Feds deliver ultimatum, demand fixes to TennCare

Feds deliver ultimatum, demand fixes to TennCare

July 9th, 2014 by Kate Belz in Local - Breaking News

Document: Tennessee mitigation letter

Tennessee mitigation letter

TennCare has no more than five days to answer to federal officials for an ongoing series of failures to comply with the Affordable Care Act and provide proper channels to enroll eligible people in Medicaid.

Tennessee has been an outlier in the nation for a series of problems with its new TennCare application process.

As of Jan. 1, all in-person help was removed from Department of Human Services, and most people signing up for TennCare have been forced to go solely through the federal health exchange HealthCare.gov.

A $35 million state computer system to determine eligibility remains unfinished nearly a year after it was required to be completed, and the state still does not have a streamlined application for TennCare applicants.

For the past seven months, hundreds of TennCare applicants have described a frustrating limbo, unable to get clear answers on the status of their applications. A call center set up by the state, called the Tennessee Health Connection, repeatedly sent perplexed callers to a federal hotline to get answers about the application process.

And since last fall, federal officials have "engaged with Tennessee on multiple occasions" to express concerns about the unfinished computer system "and the downstream impact those delays are having on the state's ability to enroll eligible individuals in Medicaid," wrote U.S. Centers for Medicare and Medicaid Services director Cindy Mann in a June 27 letter to TennCare commissioner Darin Gordon.

Tennessee has failed to meet all but one of "seven critical success factors" for implementing new Medicaid rules under the ACA, Mann said.

She said state officials had 10 business days from June 27 to submit a plan of correction for the series of problems.

Many of the problems are rooted in the state's inability to determine Medicaid eligibility in accordance with new rules that require states to decide whether someone qualifies for Medicaid based on a federal measure known as modified adjusted gross income, or MAGI.

The $35 million computer system, known as the Tennessee Eligibility Determination System, or TEDS, was supposed to do that, and was supposed to be finished last fall, in time for the wave of new Medicaid applicants under the Affordable Care Act.

But in the letter, Medicaid officials said that the state has indicated that the computer will not be ready until September 2014 - "nearly a year after the required effective date and nine months after the date Tennessee initially anticipated implementation."

TennCare officials also said they were restoring some in-person assistance at state DHS offices this spring, with at least one counselor in each office who could help answer questions about Healthcare.gov application.

But the letter stated that the state still "is not providing an direct application assistance."

For more information, read Wednesday's Times Free Press.

Contact staff writer Kate Harrison at kharrison@timesfreepress.com or 423-757-6673.