Tennessee Lawmakers Issue ‘Harsh Review’ of Governor’s TennCare Reforms, Comments To Be Forwarded to CMS

The Tennessee Legislature's TennCare Oversight Committee on Dec. 11 issued comments "highly critical" of Gov. Don Sundquist's (R) proposed waiver reforms to TennCare, the state's Medicaid managed care program, the Memphis Commercial Appeal reports (Wade, Memphis Commercial Appeal, 12/12). Sundquist's "controversial" 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). Last week, the oversight committee 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 (Kaiser Daily Health Policy Report, 12/10). The following is a sample of the committee's comments about the remainder of the proposal:

• The proposal to drop TennCare coverage for 164,000 current beneficiaries who are Medicaid-ineligible would result in a loss of more than $337 million in federal matching funds. This loss could have a "significant economic impact" on the state and the health care industry;
• The plan to drop "healthier people" from TennCare would cost the state more than $67 million through "lost" premiums and drug rebates;
• A decline in TennCare enrollment, which would likely increase the number of uninsured, would adversely affect rural and "safety-net" hospitals, which would have to care for such people. Costs for this treatment would be shared by state tax dollars and local governments (Park, Chattanooga Times & Free Press, 12/12);
• Because of the current "financial crisis," the state may not be able to "fully fund" TennCare Standard, which could further increase the state's uninsured population and burden the health care system.

TennCare Waiver Proposal 'Troublesome'
Sundquist's TennCare reform proposal "does more harm than fixing" and "ignores" the "most vulnerable Tennesseans," particularly those with mental illnesses, Paula Wade, a reporter for the Memphis Commercial Appeal writes in an op-ed for the newspaper. For example, while a mentally ill person seeking care is currently presumed eligible for TennCare coverage, under Sundquist's proposal, the person would only receive emergency treatment and have to "have the presence of mind" to enroll in TennCare Standard. In addition, Wade notes that the proposal would give the state Legislature the authority to determine TennCare Standard's "scope of coverage" -- a role she says lawmakers will "regret" because constituents will lobby to have the program cover "this or that disease." Wade concludes, "Surely this state can do better" (Wade, Memphis Commercial Appeal, 12/11).

More Termination Notices Than Anticipated
In other TennCare news, termination notices are being sent to about 77,620 beneficiaries, an increase over an earlier estimate of 52,000, the Nashville Tennessean reports. The state changed its earlier estimate after acknowledging that officials had "failed to clarify that more than one enrollee lives at each address" (Lewis, Nashville Tennessean, 12/11). The notification comes after U.S. District Judge William Haynes last month approved procedures to reverify the eligibility of 635,000 TennCare beneficiaries who previously were uninsured or who were denied private insurance because of pre-existing medical conditions. At the time, the state said notices would be sent to 27,000 beneficiaries who were "significantly behind" on paying their premiums and to about 25,000 beneficiaries with "invalid addresses" (Kaiser Daily Health Policy Report, 12/3).