NASHVILLE — TennCare officials told state auditors they don't know how many enrollees in the health coverage program lost Medicaid coverage due to paperwork snarls and confusion arising from the years-long delay in getting a new eligibility-redetermination system up and running.
Meanwhile, the agency also told Comptroller Justin Wilson's office that those cases brought to their attention of some seniors losing benefits or having the money taken from their Social Security checks "were due to members not completing and returning the redetermination packet."
The auditors' review, released Wednesday, was requested by state House Speaker Beth Harwell, R-Nashville, based on concerns raised in news reports. It recommends various steps TennCare officials should take to simplify the paper system that now includes use of robocalls and mailing a 98-page packet to seniors' homes.
By late 2018 or 2019, TennCare officials hope to have the issues addressed with a new computer system. After encountering problems with one vendor in 2015 and starting anew with another company, that's when the project is expected to be done.
All other states already have the systems, mandated under the federal Affordable Care Act, up and running.
TennCare, a Medicaid program jointly funded by the state and federal government, provides coverage to a number of low-income seniors unable to pay premiums for Medicare, a strictly federally funded program for seniors.
The comptroller's review noted "although enrollees that receive Medicare coverage through TennCare make up a small portion of the TennCare population, TennCare does not have readily available statistics on the number of such members dropped from the rolls during the recent redetermination cycle."
Auditors said the agency is already taking action on some issues as a result of the review process. A TennCare spokeswoman confirmed that.
Many enrollees' problems were initially reported last summer by the Daily News Journal in Murfreesboro.
In their review, auditors said enrollees "identified issues with coverage being terminated without warning, lengthy call center wait times, coverage being temporarily lost when packets are returned by the due date, and other problems."
Harwell, meanwhile, said in a letter to Dr. Wendy Long, who heads TennCare, that she wants the agency to submit a report to her in 60 days on what comptroller recommendations they've adopted or else "explain the reasons for not implementing them."
Among the recommendations:
» TennCare officials "should include simple and direct language in all written and verbal communications explaining that failure to return the redetermination packet could result in a reduction of the enrollee's Social Security benefits," the review says. It notes "some enrollees may be unaware that their Medicare premiums are paid through TennCare and so may not realize the potential consequences of not responding to TennCare mailings." A number of the seniors are poor or disabled.
» Auditors also said in the review the agency should "prominently feature language, both within the packets and on the outside of any envelopes, explaining the link between returning the TennCare redetermination packet and the enrollee's Social Security benefits."
» TennCare should consider providing enrollees with self-addressed, postage-paid envelopes, auditors said, noting that "such action could make the redetermination process more user-friendly."
» Officials should also review the scripts used in robocall reminders and consider more ways to contact enrollees through email or authorized representatives. Officials "should ensure the language in the calls emphasizes that the member's Social Security benefits may be reduced if the packet is not returned," says another recommendation.
Auditors say call center wait times "have been high at times, and call center staff may not have been able to confirm if TennCare received enrollees' redetermination packets."
TennCare has since increased call center funding, raised capacity from 75,000 to 150,000 calls a month and also provided daily updates of information so call center representatives can confirm whether TennCare has received an enrollee's packet.
The program as of October had 1.44 million enrollees.
TennCare spokeswoman Sarah Tanksley said via email that "overall, we are pleased that the report highlights that we have designed our redetermination process in a diligent and thoughtful way and that we have been proactively engaged in improving the process since we launched it in 2015."
She said the report "underscores our efforts to maximize member engagement in the process with our end goal being that all members who continue to be eligible for the program have their membership renewed as quickly as possible."
Michele Johnson, executive director of the health care advocacy group Tennessee Justice Center, called aspects of the comptroller's review "both breathtaking and terrifying."
"I think the telling thing is they [TennCare officials] don't even know how many people are impacted by this," Johnson said.
She said that seniors who normally receive their health coverage from the federal Medicare program for those ages 65 and older, "have to be incredibly poor" to get their coverage through the Medicaid coverage offered by TennCare.
Tanksley countered that "we are processing tens of thousands of redeterminations every month, of which individuals with MSP coverage make up a relatively small percentage."
MSP stands for Medicare Secondary Payer, a term generally used when the federal Medicare program doesn't have primary payment responsibility. In this case, it's TennCare.
Tanksley said there's "been no practical need to segment out the MSP population for any specialized reporting. We shared this same reasoning with the comptroller, and, as a result, we do not share Ms. Johnson's interpretation of his statement.
"Rather," she added, "the statement merely reflects the operational reality of our program and of the recent MSP terminations."
"However," she said, "we take seriously our members' knowledge and understanding of these various responsibilities. To that end we have engaged in public awareness campaigns to our members, we included messages on the outside of the redetermination packet envelopes and in the notices themselves that were tailored to our MSP members."
The state has also "specifically opted to allow for a retroactive eligibility period for people who return the redetermination packets after they are terminated to mitigate any issues that may be encountered in the redetermination process," Tanksley said.
Contact Andy Sher at email@example.com or 615-255-0550. Follow him on Twitter @AndySher1.