Federal Approval of Waiver To Overhaul TennCare Expected

Tennessee Gov. Don Sundquist (R) is expected on May 31 to announce that the federal government has approved the state's waiver application to alter TennCare, the state's Medicaid managed care program, the Memphis Commercial Appeal reports (Wade, Memphis Commercial Appeal, 5/31). Although the Sundquist administration on May 30 did not provide details about the waiver's approval, state Rep. Gene Caldwell (D), chair of the TennCare Oversight Committee, said he received a call from the governor's office informing him that the waiver had been approved (Lewis, Nashville Tennessean, 5/31). Sundquist's proposed reforms would scale back TennCare to a managed care plan -- called TennCare Medicaid -- for Medicaid-eligible residents. The overhaul also would 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 annual incomes below the poverty level; children in families with annual incomes below 200% of the poverty level and no access to group insurance; and medically eligible people with illnesses that make them uninsurable. Sundquist's plan also would create TennCare Assist, a premium assistance program that would help low-income workers purchase private health insurance (Kaiser Daily Health Policy Report, 2/14). About 164,000 Medicaid-ineligible individuals would be dropped from the program as a result of the changes (Park, Chattanooga Times & Free Press, 5/31). Tennessee submitted the waiver plan to federal officials in February, and since then, the state has made changes to the proposal as requested by the federal government. Caldwell said he expects those changes to be detailed during a May 31 press conference (Nashville Tennessean, 5/31). The Chattanooga Times & Free Press reports that sources said 90% of Sundquist's reforms had been approved.

Lawmakers Work to Codify Reforms
Meanwhile, state lawmakers are working to make the waiver changes state law. On June 3, the state Senate Ways and Means Committee is scheduled to hear a bill that would amend the "management and scope of TennCare" (Chattanooga Times & Free Press, 5/31). Earlier this week, the Tennessee House unanimously passed a similar bill (Kaiser Daily Health Policy Report, 5/30). A spokesperson for CMS said that making the changes contained in the waiver state law would not impact the waiver itself and simply is "standard procedure." However, Gordon Bonnyman, director of the Tennessee Justice Center, said that making the changes law means it could be "very hard to ever change" the waiver (Chattanooga Times & Free Press, 5/31). The Justice Center earlier this year filed a lawsuit on behalf of children in TennCare, alleging that the program had failed to provide adequate early periodic screening diagnosis and treatment, or EPSDT, services to them (Kaiser Daily Health Policy Report, 5/16).