Federal government OKs another piece of TennCare reform

Already, a federal appeals court has approved Gov. Phil Bredesen’s plans to cut 323,000 people from the TennCare rolls. The Legislature has endorsed the governor’s efforts.

But a major court battle still looms which also will determine if Bredesen can reform TennCare as planned.

“Today’s approval is another significant step forward in our efforts to regain control of TennCare spending while trying to preserve health care coverage for as many Tennesseans as possible,” Bredesen said in a statement. “We still have significant challenges ahead of us, but we are making progress and we will continue to do so.”

The state now needs approval from the federal courts for benefit reductions and another round of approval from the Center for Medicare and Medicaid Services for yet more benefit reductions.

Bredesen said the cost-saving reductions will allow him to spare roughly 100,000 of the sickest enrollees from the planned cuts in the $8 billion expanded Medicaid program.

Wednesday’s decision from the Center for Medicare and Medicaid Services approved benefit caps that include:

— a five prescription pharmacy limits for some adults;

— elimination of some optional services;

— the right to charge small copays on some enrollees.

“It’s a big step toward achieving savings in the program because the amount of money we spend on pharmacy is the leading expense we have,” state Finance Commissioner Dave Goetz said.

Enrollees and advocates have criticized the governor’s plans, saying they are shortsighted and will cause people to lose health care that could cost lives.

Bredesen has countered that the state needs to regain control of a program that has seen double-digit inflation in recent years and continues to eat up larger chunks of the state budget.

The so-called Grier court case, a battle over a consent decree the state had signed with legal advocates, is scheduled to resume later this month.

TennCare already has started mailing disenrollment notices, and the governor hopes to have clearance to implement all of his reforms before the end of the summer.