TennCare will cover medically needy: Bredesen
CHATTANOOGA — A federal court order expanding the state’s power to restrict TennCare pharmacy benefits likely means all 97,000 medically needy enrollees can stay on the health care program, Gov. Phil Bredesen said Thursday.
“It looks positive to being able to keep all the most medically needy people on the rolls,” the governor said during a stop to promote his pre-kindergarten program.
Bredesen said he expected to decide the fate of the medically needy, among the sickest adult patients with high medical bills, early next week after administration officials finish evaluating a ruling clarification issued Wednesday by U.S. District Court Judge John Nixon in Nashville.
The ruling concerns the so-called Grier consent decree — an agreement the state made with legal advocates for Tenncare patients in 1999. The state has said it needs to modify the decree to save money and keep thousands of the sickest enrollees on TennCare, the state’s expanded Medicaid program.
Two previous orders by the judge gave the state power to define what treatments are medically necessary and authorized state officials to require prior authorization for prescription drugs and the ability to limit prescriptions to five per month.
The order Wednesday imposes additional limitations on emergency supplies of medications and no longer requires the state to pay for services while an enrollee appeals a denial of coverage.
Drug benefits for the medically needy were extended until Aug. 8. They had been due to expire Monday, when about 190,000 adults lost prescription drug coverage as part of efforts to control escalating costs in the $8.7 billion TennCare program. Those 190,000 enrollees have been notified they are likely to lose their benefits.
Bredesen said he was sorry that enrollee advocates delayed the changes and forced a yearlong court fight after he tried to make changes that would have “kept everybody on.”
“Every time we have gotten in the quiet confines of federal court,” we have won, he said.
“It looks like we got 85 percent of what we asked for,” Bredesen said. “I have no complaints from what I know right now.”
Legal advocates weren’t against the 97,000 medically needy being kept on the rolls, but they didn’t want thousands of other enrollees to lose certain legal protections because of modifications to Grier.
They felt the state would have enough money from TennCare reserves and other means to retain the medically needy without changing the decree.
But now that the state has gotten the changes it sought, legal advocates say Bredesen has no excuse not to maintain medical coverage for the sickest enrollees.
“The state seems to have everything they need to keep 97,000 on the rolls,” said Mike Engle of the Tennessee Justice Center, the main advocate for enrollees.
The governor said now that the courts have ruled, he has no plans to call a special legislative session on TennCare as some legislators have suggested, because he has nothing new to recommend.
“Now it’s up to us to go execute it,” he said.