50,400 TennCare Beneficiaries To Lose Benefits

More than 50,400 TennCare beneficiaries are being notified this week that they are losing their benefits because they no longer qualify for the program, the Memphis Commercial Appeal reports. An additional 77,000 beneficiaries have until Dec. 29 to reply to notices asking them to reverify their eligibility for the program, and a minimum of 26,000 other cases are pending, according to the Commercial Appeal (Wade, Memphis Commercial Appeal, 12/5). The state has been conducting an eligibility reverification process, required by a waiver approved earlier this year by the federal government that allows the state to restructure TennCare eligibility and benefits. The waiver requires TennCare to reverify all non-Medicaid-eligible beneficiaries' eligibility; about 159,000 current beneficiaries are expected to be found ineligible under the new guidelines, according to state officials. The state sent out three batches of letters, beginning in July, asking beneficiaries to complete the reverification process at their local Department of Health Services office within 90 days. Beneficiaries who fail to respond to the reverification notices will be dropped from the program; many other beneficiaries will lose benefits under the program's new qualifications (Kaiser Daily Health Policy Report, 11/4). So far, 138,410 beneficiaries have lost benefits; more than 17,000 beneficiaries have appealed. TennCare advocates estimate 225,000 beneficiaries will lose their benefits when the process is complete, and many of them will still be eligible for the program because of health problems that will prevent them from buying private insurance, the Commercial Appeal reports. "The state knows that 30% of the (severely and persistently mentally ill) population has not come in to reverify despite all the outreach and the attempts to get them in. They know who those people are and that they are clearly eligible, and they're cutting them off regardless," TennCare advocate Gordon Bonnyman said. However, TennCare Director Manny Martins said he cannot stop the reverification process because he is "bound by state law, as passed by the Legislature" (Memphis Commercial Appeal, 12/5).

Physicians May Drop TennCare Select
In other TennCare news, pediatricians at Vanderbilt University's Monroe Carell Jr. Children's Hospital in Nashville said they will stop participating in TennCare Select, the second-largest TennCare health plan, unless the state provides higher payments and ends what the doctors call "bureaucratic obstacles" by Jan. 1. The program includes children with disabilities and those in state custody, as well as program beneficiaries from other TennCare plans that face financial problems. If the doctors leave the program, they would still treat emergency patients, but other patients would be transferred to facilities with physicians that accept the plan. While the hospital itself plans to remain in the TennCare Select network, there would not be any doctors participating in the program at the facility. Ron Harr, a spokesperson for BlueCross BlueShield of Tennessee, which manages TennCare Select for the state, said the problem stems from the plan's reimbursements, which he called the "lowest in TennCare." TennCare spokesperson Lola Potter said that doctors typically threaten to drop TennCare during contract negotiations (Lewis, Tennessean, 12/6).