Marilyn Wilson

The Tennessee Comptroller of the Treasury audit of the Department of Finance and Administration and the TennCare Bureau cites the state’s Medicaid program for three deficiencies, an improvement compared to 39 citations six years ago, bureau officials said.

“I think this is just further evidence ... of how much TennCare’s level of operational and fiscal efficiency has really improved,” said Marilyn Wilson, TennCare spokeswoman.

TennCare received citations for:

* Not providing adequate internal controls over access to its computer system, resulting in violations of industry-accepted security practices.

* Submitting late reports to the Centers for Medicare and Medicaid Services for home and community-based service waivers for the mentally retarded and developmentally disabled.

* Failing to re-determine eligibility or end eligibility for a class of enrollees known as the Daniels class.

The findings regarding the bureau’s computer system note that no compromises of security took place. Concerns mostly were related to issues such as log-out times on computer stations, Ms. Wilson said.

DANIELS CLASS ISSUE

The TennCare Bureau was cited for the eighth time for its continued coverage of the so-called Daniels class, enrollees whose Medicaid eligibility is in question.

The bureau has requested that a federal court lift a 1987 injunction from a court case known as Daniels that prevents TennCare from checking the eligibility of the class of about 152,000 enrollees.

About 1,100 prison inmates and more than 5,000 out-of-state residents now are receiving TennCare benefits because of that injunction, Ms. Wilson said.

The court ruled last week that TennCare personnel can disenroll the inmates after verifying that they truly are incarcerated, giving them prior notice and continuing benefits should a prisoner appeal the disenrollment, Ms. Wilson said.

Some disability rights advocates worry that some members of the Daniels class — who made it onto the TennCare membership rolls because they at one time received a federal Social Security benefit — will lose coverage when their eligibility is checked and then be unable to get needed health care.

East Ridge resident Lisa Mattheiss is worried that if the Daniels class as a whole comes under scrutiny, her 8-year-old daughter Emily will lose coverage. Emily, who has spina bifida and excess fluid in her brain, requires a wheelchair, braces, intensive therapies and other costly medical equipment, Mrs. Mattheiss said.

“The reality is I will have to quit my job in order to qualify her (for TennCare). ... Every penny that I would make would have to go into medical bills, and it still would not be enough,” she said. “If they are going to discontinue the Daniels class, they need to have some kind of back-up plan to help those who fall in the gap.”

WHAT IS THE DANIELS CLASS?

Daniels is the name given to a 1987 injunction that invalidated the state’s former Medicaid program’s process for checking eligibility for a particular group of enrollees.

Those members were enrolled in TennCare automatically when they qualified for a supplemental Social Security Administration benefit. The court injunction was at first designed to protect those enrollees, some of whom wrongly were disenrolled from Medicaid in the 1980s when they lost the Supplemental Security benefit that got them into the program, even if they should have qualified for Medicaid benefits in another category, TennCare officials said.

The TennCare Bureau now has a process for verifying the eligibility of that group. The bureau has asked a federal court to reverse the 21-year-old Daniels injunction that it said unfairly is keeping on the rolls many people who don’t qualify for TennCare.