By: TAHP | Thursday, November 5, 2026

Medicaid CEOs on the Frontlines

• Who was up: TAHP CEO Jamie Dudensing moderated three leaders who run Texas Medicaid health plans: Victoria Mora of Parkland Community Health Plan, Stephanie Rogers of Aetna Better Health of Texas, and Greg Thompson of Wellpoint Texas.
• The biggest change in five years: When pandemic-era coverage protections ended, Texas Medicaid enrollment dropped almost 40%. Thompson said the people who remain are sicker, have more chronic conditions, and need care the day they enroll, so plans had to rebuild their networks and outreach around a different population.
• What’s working:
  • Bringing a doctor to towns that never had one: Wellpoint partnered with Texas A&M and Texas Tech to build portable clinics, designed and built by students, and place them in rural communities with no provider. The universities staff them. A town that never had primary care or behavioral health now has both.
  • Paying for the next rural workforce: Wellpoint has funded more than $1 million in scholarships for rural health careers and runs summer camps that show high school students in the Permian Basin and Big Bend they can work in health care.
  • Cutting low-level ER visits 12 to 15%: Parkland’s plan and hospital share information within 48 hours of a visit, so the care team can redirect members with minor needs to a clinic.
  • Provider data in a day instead of a month: Thompson said AI cut provider data loads from 30 days to one. Every Wellpoint employee has AI tools and training, and one clinician’s idea, a QR code on member letters that explains them in plain language, is going live.
  • A directory that checks itself: Rogers said AI compares the plan’s provider directory against every other public listing and flags mismatches for staff to fix.
• One change each would make for members:
  • One health information exchange for the whole state: Mora wants a single system every provider and plan uses, so care gaps and hospital transitions show up in real time.
  • Managed care from day one: Rogers wants new members enrolled in a health plan immediately rather than waiting weeks for a plan assignment, so care management starts right away. CHIP already does it.
  • Help the whole family find coverage: Thompson wants to allow plans to help every family member find and sign up for the right coverage, whether that’s Medicaid, CHIP, or the Marketplace.

Inside the Texas Pharmaceutical Initiative’s Search for Drug Savings

• Kicking off the final day: TAHP’s Blake Hutson sat down with Mike Geeslin, Executive Director of the Texas Pharmaceutical Initiative, and Dr. Michael McKinney, who chairs its board, on how the state-created initiative is studying drug costs across state-funded health programs.
• The numbers:
  • The pool is big: State agencies and university systems spent $5.9 billion on prescription drugs in fiscal 2025 before rebates. TPI is modeling that spend claim by claim with the University of Texas Health Intelligence Platform.
  • Specialty drugs drive the spend: 1.5% of claims, 52% of spend. Generics are 85% of claims and under 8% of spend.
  • Two drug classes are half the bill: Immunomodulating anti-inflammatory drugs and diabetes drugs together account for nearly 50% of plan spend.
• What TPI is testing: Evidence-based formularies and biosimilars, full transparency into pharmacy contracts, cost-plus pricing, direct contracting and group purchasing, drug spend under the medical benefit, and shortage mitigation.
• What’s next: TPI delivers recommendations to the Legislature in December. McKinney’s advice: focus on a few areas where the data shows real impact.

HHSC and TDI on What’s Ahead for Health Plans

• Who was up: TAHP CEO Jamie Dudensing closed out the agency conversations with HHSC Executive Commissioner Stephanie Muth and Insurance Commissioner Amanda Crawford.
• What the agencies are working on:
  • Surprise billing volume keeps climbing: TDI’s dispute portal normally handles 35,000 requests a month and hit 90,000 in September and October. The system held up, and CMS is studying how the Texas process works.
  • AI guidance for plans: TDI’s bulletin reminds plans that existing insurance law applies no matter the technology. Plans remain accountable for the tool’s decisions and should keep a clear audit trail.
  • A provider enrollment redesign: HHSC’s new system, launching August 2027, pulls data from 19 licensing boards and, pending CMS approval, would make Texas the first state to link directly to Medicare’s provider database. Health plans helped design it.
  • Transparency tools at TDI: The agency has expanded public data and plain-language consumer guides on coverage and is looking for plans to help educate consumers.
• Open door: TDI wants to hear from plans with new product ideas, like cash-pay designs, before they file. HHSC wants plan feedback on the provider enrollment redesign while it’s still in prototype.
• What’s next: The Sunset staff report on HHSC is only the start of the process. Every part of the agency, including managed care, will be reviewed during session.