Enrollees remaining on TennCare worried about security
NASHVILLE — TennCare enrollees and their advocates say they can’t get too excited about Gov. Phil Bredesen’s decision to keep 97,000 of the sickest adults on the public health care program because they aren’t sure how long they will be able to stay on the program.
Last week, the governor said the state will be able to retain thousands of the medically needy because of modifications a federal judge is allowing him to make to an agreement the state made with legal advocates for TennCare patients in 1999.
The state estimates relief from the so-called Grier consent decree will save at least $100 million.
The 97,000 medically needy were to lose their benefits Aug. 10, the day after Bredesen made his announcement, but now they will stay on the program.
The question now is for how long.
Sharon McKinney of Knoxville was jubilant when she heard Bredesen’s plan. Her husband, 58-year-old Ronald McKinney, has battled Lou Gehrig’s disease for nearly 15 years and has to use a ventilator to breathe.
But her excitement faded when she found out the TennCare coverage that pays for a private duty nurse will end in March because his primary coverage is through Medicare.
“It doesn’t pay for private duty nursing, which costs about $20,000 a month,” McKinney said. “If I tried to put him in a nursing home it would cost from $25,000 to $28,000 a month; plus they don’t have beds to take care of patients on ventilators.”
TennCare spokesman Michael Drescher said the governor’s plan is a preservation of coverage rather than “an extension of time.” He acknowledges some confusion about the medically needy category, and said the state is working to redefine it.
“Until we do, we’re preserving coverage for 97,000,” Drescher said, “and that’s a significant step forward.”
Bredesen said during his announcement that the category is a work in progress.
“What we agreed to do was over the next year sort through this and find out who is eligible and who is not,” he said. “On July 1 of next year, we will reopen the program and build it back up to the 97,000 that it is today.”
Right now, state officials said those people will have full coverage until the state gets permission from the federal Centers for Medicare and Medicaid Services to place the same benefit limits on them that will apply to the core Medicaid adults.
Restrictions include limited hospital services, such as the number of visits, and a cap of five prescription drugs per month.
However, while some enrollees will have coverage for a certain amount of time, about 190,000 others are losing their health care for good. So far, nearly 135,000 termination notices have been mailed, according to state officials.
Bredesen has said he’s making cuts and reducing benefits because the state cannot afford the $8.7 billion program in its current form.
He’s tried to soften the blow with a safety net program that he recently expanded to provide four months of coverage for the disenrolled who need insulin. He’s also letting local pharmacies provide free generic drugs to people being cut.
But advocates and some state lawmakers have said the state could have avoided cuts altogether by using TennCare’s reserves or by raising taxes.
During the final two days of the recent legislative session, Rep. Joey Hensley tried to pass a bill that would provide coverage for about 67,000 chronically ill enrollees for a year, or until the reforms are instituted.
The legislation made it to the House floor but was defeated there.
Hensley, R-Hohenwald, has said the governor also opposed several bills that would have generated additional revenue by taxing cigarettes and alcohol. Bredesen vetoed one bill that would have raised the tax on the lowest-priced cigarettes, saying the measure would have endangered the state’s ability to continue to collect settlement payments from the biggest cigarette manufactures.
“Certainly anything to maintain more people on the program is good,” Hensley said of Bredesen’s decision to retain the 97,000. “But I think they could have done it anyway if they wanted to.”
Despite the retention, Courtney Jenkins-Atnip of the TennCare Saves Lives Coalition said advocates won’t be satisfied as long as thousands of other enrollees are losing coverage.
“People realize they have no other options and they’re scared,” said Jenkins-Atnip, who’s helping to organize a leadership training session later this month for enrollees and concerned citizens.
“Those people need a voice.”