Tennessee: TennCare 'cuts' brings accusations of misinformation

TennCare Bureau officials and advocates for enrollees are trading barbs over the impact of a $80 million reduction to the program’s 2009 budget as both sides charge the other with misleading the public.

As part of $468 million in cuts to the state budget, Gov. Phil Bredesen announced in May plans to reduce money budgeted for TennCare coverage for adults who don’t qualify for Medicaid but who are severely burdened by medical bills.

A maximum of 100,000 people were expected to be covered under the new eligibility category, but the new budget provides coverage only for 20,000 people.

Advocates for TennCare enrollees protested that government administrators sought to play down the changes. They argued that tighter eligibility requirements will make it harder for people to qualify for the program in the first place, regardless of the enrollment cap.

“It’s a shame that the people of Tennessee cannot rely on the state government honoring their word,” said Michele Johnson, attorney with the Tennessee Justice Center. “It’s not fair to the people of the state who desperately need health care and who have relied on that promise.”

But TennCare officials emphasized that when the state budget allows it, the new category will be expanded to pay for coverage for up to 100,000 nonpregnant, medically needy adults. The program does not limit the number of pregnant women or children who can qualify.

“I think (the advocates) miss-imply that we’re going to disenroll 80,000 people,” said Tracy Purcell, TennCare director of member services. “That’s not true. There aren’t 100,000 people in the program. The program is always subject to state funding restrictions, and so we’re only complying with the budget that the Legislature passed and the governor signed.”

Despite the changes to the budget, TennCare’s overall spending is not declining, officials noted.

TennCare’s recommended budget for the upcoming fiscal year is $7.5 billion, which is the same as the fiscal year that ends this month.

“It’s not that we have stopped spending money in TennCare,” said Marilyn Wilson, TennCare Bureau spokeswoman. “It’s not that enrollment is closed. ... We’re always going to see the need for new money in an insurance product that is not immune to the health care inflation trends that exist nationwide.”

Setting up ‘safety net’

One state lawmaker’s efforts to put aside funds for a “safety net” for those who might lose TennCare coverage due to program changes failed in the Tennessee General Assembly this session.

Rep. Charles Curtiss, D-Sparta, tried and failed to pass an amendment to an appropriations bill to put aside $125 million for a safety net, similar to the one created during the disenrollment of 170,000 TennCare recipients during reforms in 2005, he said in a telephone interview last week.

“It’s a pretty tight budget year, and it’s a crisis that’s not here yet,” he said. “A lot of people don’t like to look down the road.”

He said he will reintroduce the amendment next January.

The “medically needy spend down program” is an optional eligibility category for people who make too much money to qualify for Medicaid, but whose medical bills are high enough that they face poverty.

TennCare provides one year of coverage for those who qualify, while many other states provide only one to three months of coverage, TennCare officials said.

The 36 state Medicaid programs that choose to offer the coverage, including Tennessee, determine eligibility by subtracting an applicants’ unpaid medical bills from their income level to determine they will “spend down” to the qualifying income level.

The program is optional for Medicaid programs and never was intended to cover everybody who is uninsured — only the most needy, officials said.

“We lose sight of the fact that we’re one of the only states that offers 12 months of coverage while other states may only offer you a month, two months,” Darin Gordon, TennCare Bureau director, said. “It’s unfortunate when we lose sight of the things that we really are able to do and instead try to look at the things that people would have liked to have done if we could ignore all other realities that you have to contend with in running a Medicaid program.”

TennCare had to create a new category for nonpregnant adults who qualify so that they could impose a cap on that population to control costs.

Traditional Medicaid categories by law cannot be capped, so TennCare sought approval from the U.S. Centers for Medicare & Medicaid Services for the new category, which is called “standard spend down.” The new category could not be opened to enrollment until the federal agency that administers Medicare and Medicaid reapproved TennCare’s waiver, which occurred in October.

Bureau officials have begun the process of reverifying the eligibility of nonpregnant adults before moving them into the new standard spend down program.

Only about 10,000 of the 50,000 people in the category are expected to requalify for the program, and after the reverification process of current enrollees is complete the program will be opened to new enrollees, Ms. Purcell said.

The 20,000 cap is expected to be met in January 2009, Mr. Gordon said.

Advocates say they want consideration for medically needy enrollees with life-threatening illnesses who might not qualify under the program’s eligibility requirements. Many of those enrollees are in fragile medical states, said Tony Garr, executive director of the Tennessee Health Care Campaign, a nonprofit consumer advocacy group.

“We weren’t saying cover everybody,” Mr. Garr said. “We’re saying ... let’s find those folks who do have really serious life-threatening medical conditions and let’s do what we can to transition them into continual care.”

ISSUE OF ELIGIBILITY

Advocates contend that the fact that only 10,000 of 50,000 undergoing reverification are expected to requalify indicates that the eligibility requirements have been significantly tightened since the program was implemented.

Current enrollees in the medically needy category and family members said the reverification process is frightening.

“It’s just scary times,” said Johnson City, Tenn., resident T.J. Furchess, whose 58-year-old mother is on the medically needy spend-down program.

The family has been notified that her mother will lose her coverage on June 30, after going through reverification, Ms. Furchess said. She said her mother has blood clots, and her costly blood thinner medications are keeping her alive, her doctors said.

Ms. Furchess, who works at Girls Inc., said she’s trying to determine why her mother did not requalify and is considering taking on a second job to help her mother pay $400 a month for the drugs.

“I’m grateful for the program. (But) I can’t imagine the overall impact this is going to have on Tennessee, not only just the families but for the people that don’t have families willing to go get a second job to pay for medication,” she said.

Georgia’s Medicaid medically needy spend down program does not have a 90-day limit on medical bills, said Brian Dowd, director of member services and policy with the Georgia Department of Community Health, which oversees policy for the state’s Medicaid program.

The medically needy program in Georgia provides six months of coverage for people enrolled in that category before enrollees must go through reverification, he said.