Medically Needy Beneficiaries Will Be Allowed To Stay in TennCare, Tennessee Gov. Bredesen Says, USA

Main Category: Medicare / Medicaid / SCHIP
Article Date: 12 Aug 2005 - 0:00 PDT

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About 97,000 medically needy beneficiaries of... TennCare, Tennessee's Medicaid managed care program, will be allowed to stay in the program despite other program cuts, Gov. Phil Bredesen (D) announced on Tuesday, the AP/Memphis Commercial Appeal reports. About 190,000 TennCare beneficiaries will be eliminated from the program under a plan Bredesen proposed to reduce costs. After advocates for beneficiaries criticized the plan for dropping 97,000 beneficiaries with large, unpaid medical bills and "relatively low incomes," the state and advocates in April reached an agreement that would retain the beneficiaries in exchange for modifying the so-called Grier consent decree. The decree is an agreement that was made in 1999 between the state and legal advocates for TennCare beneficiaries, and state officials said changes to the agreement were necessary to reduce program costs and thus keep medically needy beneficiaries in the program, according to the AP/Commercial Appeal. Last month, federal court Judge John Nixon ruled that the state could modify the consent decree. Bredesen on Tuesday said, "Two weeks ago, we received a ruling from federal court Judge John Nixon that we have been awaiting. It's a ruling that we've spent the past week and a half examining, in hopes that it gives us the controls necessary to take this important step. And while we didn't get everything we asked for, we do believe we have enough to move forward" (Johnson, AP/Memphis Commercial Appeal, 8/10).

Changes To Consent Decree
Bredesen said that the ruling allows him to implement the cost-saving measures necessary to keep the medically needy beneficiaries enrolled. Those measures, which must be approved by CMS, include a five-prescription-per-month limit on medications for the medically needy, as well as limits on doctor visits, hospital stays and other medical services. Officials also said on Tuesday said that medically needy beneficiaries will see no change in benefits for the time being and that the medically needy program will not accept any new beneficiaries until July 2006 (Wissner, Tennessean, 8/10).

Reaction
George Barrett, the beneficiaries' lead lawyer, said, "These were tough negotiations, but [we] have been able to arrive at a beneficial solution which will impact approximately 100,000 Tennesseans" (AP/Memphis Commercial Appeal, 8/10). However, other advocates for beneficiaries expressed doubt that all medically needy beneficiaries will be able to retain their TennCare coverage. Michele Johnson, a lawyer for the Tennessee Justice Center, said, "A teeny tiny percentage of the 97,000 will have an opportunity to qualify" (Tennessean, 8/10).

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