TennCare Waiver Removes Lawmakers’ Excuse To Blame Program for Fiscal Problems, Tennessean Editorial Says

The recently approved waiver that will allow Tennessee to alter TennCare, the state's Medicaid managed care program, will force state lawmakers to address the program's problems rather than blame it for the state's fiscal troubles, a Nashville Tennessean editorial states (Nashville Tennessean, 6/4). The new waiver takes effect July 1 and restructures eligibility and benefits offered under the program. The waiver allows the state to split TennCare into three programs: TennCare Medicaid, TennCare Standard and TennCare Assist. TennCare Medicaid will provide benefits for Medicaid-eligible individuals as required by federal law. TennCare Standard, which will offer benefits similar to a commercial managed care plan, is open to adults with no access to group insurance and annual incomes below the poverty level, or $8,860 for an individual; children in families with annual incomes below 200% of the poverty level, or $36,200 for a family of four, and no access to group insurance; and medically eligible people with illnesses that make them uninsurable. The waiver also allows for the creation of TennCare Assist, which would provide low-income workers assistance in purchasing private health insurance (Kaiser Daily Health Policy Report, 6/3). The waiver gives state lawmakers, who have "grip[ed] for years" that TennCare benefits were not based on income levels, the ability to "control the level of care" for non-Medicaid-eligible TennCare beneficiaries by how much money they choose to appropriate to the program, the editorial says. However, hospitals and physicians contend that if legislators decide to reduce funding for the program, "effectively removing people" from the program, the number of individuals using emergency rooms for nonemergency care will increase. Cutting funding also would put providers in the position of "either providing free care or turning patients away," the editorial says. Whether the changes permitted by the waiver are "beneficial or not depends on your perspective," the editorial maintains, but it states that "one thing is certain -- TennCare will no longer be the political whipping boy for state government" (Nashville Tennessean, 6/4).