TennCare Cleared To Drop 52,000 Beneficiaries After Judge Approves Enrollment Verification Plan

Starting in December, Tennessee officials will be allowed to begin removing ineligible enrollees from TennCare, the state's Medicaid managed care program, under a compromise agreement reached Nov. 14 in federal district court, the AP/Memphis Commercial Appeal reports. After two days of negotiations between the state and the Tennessee Justice Center, which is representing TennCare enrollees, U.S. District Judge William Haynes approved a plan that will allow the state to begin sending enrollment termination notices that include "appeal rights" to 52,000 people already deemed ineligible and eventually to all 600,000 Medicaid-ineligible enrollees. A process to reverify Medicaid-eligible TennCare enrollees is already in place (Sharp, AP/Memphis Commercial Appeal, 11/15). In May 2000, Haynes blocked a plan to reverify enrollees that would have dropped ineligible beneficiaries because it failed to provide termination notices and "violated [their] rights to an appeal," (Lewis, Nashville Tennessean, 11/15).

The Agreement
Under yesterday's compromise, termination notices will be sent to enrollees who have not paid their premiums for the past four months, unless they have "one of two specific mental conditions." The AP/Memphis Commercial Appeal does not identify the two conditions (AP/Memphis Commercial Appeal, 11/15). State officials have identified 25,000 TennCare beneficiaries with "invalid addresses" and another 27,000 beneficiaries who have failed to pay their TennCare premiums for at least four months (Kaiser Daily Health Policy Report, 11/13). Rather than being dropped from the program immediately, enrollees will have 30 days to contact the state and begin paying premiums -- "missed" payments may be made over a 10-month period. TennCare will also begin consulting with other state agencies and managed care organizations to "identify the whereabouts" of enrollees with invalid addresses. Once enrollees are located, termination notices, which explain the appeals process, will be sent to them. TennCare spokesperson Lola Potter said that the reverification process will then expand to the entire TennCare population. The state will try to complete 8,000 to 10,000 verifications per month, but eventually hopes to reverify 40,000 to 60,000 enrollees a month (AP/Memphis Commercial Appeal, 11/15).