Update on Parkland Community Health Plan (PCHP) coverage

• This is an overbroad statement and may not be accurate for your child. Now that PCHP has moved Children’s Health facilities out of network, there are additional processes required for PCHP members to continue care at Children’s Health.  

• A patient would be eligible to continue receiving care for 90 days through a “Special Circumstances” approval, which PCHP sometimes also refers to as a continuity of care exception.

• These exceptions may be available for certain patients with specific medical needs, but they are reviewed and approved by PCHP on a case-by-case basis and are not automatic.

• For patients where the child’s treating doctor or provider believes that patient should qualify for “Special Circumstances,” Children’s Health is advocating with PCHP for a “Special Circumstances” approval.

• Children’s Health cannot move forward with the patient’s care until we have received a final decision on the approval or denial of those requests from PCHP.

• Even with a “Special Circumstances” approval, all hospital-based services require prior authorizations from PCHP for the services requested, and the approval will not cover care beyond Sept. 4, 2026.

• We understand how stressful and frustrating appointment changes can be for families.

• As of June 6, Children’s Health and its facilities are now out-of-network with PCHP. For services on or after June 6, there are now multiple levels of approval needed to ensure your child can receive care at an out-of-network facility.

• On the health plan side, PCHP must approve non-emergency services provided at Children’s Health facilities, and we cannot schedule or continue services without the required approvals from the health plan. On the hospital side, we also have policies and procedures for out-of-network patients that we must now follow, which were not required before June 6. If we cannot obtain the required approvals from PCHP and a single case agreement or “Special Circumstance” exception, we will re-direct you to PCHP so that you can find an in-network option for your child’s care, consistent with our policies. As your health plan, it is PCHP’s duty to maintain a provider network that gives you sufficient access to the care you and your child need.

• These changes are not being made lightly. Because PCHP has moved Children’s Health out of network, we must obtain approval from PCHP before non-emergency services can occur at our facilities.

• If PCHP and Children’s Health cannot agree on a Single Case Agreement, PCHP is obligated to find your child an in-network provider.

• While PCHP is honoring prior authorizations issued before June 6, the prior authorization is only one level of approval needed now that Children’s Health is out-of-network.

• In order for Children’s Health to move forward with out-of-network care, PCHP must also approve either a “Special Circumstance” exception or a single case agreement for those services. If PCHP and CHST do not reach an agreement, PCHP is obligated to find your child an in-network provider.

• In some cases, PCHP may require new or additional approvals for services provided at Children’s Health after June 6, due to Children’s Health facilities being out-of-network.

• Our concern is that families who need access to non-emergency services at Children’s Health will continue encountering frustrating administrative delays so long as Children’s Health facilities remain out-of-network with PCHP. As an out-of-network facility, there are now multiple layers of approvals that are needed before Children’s Health can provide services to an out-of-network patient.

• Emergency care remains covered; however, for non-emergency care, PCHP determines whether services at an out-of-network hospital are approved, which may affect whether your child can continue receiving care at Children’s Health.

• Switching to an in-network Medicaid or CHIP plan is the most reliable way to preserve uninterrupted and timely access to the Children’s Health facilities, physicians, specialists and care teams they know and trust.

• You do not have to change your health plan, and your Medicaid and CHIP coverage remains intact despite this termination.

• Families can choose whether to remain with PCHP or transition to another STAR or CHIP plan.

• However, because Children’s Health facilities are now out-of-network for PCHP STAR and CHIP plans, there will be new administrative approvals needed prior to receiving future services at Children’s Health facilities that you did not have to wait for before June 6. PCHP must approve non-emergency services provided at Children’s Health going forward and complete an agreeable Single Case Agreement for your child’s care to take place.

• Switching to a STAR or CHIP plan that remains in-network with Children’s Health is the easiest way to help preserve uninterrupted access to Children’s Health physicians, specialists and facility-based services.

• By having an in-network health plan, your child’s care experience can be more easily coordinated by reducing administrative barriers and allowing care teams to focus on timely, connected care for your child.

• The physicians and providers at Children’s Health Medical Group and UT Southwestern medical group remain in network with PCHP, but the majority of these doctors and providers practice exclusively at Children’s Health facilities which PCHP has moved out of network.

• In some instances where services are being offered in an office building, new approvals from PCHP may not be required because the care is being delivered at a location not deemed a Children’s Health facility. For other visits at Children’s Health facilities, there may be additional approval needed now that Children’s Health is out-of-network. For example, if your child needs imaging, labs, procedures, surgery or hospital-based follow-up care at a Children’s Health facility, PCHP approval is still required.

• Approximately 90% or more of pediatric specialty visits rely on additional services that would be provided at Children’s Health facilities, making this a common and essential part of care. We take this into consideration when working with patients enrolled in out-of-network plans, like PCHP, because we understand how frustrating a continued delay can be after you and your child have already attended the initial doctor’s visit.

• This means should your child’s physician order additional tests or services that need to be performed at a Children’s Health facility, the out-of-network status may result in delayed scheduling or disrupted treatment plans as we attempt to obtain approvals from PCHP.

• As a Medicaid managed care plan, PCHP does have a duty to maintain an adequate network that can provide the care your child needs. When possible, choosing an in-network option will provide the most consistent care option for your child. For that reason, now that PCHP has chosen to move Children’s Health to an out-of-network status, we will often re-direct PCHP members back to PCHP so that PCHP can identify an option within their network for your child.

• Children’s Health remains dedicated to providing high-quality, specialized services for pediatric patients across Texas, and the easiest way to preserve uninterrupted access to care at Children’s Health is to enroll with an in-network health plan.

• Children’s Health is one of only a few dozen freestanding, independent children’s hospitals in America. These institutions are built on the understanding that children achieve better outcomes when care is designed specifically for their unique needs, rather than adapted from adult care models.

• Children’s Health is the most comprehensive pediatric health care system in North Texas, uniquely equipped to care for children who need the highest level of pediatric care with highly specialized physicians, advanced technology, long-term programs and services dedicated exclusively to children.

• Children’s Medical Center Dallas is the region’s only Level I pediatric trauma center, and our system provides highly specialized pediatric experts, technology and services designed specifically for children.

• Many hospitals can provide general pediatric services. However, children with complex medical needs often require pediatric-only specialists, advanced surgical teams, dedicated pediatric intensive care units, and coordinated care teams that are built entirely around children – care Children’s Health has proudly provided North Texas families for more than a century.

No, Children’s Health continues to accept other Medicaid managed care plans. This change only affects Parkland Community Health Plan (PCHP) STAR and CHIP plans as of June 6, 2026.

There are two ways to obtain a copy of your child’s medical records for care transition:

• Access through MyChart at mychart.childrens.com; or

• Contact Health Information Management at 214‑456‑2509