Sundquist ‘Still Working Out Details’ for TennCare Reforms

Although a commission nine months ago offered Tennessee Gov. Don Sundquist (R) recommendations for reforming TennCare, the state's Medicaid managed care program, his administration "is still working out details to revamp the controversial program," the Memphis Commercial Appeal reports. Tennessee established TennCare in 1993 through a Medicaid waiver that will expire Dec. 31, and the state plans to apply for a new federal waiver this year. According to TennCare Director Mark Reynolds, Sundquist hopes to send a proposal to the state TennCare Oversight Committee in October, develop a "fully detailed plan" in November and send the Medicaid waiver application to HHS by Dec. 31. HHS Secretary Tommy Thompson has agreed to extend the TennCare waiver "until the new program is approved and implemented," the Commercial Appeal reports. Sundquist has said that he will adhere to a recommendation offered by the Commission on the Future of TennCare that would divide the program into three parts -- TennCare, TennCare Standard and TennCare Assist. Under the commission's proposal, TennCare would serve the 800,000 state residents eligible for Medicaid. TennCare Standard would offer "scaled-back" benefits, including "little or no" mental health coverage and limited prescription drug coverage, for "medically uninsurable" residents and low-income families who do not qualify for traditional Medicaid and have "no access" to employer-sponsored health coverage. TennCare Assist would provide subsidies to help low-income Tennessee residents purchase employer-sponsored health coverage.

Health Advocates Balk
Some health advocates "fear" Sundquist "will be pressured" into reforms to "appease political critics at the expense of good health policy and a sound, practicable structure." Tony Garr, executive director of the Tennessee Health Care Campaign, said, "My main concern is that the governor will try to fix things that aren't broken." Garr also warned that dividing TennCare into three parts would "cut off" health coverage for 5,000 children, vision and dental coverage for 220,000 children and basic coverage for 100,000 adults who pay premiums to receive TennCare benefits. "Splitting TennCare into three groups -- all that's going to do is cost more money. It creates another category of eligibility, and that's going to just add another layer of hassle-factor on providers," Garr said, adding, "In addition to trying to find out whether they're really eligible, they'll have to figure out what benefit plan they're in." However, the Tennessee Medical Association said it would support dividing TennCare into three parts "as long as there are single administrators and uniform rules, drug formularies and forms for each program," TMA spokesperson Russ Miller said. Some health advocates also worry that federal officials could halt or "try to cut back" the "generous" matching funds Tennessee receives to mental health, mental retardation and children's services programs under TennCare (Wade, Memphis Commercial Appeal, 8/19).