TennCare ‘safety net’ still a work in progress
NASHVILLE (AP) — Thirty-five percent of the state’s TennCare enrollees would see increases in their medical co-payments under Gov. Phil Bredesen’s plan to reform the financially explosive program.
But people who can’t afford the extra cost — ranging from $1 to $40 per doctor’s visit according to how they qualify for benefits — wouldn’t go untreated.
Instead, the governor proposes a system of “safety net” hospitals, county clinics and other medical providers from which those people could receive health care.
“It is not as convenient for a beneficiary as using a private doctor or local hospital or pharmacy, but it ensures that no one is ever denied care because of the inability to pay,” Bredesen said when he outlined his proposal to state lawmakers.
The safety net proposal is just one part of a far-reaching reform package developed by the Bredesen administration to help curb future spending in the state’s $7.8 billion expanded Medicaid program for 1.3 million poor, disabled or otherwise uninsured citizens.
Sixty-five percent of TennCare’s enrollees — 859,000 pregnant women, children, and the disabled — would be protected from almost all proposed benefits reductions.
For the remaining 35 percent, the proposal would mean the state pays only for the cheapest prescription drug in any category — with a limit of six prescriptions per month. There also would be increased co-payments for services and new limits on hospital and doctor visits.
Legislation to implement Bredesen’s plans began moving through the General Assembly last week, although the safety net provision isn’t included because it doesn’t require lawmakers’ approval.
Instead, the Bredesen administration — specifically Finance Commissioner Dave Goetz — has been developing it behind the scenes, soliciting input from hospitals and clinics that might be affected.
But the plan, set to take effect in January, is still far from complete. Many major decisions remain to be made.
That includes the answers to basic questions such as:
— Which hospitals and clinics will participate?
— How much will they be paid by the state?
— Will any limits be placed on services?
“We’re still in the design phase,” Goetz says.
Tennessee already has a system of designated “safety net” hospitals, which receive federal funding and additional state dollars for taking in a larger number of uninsured and TennCare patients.
Those include The Regional Medical Center of Memphis, Metropolitan Nashville General Hospital, Vanderbilt University Medical Center in Nashville, Erlanger Medical Center in Chattanooga, University of Tennessee Memorial Hospital in Knoxville and Johnson City Medical Center.
Bredesen’s current proposal is separate from that list, but likely will include many of the same hospitals, Goetz said.
“We have to determine what we think the workload will be,” Goetz said. “We want to assess existing (safety net providers), but also go beef up county health offices to make sure we have adequate access.”
But while access is a concern, the administration also has said it doesn’t want free services to be so convenient that they attract TennCare enrollees who can afford the co-payments.
“There has to be some kind of consequence for not making the co-pay — not denial of service — but some kind of consequence,” Goetz said.
Tennessee’s hospitals originally had some concerns about the governor’s plan, but feel more confident of their role after discussions with the administration, said Craig Becker of the Tennessee Hospital Association.
“Everybody has said they want to have at least the opportunity to be involved as one in their communities,” Becker said.
But, as do most things, it all comes down to money, he said.
“How much will be (given to participate) in this? If the money runs out, what happens then?” he asked. “There are certainly some concerns there.”
———
On the Net:
Bureau of TennCare, http://www.state.tn.us/tenncare/