential disruption of care that the HHSC’s contract would have caused further fueled concerns from healthcare providers and community members.
“We urge state lawmakers to take a closer look at the procurement process,” Smith said. “Texas families deserve health solutions that are based on quality, and we need health plan partners with a track record of high performance. Driscoll’s continued inclusion is a victory for the families we serve, and we are committed to fighting for what’s best for our members.”
The court’s decision is temporary, and the future of Texas’s Medicaid and CHIP contracts remains uncertain. However, the injunction brings much-needed attention to the flaws in the procurement process and offers an opportunity for reform.
Healthcare experts are now calling for greater transparency and the inclusion of performance-based metrics in future contract decisions. Many hope this ruling will set a precedent for higher Medicaid and CHIP services standards, ensuring that only the most qualified and community-focused health plans are selected.
For Driscoll Health Plan, the ruling represents a legal win and a validation of its mission. As one of the highest-rated health plans in Texas, Driscoll has long been an example of quality care in the state’s healthcare landscape. Its continued presence ensures that families dependent on Medicaid and CHIP can access the necessary care.
As the legal battle continues, the focus shifts to how the state will respond to the court’s ruling. Lawmakers, healthcare providers, and community advocates must work together to ensure that future decisions prioritize quality, performance, and the well-being of Texas’s most vulnerable populations.
The Travis County Court’s decision to block the managed care contract is a big win for Driscoll Health Plan and the communities it serves. It reinforces the importance of quality-based performance measures in Medicaid and CHIP procurement and highlights the risks of allowing low-performing health plans to displace community-rooted providers.
As the legal process unfolds, Driscoll remains a vital part of the healthcare safety net in Texas, continuing to provide high-quality care for its 193,000 members. The ruling reminds us that healthcare decisions should prioritize the needs of patients and communities over administrative convenience, and it may mark the beginning of much-needed reform in Texas’s Medicaid and CHIP programs.
