TennCare Functioning at ‘Emergency Operations Level’ During Partial Shutdown of Tennessee State Government

Medical care for individuals in TennCare, Tennessee's Medicaid managed care program, has not been impacted by the state government's partial shutdown this week, the Chattanooga Times Free Press reports (Park, Chattanooga Times Free Press, 6/2). Because state lawmakers have yet to reach an agreement on an appropriations bill, the state's new fiscal year began July 1 without a state budget plan. The state Senate passed a plan June 30, but the state House rejected it (Commins, Chattanooga Times Free Press, 7/1). As a result, the government has shut down partially, and TennCare has "scale[d] back" its operations. For example, TennCare's Program Integrity Unit, which investigates fraud and abuse, and the quality oversight division, which monitors patient information to ensure appropriate care, will be closed until a budget is passed. In addition, TennCare is operating without any administrative staff and the TennCare hotline, which fields questions from beneficiaries, will operate with a staff of 15 instead of 50. The appeals process, which allows patients to challenge a coverage or enrollment decision, also will be "slowed down," according to TennCare spokesperson Lola Potter. "We are staffed at an emergency operations level, and we can probably operate this way until Friday, given that nothing dramatic happens," she said, adding, "But beyond that, we may run into problems." The Free Press reports that the shutdown has not affected TennCare's claim processing and provider payments.

Reforms on Track
Despite the partial shutdown, the state will implement Gov. Don Sundquist's (R) planned reforms of the program (Park, Chattanooga Times Free Press, 7/2). The federal government on May 31 approved the state's waiver application to restructure TennCare eligibility and benefits. The waiver, which took effect July 1, allows the state to create TennCare Medicaid for Medicaid-eligible individuals and TennCare Standard for 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, $36,200 for a family of four, and no access to group insurance; and medically eligible people with illnesses that make them uninsurable. TennCare Medicaid will give beneficiaries coverage similar to what is currently offered through TennCare, while TennCare Standard will offer scaled-back benefits similar to those available through commercial managed care programs. 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, 6/12).