TennCare Oversight Committee Approves Part of Sundquist’s Proposed Reforms, Expected To Approve More Dec. 11

The TennCare Oversight Committee last week approved three pages of Gov. Don Sundquist's (R) proposed waiver reforms to TennCare, the state's Medicaid managed care program, the Chattanooga Times & Free Press reports (Park, Chattanooga Times & Free Press, 12/6). Among other changes, Sundquist's overall proposal, to be sent to federal officials as a modification of the existing TennCare waiver, would scale back the program to a managed care plan -- called TennCare Medicaid -- for Medicaid-eligible residents. Sundquist's plan also calls for the creation of TennCare Standard, which would offer benefits similar to those under a commercial managed care plan to adults with no access to group insurance and with incomes below the poverty level; children in families with incomes below 200% of the poverty level and no access to group insurance; and "[m]edically eligible" people with illnesses that make them uninsurable. The proposal also would create TennCare Assist, which would offer "premium assistance" to low-income workers to purchase private health insurance (Kaiser Daily Health Policy Report, 11/19). The committee last week approved Sundquist's plan to divide TennCare into three separate eligibility pools, as well as a provision that would create protocols for beneficiaries to file complaints for denial of care. The committee has yet to vote on the proposal that would drop 180,000 Medicaid-ineligible TennCare beneficiaries from the program, a plan to establish a one-time enrollment period and changes to TennCare benefits, such as eliminating coverage for lung and bone marrow transplants. The waiver proposal does not require the committee's approval; however, any committee comments will be attached to the plan when it is submitted to CMS. The committee is expected to meet Dec. 11 to vote on the remaining 37 pages of Sundquist's proposal (Chattanooga Times & Free Press, 12/6). For more information on health in Tennessee and other states mentioned in today's Kaiser Daily Health Policy Report, visit State Health Facts Online.