Tennessee Officials Ask District Judge To Reconsider Decision Mandating Separate Program for Children in TennCare

The following is a summary of recent news on TennCare, Tennessee's Medicaid managed care program:

• State Attorney General Paul Summers filed a motion last week asking U.S. District Judge John Nixon to "reconsider" a ruling issued last month that ordered the state to shift the 668,000 children enrolled in TennCare into a new program (Park, Chattanooga Times & Free Press, 1/25). Last month, Nixon ordered state officials to move all children under age 21, who make up 40% of total TennCare enrollment, into another program because the state has "failed to provide adequate" early and periodic screening, diagnosis and treatment services to them (Kaiser Daily Health Policy Report, 1/10). State officials have said that moving the children could end the managed care aspect of TennCare and cause about 630,000 beneficiaries to lose their health coverage. If Nixon does not change his ruling, Tennessee officials have asked for time to appeal the decision to the Sixth Circuit Court of Appeals in Cincinnati. The Tennessee Justice Center, which filed the complaint against the state leading to Nixon's ruling, did not comment on the motion, but said it would file a response by Feb. 4 (Chattanooga Times & Free Press, 1/25).
• Tampa, Fla.-based Applied Health Outcomes on Jan. 24 presented a report on the "state of quality" in TennCare to the TennCare Centers of Excellence, a 15-member panel tasked with finding ways to improve care for TennCare beneficiaries, the AP/Memphis Commercial Appeal reports (AP/Memphis Commercial Appeal, 1/26). According to the report, only 20.6% of TennCare beneficiaries with heart disease were screened for high cholesterol between July 1, 2000, and June 30, 2001, compared with 68.9% of privately insured patients. In addition, only 55% of beneficiaries with schizophrenia received "follow-up" treatment, compared with 70% of people with private coverage. The study also found that 57% of TennCare beneficiaries with asthma received the appropriate medication, a rate similar to the national average for individuals with private insurance. In addition, 60% of TennCare patients with heart failure received an ACE inhibitor -- a class of drugs that widen blood vessels and make it easier for the heart to pump blood -- a "greater percentage" than privately insured heart patients (Snyder, Nashville Tennessean, 1/25).
• Tennessee Citizen Action and the Tennessee Health Care Campaign have begun an e-mail campaign designed to prevent changes in TennCare proposed by Gov. Don Sundquist (R), the Nashville Tennessean reports. The two groups have encouraged "interested parties" to e-mail all the state legislators because they are "concerned" about beneficiaries who would lose their TennCare coverage under the proposal (McFadyen-Ketchum, Nashville Tennessean, 1/25). Sundquist's "controversial" proposal would scale back the program to a managed care plan -- called TennCare Medicaid -- for Medicaid-eligible residents. About 500,000 Medicaid-ineligible beneficiaries would lose coverage as a result. 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, 11/19/01). The proposed changes were part of a waiver request sent to federal officials as a modification of the existing TennCare. Earlier this month, CMS approved the waiver, allowing TennCare to exist as is for one more year. However, Sundquist and federal officials are expected to continue discussions on the governor's proposals to alter the program (Kaiser Daily Health Policy Report, 1/8).