Tennessee Comptroller Gives Final Approval to TennCare Reform Package, Waiver Proposal Sent to Federal Officials

Tennessee Comptroller John Morgan has approved Gov. Don Sundquist's proposal to reform TennCare, the state's Medicaid managed care program, the last step necessary before state officials sent the plan to federal officials for approval, the Chattanooga Times & Free Press reports. The proposal, which was sent to HHS on Feb. 12 in the form of a Medicaid waiver request, took two years to draft. State officials have been in talks with the federal government about the proposed changes and hope to have some of the "key reforms" approved in time to implement them by 2003. Federal officials already have agreed to extend the state's TennCare waiver for one more year but have said the program must be "scaled back" to cut costs if it is to continue past 2003. TennCare spokesperson Lola Potter said Sundquist's proposal adheres to federal officials' "desire" to make TennCare "tighter and more accountable" (Park, Chattanooga Times & Free Press, 2/13). Sundquist's proposal would scale back the program to a managed care plan -- called TennCare Medicaid -- for Medicaid-eligible residents. The plan also calls for the creation of TennCare Standard, which would offer benefits similar to those under a commercial managed care plan to the following groups: 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 medically 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, 12/12). Morgan "tweaked" Sundquist's proposal before approving it. His changes include:

• Currently enrolled children in families with annual incomes below 200% of the poverty level, or $35,300 for a family of four, will be eligible for TennCare Standard even if their families are eligible for employer-sponsored coverage;
• People considered medically eligible with annual incomes below 100% of the poverty level, or $8,590 for an individual, would be eligible to enroll in TennCare Standard year-round, instead of waiting for enrollment periods; and
• Individuals dually eligible for Medicare and TennCare will be "grandfathered into the new program" and allowed to continue to receive drug benefits under TennCare (Wade, Memphis Commercial Appeal, 2/13).