Governor optimistic about keeping 97,000 on TennCare

During his address to the 2005 Tennessee/White House Conference on Aging, the governor took a moment to rehash recent legal developments concerning TennCare.

On Friday, U.S. District Court Judge John Nixon issued an order that gives the state and the Bureau of TennCare the power to define what treatments are medically necessary.

Nixon had already issued a partial order the day before that authorized the state to require prior authorization for prescription drugs and the power to limit prescriptions to five per month. His latest ruling went even further.

Bredesen has said the state needs to modify the so-called Grier consent degree — an agreement the state made with legal advocates for TennCare patients in 1999 — to save money and keep thousands of medically-needy enrollees on the $8.7 billion program.

“It’s my hope that in a couple of days I can stand before you and say that we have succeeded in our efforts to keep 97,000 of the sickest and neediest enrollees on TennCare,” Bredesen said Monday.

Pharmacy benefits of the medically needy enrollees were scheduled to end on Monday. But state officials said they needed clarification on some sections of Nixon’s ruling, and gave those enrollees a 10-day extension of pharmacy benefits.

The extension did not affect another 200,000 people who did lose their benefits on Monday and will eventually be kicked off the program all together.

Bredesen is cutting TennCare rolls and reducing benefits because he says the state cannot afford the program in its current form.

TennCare spokesman Michael Drescher said Nixon did clarify on Monday several questions the state had.

“We continue to be encouraged that the judge is moving quickly,” Drescher said. “The whole thing was making the modification to Grier to keep people on the program, and it looks like we’re doing that.”

Enrollee advocates, however, have said the changes will leave those on the program without certain legal protections.

“This is a horrible day,” Gordon Bonnyman of the Tennessee Justice Center, the main advocate for enrollees, said of those adversely affected by Monday’s events. “We’ve got hundreds of thousands who are losing their insurance.”

Bonnyman said the state has millions of dollars in TennCare reserves that could be used to spare the medically needy without modifying the decree.

But state officials say the reserves — projected at close to $200 million by the end of next year — are not sufficient for a program that costs billions and needs repair.

During his speech Monday, Bredesen also took time to directly address TennCare enrollees. He said making the cuts was difficult, and he’s doing all he can to provide a soft landing for them.

One major initiative is the so-called “safety net” plan, which bolsters local health clinics, helps hospitals with indigent care costs and other measures. It also helps the severely mentally ill with prescription drug costs.

“I know you’re scared, and that you’re worried,” he said. “But please also know this: I’m not giving up. I am continuing to fight for you.”