Judge Says Ruling Requiring Separate Program for Children Does Not Mean End of TennCare

The court order requiring Tennessee officials to shift children from TennCare, the state's Medicaid managed care program, into a separate health care program, will not end the managed care aspect of TennCare or destroy the overall program, according to a clarification by U.S. District Judge John Nixon, who issued the court order, the Memphis Commercial Appeal reports. In a hearing on Feb. 7, Nixon clarified the ruling he made in December, saying it did not "mean the end of TennCare" (Wade, Memphis Commercial Appeal, 2/9). In December, Nixon ordered state officials to move all children under age 21, who make up 40% of total TennCare enrollment, into a separate 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). In issuing the order, Nixon "had harsh words" for the managed care aspect of the program, saying that it "allowed" MCOs participating in the program to "neglect the health needs of children." State officials interpreted Nixon's order to mean that health services for children should be provided on a fee-for-service basis instead of through a managed care system. State officials maintained, however, that if they followed the ruling in that manner, it would "create a fundamental conflict" with the waiver the state has to operate its Medicaid program as a managed care program (Memphis Commercial Appeal, 2/9). State officials added that ending the managed care aspect of TennCare could mean that about 630,000 beneficiaries would lose their health coverage (Kaiser Daily Health Policy Report, 1/28). State officials had asked Nixon to reconsider his ruling. While Nixon declined that request, he "verbally assured" state officials during last week's hearing that the order "does not prevent the state from using a managed care program to serve children." TennCare Director Mark Reynolds said the clarification will allow the state to work with a court-appointed special master to develop a solution to comply with Nixon's order that is "not outside the bounds" of the TennCare waiver (Memphis Commercial Appeal, 2/9).