Federal Judge Names Former North Carolina Medicaid Official As TennCare ‘Special Master’

A federal judge has appointed a "special master" to determine whether about 60,000 "uninsurable" adults are still eligible for health coverage through TennCare, Tennessee's Medicaid managed care program, the Nashville Tennessean reports. Alene Goolsby, a former assistant director of North Carolina's Medicaid program, will monitor the state's compliance with a court-ordered "eligibility verification process" (Lewis, Nashville Tennessean, 11/6). On Oct. 26, U.S. District Judge William Haynes blocked a plan proposed by Tennessee Gov. Don Sundquist (R) to close enrollment in TennCare to uninsurable adults and ordered the appointment of a special master to ensure that the state removes ineligible members from the program. 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 (Kaiser Daily Health Policy Report, 11/1). TennCare spokesperson Lola Potter said the "issue" is that 10,000 to 15,000 of a group of 60,000 "uninsured adult" beneficiaries may not qualify for TennCare coverage "for a variety of reasons." Haynes also appointed Nashville attorney Michael Passino as counsel to the special master and said he would consider appointing a "computer expert." State officials last week filed a motion with the 6th U.S. Circuit Court of Appeals in Cincinnati to block the appointment of a special master, saying the special master would be "a severe and unjustified intrusion on the responsibilities of elected officials" (Nashville Tennessean, 11/6). In other TennCare news, the state Legislature's TennCare Oversight Committee is meeting Nov. 6-7 with the Sundquist administration to review the governor's waiver proposal before it is submitted to the Centers for Medicare and Medicaid Services on Dec. 15. State Rep. Gene Caldwell (D), chair of the committee, said, "We're going over all aspects of the waiver" (Flessner/Park, Chattanooga Times & Free Press, 11/6). In addition to the proposed closure of the program to uninsurable adults, Sundquist's Medicaid waiver proposal would split TennCare into three insurance pools. Beneficiaries who are categorically eligible for Medicaid 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 (Kaiser Daily Health Policy Report, 10/4).