Tennessee Governor Blames State Justice Center for TennCare’s Problems

The future of TennCare, Tennessee's Medicaid managed care program, is being "threatened" by "some federal judges" and litigation filed by the Tennessee Justice Center, Gov. Don Sundquist (R) said on Jan. 14, the Nashville Tennessean reports. Sundquist specifically targeted the Tennessee Justice Center, which filed a lawsuit leading to the recent ruling by U.S. District Judge John Nixon that 440,000 children in TennCare be transferred into a new, separate program because TennCare has failed to provide adequate early periodic screening, diagnosis and treatment services to them. Sundquist said, "If TennCare fails, it won't be on the backs of those who created it and have worked hard to preserve it. If TennCare fails, it will be because of those who have pushed the program past its capabilities through the courts without trying to reach reasonable solutions" (Lewis, Nashville Tennessean, 1/15). TennCare officials have said Nixon's order could eliminate the managed care aspect of TennCare, effectively ending the state's federal waiver to operate the program and forcing the state to return to a traditional Medicaid program (Kaiser Daily Health Policy Report, 1/10). Sundquist added, "Lawsuits filed by the Tennessee Justice Center and subsequent court actions are straining the program's current resources and making it difficult to improve the program in years to come" (Nashville Tennessean, 1/15).

Lawmakers Call for Hearings
Legislators on the joint TennCare Oversight Committee also have responded to Nixon's order, calling for "immediate hearings" on the issue, the AP/Knoxville News-Sentinel reports. State Sen. Roy Herron (D) said he would call for hearings because the committee was not briefed on the order when the legislative session began last week. Herron also called for the state to withdraw its recommendation that Nixon name former TennCare Director Manny Martins as "special master" of the new program for children (AP/Knoxville News-Sentinel, 1/14). In his ruling, Nixon ordered the appointment of a special master to monitor the new program and report to him (Nashville Tennessean, 1/15). Martins now oversees TennCare managed care organizations as the program's assistant commissioner of commerce and insurance. Both the state and the Tennessee Justice Center have said Martins "would be an ideal choice" (Kaiser Daily Health Policy Report, 1/14). Martins, however, is "considered controversial" by many doctors, the AP/News-Sentinel reports. Iris Snyder, chair of the TennCare subcommittee of the Tennessee Academy of Pediatrics, said that many doctors would not participate in a program managed by Martins. "To us, he represents someone who would be very difficult to deal with," she said. Nixon reportedly also isconsidering Vernon Smith, an executive with Health Management Associates, and Linda Schofield, a consultant in Simsbury, Conn., for the "special master" position. Whomever Nixon selects will be required to submit a proposal for the new program within 90 days (AP/Knoxville News-Sentinel, 1/14).

Litigation Not To Blame
The notion that litigation is to "blame" for "killing" TennCare is "bunk," Memphis Commercial Appeal reporter Paula Wade -- who has covered TennCare extensively -- writes in an op-ed for the paper. She adds that the "finger-pointing persists" because it is a "handy way for the Sundquist and Bush administrations to avoid blame for the expected scaling-back of federal support for TennCare." With TennCare's waiver up for renewal this year, Sundquist had proposed eliminating TennCare coverage for 180,000 beneficiaries, continuing coverage for Medicaid-eligible beneficiaries and creating an optional program with scaled-back benefits for about 300,000 others. Sundquist "won a reprieve" though, when federal officials agreed to allow TennCare to continue as is for one more year. Wade writes that the program's problems are not the result of litigation but rather result from TennCare's "long history of poor management, lack of MCO oversight and ancient computers that won't support even the basic functions of the program." In addition, the policy goals of the Clinton administration were different from those of the current administration, Wade says. For instance, federal officials now are not as willing as those in the Clinton administration to "bend funding rules and budget targets" to make TennCare functional. Wade concedes, though, that this is reasonable, given that Tennessee has failed to manage TennCare as required by the waiver (Wade, Memphis Commercial Appeal, 1/15).