Tennessee Officials Shift 279,000 TennCare Enrollees to New Plan After Access MedPLUS’ ‘Premature Collapse’

Tennessee officials on Oct. 19 shifted 279,000 members of Access MedPLUS, the largest health plan in TennCare -- the state's Medicaid managed care program -- into a plan operated by BlueCross BlueShield of Tennessee after Access MedPLUS suffered a "premature collapse," the Memphis Commercial Appeal reports. On Oct. 18, Tennessee officials "seized control" of Access MedPLUS after the health plan "abruptly fired" 300 employees without notice or severance pay (Wade, Memphis Commercial Appeal, 10/20). The state originally had planned to shift Access MedPLUS beneficiaries to BCBS' TennCare Select on Nov. 1, the day after Access MedPLUS' contract with the state expires (Snyder, Nashville Tennessean, 10/20). "We would have preferred not to do it this way. But we were getting calls from members saying they could not get ... services," TennCare Director Mark Reynolds said. Reynolds said that state providers will still accept Access MedPLUS member cards and approvals for services (Memphis Commercial Appeal, 10/20). In addition, the state will allow Access MedPLUS members to visit their doctors for four months, regardless of whether they participate in the TennCare Select network (Nashville Tennessean, 10/20). Reynolds said that most primary care providers in the Access MedPLUS network also serve TennCare Select members (Memphis Commercial Appeal, 10/20). The state will reimburse providers who serve Access MedPLUS members based on TennCare Select rates (Nashville Tennessean, 10/20).

Financial Problems
Meanwhile, state officials have "remained reticent" about Access MedPLUS' financial status (Memphis Commercial Appeal, 10/20). Last Thursday, the state won a court order to "seize" operations at Access MedPLUS after financial reports "indicated the health plan was insolvent." Davidson County Chancery Court will hold a hearing Nov. 2 to determine whether the state will "rehabilitate" Access MedPLUS or "liquidate" the health plan to pay debts (Nashville Tennessean, 10/20). The Commercial Appeal reports that "there is little left to salvage" after Access MedPLUS lost its $39 million-per-month TennCare contract, which has provided 99% of the health plan's revenues. The health plan also has incurred more than $54 million in debts (Memphis Commercial Appeal, 10/20). For further information on state health policy in Tennessee, visit State Health Facts Online.

CEO Calls for Reform
The president and CEO of BlueCross BlueShield of Tennessee emphasized his commitment to TennCare last week, but said that the state's Medicaid managed care program needs an "overhaul" and increased funding. In an interview with the Nashville Tennessean conducted on Oct. 17 and published Oct. 21, Thomas Kinser said that the state needs to "make market forces work in better ways than they do now" to increase the viability of the program and ensure the participation of managed care organizations. Noting the size of TennCare, which provides "comprehensive benefits" to roughly 1.5 million people, Kinser said the state should bring into "balance" the "number of people covered and the way you pay providers and the delivery mechanisms of competing HMOs." He also called for tightening the program's eligibility system by increasing state oversight of enrollees. "TennCare is the program of last resort, but people's statuses change month to month, year to year. There needs to be a discipline, a rigorous review to be sure that the people on there are the right people" (Nashville Tennessean, 10/21).