After Failure of Two TennCare Health Plans, Some Question Future of Program

The failure of two of TennCare's largest managed care plans in the past three years has led some lawmakers and providers to question the viability of Tennessee's Medicaid managed care program, the Chattanooga Times & Free Press reports. The state took over Xantus Health Plan of Tennessee in 1999 and Access MedPlus last November after each accumulated multimillion-dollar debts. Xantus, which is now "being rehabilitated by the state," reported a negative net worth of $24 million in 1999 and had outstanding claims of $60 million to providers, while Access MedPlus, which is being liquidated by the state, reported a negative net worth as of June 30, 2001; it is estimated that the company owes $80 million to $100 million to providers for outstanding claims. "The MCOs and the state have let us down by not being fiscally responsible," Yarnell Beatty, general counsel with the Tennessee Medical Association, said. And according to Dennis Pettigrew, CEO of a Chattanooga hospital system, the state is now liable for the companies' debts to providers. "The state's exposed. Without an appropriate and well-meaning oversight function, I don't think TennCare going's to survive," he said. TennCare officials, however, say that the state has increased oversight of managed care companies, including fines for late payments. And while providers say that problems with Access MedPlus were "apparent for years before the state stepped in," officials and lawmakers say that the increased oversight will prevent future collapses. "That's not going to happen again," state Rep. Brenda Turner (D) said (Park, Chattanooga Times & Free Press, 1/8).

Former Access Patients Search for Doctors
Meanwhile, former Access MedPlus members remain "confused" about where to access health care (Park, Chattanooga Times & Free Press, 1/7). After taking over the health plan, state officials temporarily shifted 279,000 Access MedPlus members into a plan operated by BlueCross BlueShield of Tennessee (Kaiser Daily Health Policy Report, 10/22/01). While former Access MedPlus enrollees have until Jan. 31 to select a new health plan within TennCare before they are assigned to one, some patients live in areas where the remaining managed care organizations cannot handle the "influx of new enrollees." Those in areas where managed care is not an option will remain in TennCare Select, the BlueCross "backup" plan, according to TennCare spokesperson Lola Potter. However, Michele Johnson, an attorney with the Tennessee Justice Center, a patient advocacy group, said that because many TennCare health plans have different providers, some patients may need to switch doctors, yet "there are shortages across the system" (Chattanooga Times & Free Press, 1/7).