State proceeding with original plan of TennCare disenrollment

A federal appeals court last week approved Tennessee’s procedures for removing people from TennCare, allowing the state to move ahead with its plans.

“If the appeals court had come back and said we have to redo those letters, that would have put us about a month behind,” TennCare spokesman Michael Drescher said Tuesday. “But now we can continue according to our original plan.”

A three-judge panel of the 6th U.S. Circuit Court of Appeals in Columbus, Ohio, ruled last Friday that the state does not have to hold a hearing for each TennCare recipient before removing them from the program.

The decision overturned a federal judge’s ruling that Tennessee’s procedures for disenrollment were inadequate and that all enrollees cut from the $8 billion expanded Medicaid program were entitled to a neutral hearing in case they had been wrongfully terminated.

The state argued that such hearings would be impractical, and that its disenrollment procedure met all legal requirements.

In its ruling, the appeals court said the federal Centers for Medicare and Medicaid Services, which oversees state Medicaid programs, “has approved the State’s policies as fully compliant with its regulations, a determination to which we owe ‘substantial deference.'”

Gov. Phil Bredesen has proposed removing up to 323,000 adults from TennCare to save money in the next fiscal year, but he recently released a plan to spare the sickest enrollees and keep the cuts at about 226,000 people.

Drescher said that plan is contingent upon a consent decree hearing scheduled for June 13 which concerns procedural protections afforded enrollees who are terminated, or denied or delayed TennCare services. The state has asked to modify the consent decree so it can began the cuts.

The notices being sent out next week will stand out, officials say, because the front of the envelopes will have green writing on them, unlike anything TennCare has sent out before. The “request for information” form inside the envelope will be brown.

Drescher said those individuals to be spared under the governor’s plan will also receive notices, but won’t be held to the same requirements as the other enrollees.

Their letters will state they are no longer eligible and have 30 days to return the document disputing eligibility. Officials said the state will consider only factual errors.

Once those letters are returned, officials will evaluate each of them to determine if the person is still eligible. If not, the individual will be sent a termination letter stating coverage will end in 20 days. Those who ignore the letters will be the first to be disenrolled, officials said.

Michelle Mowery Johnson, spokeswoman for the Tennessee Department of Human Services which will be processing the letters, said the department is ready for the disenrollment.

“We’ve been working with the TennCare Bureau to make sure the process is done as efficiently as possible, and we feel we’re prepared,” Johnson said.

Four call centers have been spread out across the state to assist enrollees, and Johnson said each DHS office also has taken steps to accommodate the large number of people expected to call or come by the offices.

Before adjourning last week, lawmakers attempted to soften the blow of the cuts by approving the governor’s so-called “safety net” plan, which spends roughly $100 million to bolster local health clinics, help hospitals with indigent care costs and other measures. It also helps the severely mentally ill with prescription drug costs.

Bredesen has said the cuts are needed to save the state $500 million to $600 million in the coming year.

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Anyone with disenrollment questions should contact the Family Assistance Service Center at (866) 311-4287.