Tennessee: Thousands of TennCare enrollees may lose coverage

Tennessee: Thousands of TennCare enrollees may lose coverage

January 9th, 2009 by Emily Bregel in Local Regional News

Kathy Corley's 2-year-old daughter Anna has Down syndrome and was born with a malformation of her esophagus. She has a feeding tube and heart problems that may require surgery.

Her care would cost close to $25,000 a year if the family didn't get money from TennCare through its "Daniels" classification, said Ms. Corley, who lives in Signal Mountain.

"Our private insurance is grossly inadequate to cover her needs," she said.

But under a court order released Thursday, Anna could lose her TennCare coverage.

"I just don't know what we will do," she said.


Daniels is the name given to a 1987 injunction that invalidated Tennessee's former Medicaid process for checking eligibility for a particular group of enrollees - members of the "Daniels class." Those members were enrolled in TennCare automatically when they qualified for a supplemental Social Security Administration benefit.

The TennCare Bureau said it now has a fair process for verifying eligibility and on Thursday, a federal court reversed the 21-year-old Daniels injunction, ruling that TennCare can now check the eligibility of those 150,000 enrollees.

TennCare estimates that the state spends about $1.2 billion annually to provide health care insurance for the 150,000 Daniels class members.

The eligibility status of thousands of Daniels class enrollees is uncertain after a federal court decision ruled that state officials can re-evaluate whether those enrollees truly qualify for the state's managed Medicaid program.

TennCare officials say the court decision will allow them to save money spent on enrollees who should not be on TennCare anyway, resulting in fewer cuts to the program down the line.

But advocates for the disabled, who make up a large portion of the enrollees in question, say the decision could have a devastating impact on a fragile group of people who may have no other health care options.

"Most families (who lose this coverage) will have to go without care or the cost of the care will be shifted to the local government and hospitals," said Tony Garr, executive director of the Tennessee Health Care Campaign, a Nashville-based advocacy group for TennCare enrollees. "There will be serious health consequences."

The court's decision lifted a long-standing court order known as "Daniels" that prevented TennCare from checking the eligibility of 150,000 people enrolled in Tennessee's Medicaid managed care program.

Members of the Daniels class automatically qualified for TennCare when they qualified for the Supplemental Security Income benefit from Social Security.

The 1987 Daniels injunction was intended to protect those enrollees, some of whom were wrongly disenrolled from Medicaid in the 1980s, even if they should have qualified for Medicaid benefits in another category.

State officials say they now have a fair way to check those enrollees' eligibility.

TennCare officials said in a news release that they do not know how many Daniels class members still will qualify after the reverification, but the state could save $120 million annually if only 10 percent are found not to be eligible.

"It's simply a matter of fairness that we are allowed to take people off the program who no longer qualify to minimize the budget reductions we will have to make that will impact TennCare's truly eligible members," said TennCare Director Darin Gordon in the Thursday release.

Advocates maintain that a safety net program should be in place before any cuts go through.

In 2005, when a financial crisis led TennCare to carry out a large-scale disenrollment, officials gathered to discuss what kind of programs would be needed to take care of those who would lose coverage, Mr. Garr said.

"These are even larger cuts than they did in 2005, and it's even to a more fragile population, and they're not even talking about establishing some kind of safety net commission to study this and see how they can minimize the harm to families," he said.