Tennessee Newspapers Examine Access to Care, Proposal to ‘Split’ TennCare

State officials and lawmakers are debating whether a proposal to separate Medicaid-eligible and non-Medicaid-eligible populations under TennCare will save "taxpayer dollars in the face of a state budget crisis" or "cost the state more in the long run," the Chattanooga Times & Free Press reports. Under TennCare, 800,000 beneficiaries are Medicaid-eligible, and 600,000 are not. Under the proposal, non-Medicaid-eligible beneficiaries would pay higher premiums and copayments. TennCare spokesperson Lola Potter said the state is performing a review of the proposal, adding that it is "unclear" when the analysis will be completed. State Rep. Chris Clem (R), who favors splitting the two groups, said that the uninsured and uninsurable "who can afford to pay for their care should, rather than relying on the state." Tony Garr, executive director for the Tennessee Health Care Campaign, said that if the state implements the proposal, about 220 children would lose dental, vision and preventive health benefits under TennCare, and "at least" 150,000 adult beneficiaries would lose coverage altogether because of the cost (Park, Chattanooga Times & Free Press, 8/13).

'Too Much' at 'Too Great a Cost'
TennCare "offers too much to too many at too great a cost to taxpayers," a Chattanooga Times & Free Press editorial states. Besides the plan to separate TennCare beneficiaries into Medicaid-eligible and non-Medicaid-eligible groups, the state also needs to make other reforms, the editorial says. Those reforms include "recommendations ... given by those who have studied [TennCare's] problems." The editorial concludes, "As Tennessee temporarily dodges very serious general revenue shortfalls, major action to save money on TennCare seems to be the first step toward tough tax solutions that eventually must be found" (Chattanooga Times & Free Press, 8/13). For further information on state health policy in Tennessee, visit State Health Facts Online.

Hospital Participation in TennCare Examined
In other TennCare news, of the three Memphis, Tenn., hospital systems -- the state's leaders in provision of uncompensated care -- Baptist Memorial Healthcare Corp. hospitals in Shelby County "trailed" behind Methodist hospitals and the Regional Medical Center at Memphis, also known as The Med, in providing care for TennCare beneficiaries, the Memphis Commercial Appeal reports. The Commercial Appeal has been compiling data on hospitals' participation in the state's Medicaid managed care program in response to a "vo[w]" by Gov. Don Sundquist's (R) administration "to spotlight" hospitals' participation "partly in hopes of stopping an exodus of providers from the program." Administration officials also have asked state regulators to "pay closer attention" to a facility's participation in TennCare while evaluating requests to expand or add services. In 1999, Methodist's Shelby County hospitals did more than three times the TennCare business than Baptist's hospitals did, and the Regional Medical Center "did even more," the Commercial Appeal reports. In 2001, Baptist expects TennCare beneficiaries to account for 2.2% of income at its Shelby County hospitals, down from 4.7% in 1999. At other hospitals in the Baptist system, TennCare beneficiaries are expected to account for 2.3% of income, compared with 3.5% in 1999. Baptist's declining participation in TennCare "reflects corporate business decisions," the Commercial Appeal reports. Baptist has a contract with only one of the four MCOs that insure TennCare beneficiaries in West Tennessee. The Med and Methodist also provide more uncompensated care than Baptist hospitals, the Commercial Appeal reports. In 1999, Memphis-area Baptist hospitals provided $47.6 million in uncompensated care, compared with Methodist's $61 million and The Med's $84 million. According to Baptist officials, the hospital system's falling amount of uncompensated care in its Shelby County hospitals is because of the system's efforts to provide more care at regional hospitals (Powers, Memphis Commercial Appeal, 8/12).