State cuts 84,000 from TennCare rolls in 2009

State cuts 84,000 from TennCare rolls in 2009

October 8th, 2009 by Andy Sher in Health

NASHVILLE - State officials so far have cut an estimated 84,000 people from TennCare rolls since a federal judge ruled in January the state once again could act to reverify the eligibility of enrollees who originally qualified for the program through a federal Social Security Administration benefit.

The 84,000 represents a 57 percent reduction to a group of 147,000 people who had been part of the so-called "Daniels class" of TennCare enrollees, according to Oct. 2 TennCare Bureau figures.

Another 40,000 enrollees have been deemed eligible to continue their TennCare coverage for another year. Eligibility determinations still are under way for another 23,000 people, including some 10,000 children, according to the TennCare Bureau.

The Bredesen administration's move is drawing criticism from some lawmakers and advocates for the poor and disabled. But TennCare officials say the Daniels class is undergoing the same annual review that TennCare's other 1.1 million enrollees have undergone for years.

"We had a 21-year buildup," TennCare Chief Financial Officer Scott Pierce recently told House Health and Human Services Committee members regarding the Daniels class.

Until January, the state had been blocked since 1987 by court injunction from moving to reverify Daniels class members in TennCare, the state's version of Medicaid. TennCare is funded jointly by the state and federal governments.

The Daniels class includes men, women and children who originally qualified for TennCare under the federal government's Supplemental Security Income program, which covers some people who are poor, elderly or disabled. It also includes children who were hospitalized at birth for lengthy periods due to major illnesses and disabilities.

Tennessee Health Care Campaign Executive Director Tony Garr said some of TennCare's sickest and most medically "fragile" adults and children now are being cut from the program at the worst possible economic time.

"This governor does not understand what it's like to be low income and really hasn't shown much empathy for these folks," said Mr. Garr, a frequent Bredesen critic. "He's shown no leadership towards trying to provide a safety net or soft landing ... for a very vulnerable population."

Bredesen spokeswoman Lydia Lenker countered in an e-mail that "Tony Garr makes a living mis-stating the facts about health care in Tennessee. The truth is that Governor Bredesen brought stability back to the TennCare program, and has expanded long-term care options for seniors and created new health care programs that provide health insurance and health services to more than 100,000 Tennesseans, including 41,000 children."

TennCare spokeswoman Carol Fite said that of the 84,000 TennCare enrollees who have been cut, 55,000 are now on the federally funded Medicare program for the elderly.

Ms. Fite also noted the state is making special efforts to help children, noting some could qualify for TennCare under other Medicaid categories. Other enrollees, including some children, could be helped to some extent by the state's Cover Tennessee programs, a non-Medicaid health initiative, she said.

TennCare Oversight Committee Chairman Joey Hensley, R-Hohenwald, a physician, said that while many in the Daniels class "don't meet qualifications, it's still a sad situation."

He favors the state re-instituting a special "spend down" category of TennCare that until 2005 provided coverage to the medically needy or their family members who had depleted most of their financial resources.

"So far Tenncare doesn't want to do that - because of the cost," he said.

Citing the state's current revenue problems, Ms. Fite said "we recognize there's a problem with health care coverage nationwide, but the solution can't be to extend the (TennCare) program without the means to pay for it."

WHAT'S HAPPENED

A federal judge in January lifted a 1987 court injunction that kept the state from re-verifying the eligibility of 147,000 enrollees in the Daniels class. Those enrollees once qualified for TennCare under federal Supplemental Security Income guidelines. Since then the state has:

* Disenrolled 84,000 people from TennCare. About 55,000 now are covered by Medicare, and another 29,000 no longer have any government health care.

* Deemed 40,000 eligible for continued TennCare coverage

* 26,000 people, including some 10,000 children, still undergoing eligibility determinations

* Source: TennCare Bureau