The move, which has not been finalized, would drop three large health plans run for two decades by nonprofit children’s hospitals.

Texas health officials are poised to drop the state’s three largest nonprofit children’s health plans from multibillion-dollar Medicaid and children’s health insurance contracts — threatening the future of plans run by legacy children’s hospitals in Fort Worth and South Texas and shaking up health care coverage for low-income families throughout the state.

Some 1.8 million Texans who receive Medicaid coverage from six managed care organizations across the state would lose their current health plans and be shifted to new insurers next year if Texas Health and Human Services stands by a recent decision to redistribute the contracts after a competitive bidding process.

The change would mean a reduction in the number of managed care organizations that administer the state’s Medicaid STAR and Children’s Health Insurance Program, a shift toward for-profit companies in most areas of the state, a smaller number of top-rated plans administering care, and the introduction of new national plans to regions historically served by local MCOs.

Among those who would be affected are a collective 700,000 families, pregnant women and children covered by Cook Children’s Health Plan in the state’s Tarrant service area, Texas Children’s Health Plan in the Harris region, and Driscoll Health Plan in South Texas, all which formed when the CHIP program was created two decades ago.