Bredesen wants TennCare clarification
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“I would say it certainly appears that most or all of them will be able to stay,” Bredesen said after speaking at the National Academy for State Health Policy conference. “We just need to clarify a couple of things so I can give some precise answers. And that will happen in the next 24 or 48 hours.”
Several enrollees holding signs silently protested outside the hotel where the conference was held, while others passed out leaflets inside.
A few were sprinkled throughout the audience Bredesen spoke to. Lisa Abell was among them and stood up during the governor’s speech and challenged him for not addressing enrollees’ suggested alternatives to cutting more than 190,000 people from the expanded Medicaid program.
“Just because we’re poor, doesn’t mean we’re dumb,” said the 44-year-old Abell, who is among the thousands of enrollees already receiving disenrollment letters.
Bredesen has said ideas pitched by the protesters, some of whom have staged a sit-in at his Capitol Hill office, won’t do what is needed.
During his speech, the governor reiterated three main points he has made in previous speeches about TennCare and Medicaid in general. They are: Everybody pays something, pay for the important things first, and pay for what works.
Abell said after the governor’s speech she felt he implied that enrollees have no “financial investment” in TennCare. “That’s not true,” she said.
“There’re people who have serious illnesses and they’re paying what they can,” Abell said. “The problem is that private insurance companies can charge our government whatever they want to for services.”
Bredesen has said he’s cutting TennCare rolls and reducing benefits because the state cannot afford the $8.7 billion program in its current form.
This month’s ruling by U.S. District Court Judge John Nixon concerning the so-called Grier consent decree — an agreement the state made with legal advocates for TennCare patients in 1999 — is expected to give the state more financial flexibility.
Bredesen said the judge’s ruling was vague about the appeals process — one of the main issues from which the state is seeking relief — and is among the items that need clarification.
Currently, the state cannot deny an enrollee’s appeal for medical coverage. State officials want to change that so appeals are made mostly on “factual disputes.”
The state said it needs to modify the decree to save money and keep thousands of the medically needy, or sickest enrollees, on TennCare.
Legal advocates aren’t against those people being kept on the rolls, they just don’t want thousands of other enrollees to lose certain legal protections because of modifications to Grier.
Advocates believe the state should have enough money from TennCare reserves and other means to retain the medically needy without changing the decree.
Gordon Bonnyman of the Tennessee Justice Center, the main advocate for enrollees, said Monday he hasn’t decided whether to appeal Nixon’s ruling.
Meanwhile, pharmacy benefits for the medically needy are scheduled to end as early as Wednesday. Even though he could have a decision by then, Bredesen said he understands enrollees’ frustration.
“If I were a protester, I would certainly take advantage of the opportunity of people coming in from around the country and me coming over to speak; I don’t object to that,” said Bredesen, referring to Abell’s comments. “But I’m doing the best job I know how, and I think we’re making an awful lot of progress on TennCare.”