Key TennCare hearing to start at end of month

U.S. District Judge John Nixon set the date Thursday after a conference call with attorneys for TennCare enrollees and the state.

The development comes a day after federal regulators approved a second part of the state’s plan to reduce benefit limits for TennCare, the state’s $8 billion expanded Medicaid program.

A federal appeals court has already approved Bredesen’s plans to cut 323,000 people from the TennCare rolls, and the Legislature has endorsed his efforts.

But 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.

The outcome of the so-called Grier court case — a battle over a consent decree the state signed in 1999 with legal advocates — at the end of the month will be a major factor in whether those reductions are granted.

At issue are modifications to the consent decree that would save the state money and allow about 100,000 enrollees who are designated as “medically needy” to remain on TennCare. That group includes the sickest TennCare patients who are not eligible for Medicaid, which covers the poor.

Bredesen has said cuts are necessary to save the state $500 million to $600 million in the coming fiscal year. TennCare has already started mailing notices to the nearly 226,000 currently scheduled to be cut.

On Thursday, the governor said the most important element of Wednesday’s federal decision is that it’s now more likely he will be able to keep thousands of the sickest enrollees on TennCare.

“This set of approvals (Wednesday) was very, very important,” Bredesen said. “Both in moving the general program of reform forward but specifically in order to enable us to really make our best shot at keeping those 100,000 on the rolls.”

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

— a five prescription pharmacy limit for adults;

— elimination of some optional services;

— the right to charge small copays on some enrollees.

TennCare spokeswoman Marilyn Elam said the prescription limit will effect all of the roughly 500,000 adults remaining on TennCare.

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

“The consequences of these cuts will be catastrophic,” said Michele Johnson, an attorney for the Tennessee Justice Center, one of the leading advocates for enrollees. “Both in terms of peoples’ health and the eventual costs to every citizen in Tennessee.”