Proposed TennCare Reforms May Not Solve Problem of Low Provider Participation

Even if the federal government approves Tennessee's proposal to reform TennCare, the state might not have enough money to fund the changes or entice doctors to remain in the financially troubled Medicaid managed care program, the Memphis Business Journal reports. Since the creation of TennCare in 1993, two managed care plans that participated in the program have gone bankrupt, and "providers have been abandoning the rest." Many physicians continue to treat TennCare patients on an emergency basis, but often do not charge for care because the administrative cost of filing a claim with TennCare is greater than the reimbursement. Jesse Woodall, an OB/GYN and chair of the Tennessee Medical Association's legislative committee, said, "Between now and the summer with the TennCare situation, something has got to happen." He added that many physicians left the program after they were "lied to [and] cheated. ... Now the state and the TennCare people say they're going to make it right, but they've said that for eight years" (Shepard, Memphis Business Journal, 2/15). Tennessee sent its waiver reform proposal to HHS on Feb. 12 after two years of debate. The proposal would scale back the program to a managed care plan -- called TennCare Medicaid -- for Medicaid-eligible residents. It would also create 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. Finally, the proposal would create TennCare Assist, which would offer premium assistance to low-income workers to purchase private health insurance (Kaiser Daily Health Policy Report, 2/14).