Key TennCare hearing to begin today
NASHVILLE — State officials are optimistic about sparing 97,000 people from TennCare cuts if they’re able to successfully argue for modification of a key court settlement during a hearing that begins this week, but the leading representative for enrollees is doubtful.
“This is not going to be resolved in the courts,” said Gordon Bonnyman, executive director of the Tennessee Justice Center. “It’s sad people are being given false hope.”
Both sides will begin presenting their cases to U.S. District Judge John Nixon on Wednesday.
At issue are modifications to the so-called Grier court case — a battle over a consent decree the state signed in 1999 with legal advocates — that would save the state money and allow thousands of enrollees who are designated as “medically needy” to remain on the expanded Medicaid program.
The medically needy include the sickest TennCare patients who are not eligible for Medicaid, which covers the poor.
Gov. Phil Bredesen has said cuts are necessary to save the state $500 million to $600 million in the coming year. The nearly 226,000 currently scheduled to be cut started receiving notices earlier this month.
At the hearing, attorneys for enrollees will spell out their concerns to state lawyers so possible modifications can be made. In a recent response to the state’s request for modifications, plaintiffs’ attorneys disagreed with the changes, including one that would controls prescription drug costs.
The state wants to limit enrollees prescriptions to five per month. But plaintiffs’ attorneys said the current decree “prohibits ‘hard’ monthly prescription limits, and therefore plaintiffs oppose this request,” according to the court document.
Bredesen has said the modifications are necessary to save enough money to prevent the enrollees from being cut.
George Barrett, a lawyer who has been allowed to intervene on behalf of enrollees in danger of losing coverage, also agrees that the changes are needed to spare cuts. Barrett reached a compromise with the governor a few months ago to save the 97,000 enrollees.
“We have a written agreement with the governor,” he said.
Federal regulators already have approved most of the governor’s plan to reform the $8.7 billion health care program.
“We look forward to making our case before Judge Nixon and we hope that his decision will allow us to preserve TennCare coverage for the medically needy population,” Bredesen spokeswoman Lydia Lenker said.
Nevertheless, enrollees at the center of the court case are holding out hope that Bredesen will change his mind and keep everyone on TennCare.
Since June 20, a group of TennCare enrollees and advocates have staged a sit-in at the governor’s Capitol Hill office, calling for Bredesen to end the cuts. On Sunday, the governor brought hot fast-food lunches to protesters who had stayed in the Capitol over the weekend and talked about each of their situations, according to both sides.
No agreements were reached, however, because Bredesen has said ideas pitched by the protesters won’t do what is needed. But protesters did get a slight victory last week when the governor announced he had found a way to keep private duty nursing available for up to 200 wheelchair-bound people on ventilators.
Glen Barnhill is one such individual and said the governor’s decision is “a step in the right direction.”
“I felt really good about that,” said Barnhill, one of the protesters. “I hope that we will be able to make progress on getting more that are being cut back on the program.”
Summary Box:
WHAT’S HAPPENING: Hearing to determine whether 97,000 of TennCare’s medically needy stay enrolled begins Wednesday.
THE LEGAL ISSUE: Modifications to a consent decree — such as limiting prescription drugs — that would save the state money and allow the enrollees to remain on the expanded Medicaid program.
BIG PICTURE: Besides the medically needy, the state says it needs to cut nearly 226,000 enrollees from TennCare to save the state $500 million to $600 million in the coming year.