Bredesen says obstacles remain for TennCare reform

Bredesen said the state needs to come out on top in a lawsuit involving another consent decree that officials have blamed for getting in the way of better TennCare management if they hope to mitigate the cuts.

Last week, a federal appeals court cleared the way in the Rosen case for the state to go ahead this summer with disenrolling the adults in the expanded population of the $8 billion Medicaid program.

Now, Bredesen said he hopes for relief in the Grier case, which he said prevents such initiatives as mandatory generic drug usage, preferred drug lists and more managed care. A hearing in that case is scheduled for May 9.

“I would say that’s the main impediment at this point,” Bredesen said. “If we were able to get some relief there, I think it would open up other possibilities in TennCare. Although, to be honest, time is getting really, really short now.”

Legal advocates have rejected the notion that any of the court cases stand in the way of cost-saving initiatives like disease management.

Bredesen said he is still looking for alternatives to cutting much of the expanded Medicaid population, many of whom qualify for TennCare not because they’re the poorest, but often because they’re among the sickest Tennesseans.

“There are some people that are quite sick and dependent on TennCare and I feel an enormous responsibility for these people and I am going to keep doing everything I possibly can to find some ways of helping them through this,” he said.

Bredesen said any money the state saves by getting clearance for the types of reform he originally tried to implement last year would be spent keeping more people on TennCare.

“I don’t think at this point we have any possibility of retaining everybody on the rolls, but we could certainly keep some additional people if we got some changes (to the Grier settlement),” he said.

The Grier consent decree dates back to former Gov. Don Sundquist’s administration. It was an attempt to settle judgments that found the state wasn’t following federal Medicaid law.

Since the settlement affects TennCare’s ability to deny prescription drugs, officials have said they are unable to dictate the use of generics or cheaper alternatives. And Bredesen said he isn’t counting on changes to the settlement.

“I want to be clear, I see no signals that we’re getting any of those changes at this point and we are on the path of just carrying forward with the decision we made in January, which is to go ahead and change the number of people TennCare is providing health insurance for,” he said.

Right now TennCare serves more than 1.3 million people — about 23 percent of the state’s population.