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Bill

HB 5185

Relating to contracts with managed care organizations, including the procurement of managed care contracts, under Medicaid and the child health plan program.

89th Legislature (2025) Introduced by James Frank

HB 5185 reforms Texas Medicaid and CHIP managed care procurement and contracts, affecting healthcare delivery to 4+ million low-income Texans and billions in state spending.

Referred to Human Services
#health&humanservicescommission(v0177) #health--children'sinsurance(i0388) #humanservices--childservices(i0895) #humanservices--medicalassistance(i0905) #managedcare(s0454) #medicaid(s4885)
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Bill Summary · HB 5185

Legislative bill overview

HB 5185 modifies Texas's procurement processes and contractual requirements for managed care organizations (MCOs) that administer Medicaid and the Child Health Plan Program (CHIP). The bill addresses how the state enters into, manages, and potentially modifies contracts with these private insurance companies that deliver healthcare services to low-income Texans.

Why is this important

Managed care contracts represent billions in state spending and directly affect healthcare access for approximately 4 million Texans on Medicaid and CHIP. Changes to procurement rules, contract terms, or oversight mechanisms can influence provider networks, patient protections, MCO profitability, and the state's negotiating leverage—ultimately affecting quality of care, costs, and program sustainability.

Potential points of contention

  • Procurement transparency vs. flexibility: Stricter procurement requirements may increase accountability but could reduce the state's negotiating agility or limit qualified bidders
  • MCO financial pressures: New contractual obligations or reduced reimbursement could pressure insurers to restrict networks or deny services, versus allowing them operational freedom
  • Patient protections: The bill's specific language on network adequacy, appeal processes, or service coverage will determine whether protections strengthen or weaken for vulnerable populations

Compiled from official sources — confirm details with the bill’s official record.

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