Federal Judge Blocks Tennessee Plan to Close TennCare to Uninsurable Adults

A federal judge on Oct. 26 blocked a plan proposed by Tennessee Gov. Don Sundquist (R) to close enrollment in TennCare, the state's Medicaid managed care program, to uninsurable adults and ordered the appointment of a "special master" to ensure that the state removes ineligible members from the program, the Memphis Commercial Appeal reports. Sundquist had moved to close TennCare to uninsurable adults -- beneficiaries who are not otherwise categorically eligible for Medicaid but cannot obtain private health coverage as a result of pre-existing medical conditions -- on Oct. 1 to help "stem the growth" in the program's enrollment, which is nearing the 1.5 million cap set by the state's Medicaid waiver. In addition, Sundquist had hoped to reduce a projected $37.5 million budget shortfall. The Commercial Appeal reports that the plan would have saved the state an estimated $7.5 million in TennCare expenditures. However, in a 57-page opinion, U.S. District Judge William Haynes ruled that the state "couldn't unilaterally shut off" TennCare enrollment to uninsurable adults. He said that the move would "violate a previous court settlement." Haynes ruled that a special master must oversee the state's reverification process and that the state must remove as many as 15,000 ineligible members from the program "to make room" for new members "as soon as possible." The Commercial Appeal reports that the decision represents a "major slap" at the "controversial" TennCare program, which provides health insurance for 1.45 million Tennessee residents. Sundquist spokesperson Alexia Levison said that the governor would review the court order, "but from what we understand initially from the judge's action, we strongly disagree with it." She added, "We need to review and evaluate the contents of the order to fully comprehend the consequences to the state." Haynes said that the state has the "right" to modify TennCare policy, but must abide by past court agreements and federal regulations (Wade, Memphis Commercial Appeal, 10/26). For further information on state health policy in TennCare, visit State Health Facts Online.