Defending TennCare Reform Proposals, Sundquist Says He Expects CMS To Approve Plan

Responding to critics who have said his plans to revamp TennCare, Tennessee's Medicaid managed care program, will never be approved by the federal government, Gov. Don Sundquist (R) on Oct. 2 said he believes the government will "be receptive" to the ideas, the Chattanooga Times & Free Press reports. He said, "TennCare is an experiment and it's one that is ever-evolving. I believe our waiver will be approved." Under Sundquist's Medicaid waiver proposal, TennCare would be split into three insurance pools. Medicaid-eligible beneficiaries would be placed into TennCare Medicaid, Medicaid-ineligible beneficiaries with no access to employer-sponsored health coverage would be placed in TennCare Standard and people who have access to employer-sponsored insurance but cannot afford the premiums would be put into TennCare Assist, which would subsidize premiums. The proposal also would cut from TennCare about 180,000 beneficiaries who are Medicaid-ineligible, a move that would save the state $150 million (Commins Chattanooga Times & Free Press, 10/3). Critics of the proposal have said that by "renegotiating" the federal waiver that created TennCare, the state "risks" losing federal matching dollars. In addition, critics say the Centers for Medicare and Medicaid Services could reject the waiver application because the revamped program would cover fewer people. Gordon Bonnyman, an attorney with the Tennessee Justice Center, said, "[CMS] has said it is willing to give states flexibility to propose new things, but they have to show that it is for the purpose of expanding coverage." He added that it is "unlikely" that CMS will provide funding for TennCare Standard or TennCare Assist because no other state receives such funding (Chattanooga Times & Free Press, 10/3). But Sundquist said, "Even with the cuts, we'll cover more people in Tennessee than any other state" (de la Cruz, Nashville Tennessean, 10/3). "(CMS) knows the financial problems in Tennessee. We're not saying we're never going to insure those individuals. What we're saying is we don't have the tax base to support it right now but we're going to have a good system ... to increase [enrollment]," Sundquist added (Chattanooga Times & Free Press, 10/3).

More TennCare News
The following is a roundup of other recent TennCare-related news:

• State Rep. Gary Odom (D) has proposed legislation that would require employers to notify the state whether they offer health insurance coverage to their employees. Odom said, "It seems to me that this is a very critical piece of data that is not now available anywhere in the bowels of state government. Yet one of the provisions in current law is you are not eligible for TennCare if you have an employer-sponsored health insurance plan available to you as an employee." Odom's measure also would establish a definition of "uninsurability" and require TennCare applicants to submit two rejection letters from insurance companies that denied coverage based on that definition (Cheek, Nashville Tennessean, 10/3).
• Leaders of Nashville's black community plan to march on the state Capitol on Oct. 15 in a show of support for Access MedPLUS, an insurer in danger of losing its contract with TennCare. Unless the minority-owned Access MedPlus, the largest TennCare health plan, proves by Oct. 7 that it is able to pay its bills and is "financially sound," the state will terminate its TennCare contract. Tennessee in January attempted to take over the company's management but failed; since May 2000, the company has been under state supervision because of computer problems that prevented the health plan from paying care providers "promptly or accurately." Several leaders in the black community have charged the state with discriminating against the health plan. Rosetta Miller-Perry, president of the Greater Nashville Black Chamber of Commerce, and Neal Darby, the chamber's executive director, have said that the state put "stringent requirements" on Access MedPLUS that other health plans were not subject to. State officials, however, have denied any discrimination, saying that the health plan failed to file required financial reports and showed signs of "substantial [financial] deterioration" (Snyder, Nashville Tennessean, 10/3).