Texas Covered ’25 Wraps Up with Medicaid CEOs & Agency Leaders

By: TAHP | Thursday, November 6, 2025

TPI Shares Goals for the Future

• Starting off the day: Mike Geeslin (Executive Director of TPI) & Dr. Michael McKinney (Board Chair of TPI) opened with a discussion about collaboration, cost solutions, and patient access.
• What they said:
  • The state charged TPI with reducing drug spend-that's their priority. TPI will deliver a "business plan" to the Legislature ahead of next session.
  • Early research on other states supports centralized claims systems, economic analysis, stress testing, and coordination.
  • Health care reimbursement and market dynamics are shifting rapidly. Data and analytics that can anticipate federal impacts will be crucial.
  • GLP-1s are major cost drivers and coverage varies across state funded health plans. Early lessons showed that physicians and patients may falsify medical records to gain coverage.
  • TPI highlighted the need to come up with an ideal PBM structure, determine whether a statewide PBM is possible, and rethinking contracting.
• The bottom line: Reducing drug costs is about designing a sustainable system that connects reimbursement, data, and outcomes.

Medicaid CEOs on the Frontlines

• CEOs took the stage: Four Medicaid CEOs joined TAHP CEO, Jamie Dudensing, to dive into today's challenges and opportunities.
  • Greg Thompson, President and CEO, Wellpoint
  • Dee Cavaness, Chief Executive, Texas Medicaid, BCBSTX
  • Stephanie Rogers, CEO, Medicaid, Aetna
  • Don Langer, CEO, UHC Community Plan of Texas and Oklahoma
• Their priorities:
  • The pool of money that drives health care is not growing. We need innovation and collaboration if we want to improve health outcomes.
  • Technology and data innovation are helping reduce provider frustration and improve the member experience.
  • The health care workforce shortage is a growing concern. Investment in training, incentives, and local partnerships is essential.
• Spotlighting plan initiatives:
  • Wellpoint and TORCH shared a video about their collaboration to support rural health care access.
  • Programs like BCBS Texas' Special Beginnings improve prenatal care and provide mental health support for mothers.

HHSC on Texas' Evolving Health Landscape

• A view from the top: Cecile Erwin Young, the Executive Commissioner of Texas HHSC, provided insights on the major policy and regulatory shifts shaping the Texas health care industry.
• The Commissioner's key points:
  • When Cecile Erwin Young became commissioner in 2020, she outlined priorities including transparency, contract management, better client services, and faster operational processes.
  • HHSC leadership is focused on collaboration and efficiency internally and across organizations. The agency recently worked to improve their foster and kinship care systems.
  • Looking into areas in contract management that lack the robust reporting requirements or level of interest of others.
  • The Commissioner encourages partners to communicate openly with HHSC. She said that partnerships "should not be adversarial," and that partners should let HHSC know if they're sensing that.
• Her thoughts on Sunset:
  • 2015 Sunset reorganization was "very hard" because it took HHSC from five agencies to three.
  • HHSC's "number one goal" for their 2025 Sunset review is ensuring that their clients continue to receive services.
  • The agency has conducted 46 meetings as part of their Sunset review, with 11 more to go.
  • For more info, check out HHSC's Self-Evaluation Report and TAHP's SER Summary.

TDI Shares Regulatory Updates

• TDI rounded out the conference: Three crucial members of the agency explained how TDI is approaching implementation, oversight, and guidance.
  • Kenisha Schuster, Associate Commissioner of Government Relations, TDI
  • Debra Diaz-Lara, Deputy Commissioner of Life and Health, TDI
  • Essi Eargle, Manager of Accident and Health Program, TDI
• Streamlining processes:
  • Efforts to improve efficiency include clarifying submission requirements, eliminating duplicate processes, simplifying fees, and permitting multiple group filings.
  • Filings submitted without fees are will now be rejected upfront, and carriers must provide details on any new programs or initiatives.
  • New plain language requirements call for tables of contents, definitions, clear formatting, short sentences, and legible fonts.
• Big updates:
  • September saw a flood of submissions to the state's surprise billing medication program for facility claims as the window closed for older claims.
  • A new template for network adequacy submission will be ready for review in December.
  • TDI is building a portal for plans to submit goldcarding data. In addition, they are looking into a gold card reporting and appeals process. Rules are coming in December.
  • TDI is scheduled for a 2028-2029 Sunset review cycle and a State Auditor's Office review sometime in FY26 or FY27.