Outside agency would aid TennCare reform
It doesn’t take a team of physicians to diagnose the problems with TennCare. The state-run health care organization needs more than over-the-counter medication to makes its operation run more smoothly. Major surgery is more likely the answer.
It’s with that in mind, some lawmakers are looking to hire an outside agency named Market Models to perform a full-scale TennCare audit. This would be done to trim TennCare enrollment with the idea that fewer patients would mean less costs to taxpayers.
If the results of a recent Market Models report are accurate, TennCare is faced with a monumental challenge – fraud. The independent agency evaluated over 1,600 TennCare applicants and found almost one-fourth were out-of-state residents. Another 8 percent were dead.
We should keep in mind Market Models was only evaluating TennCare applicants. These are people who are not yet on the TennCare rolls.
To be fair, there’s a chance TennCare officials would have quickly caught all of the out-of-state applicants and never offered them health insurance. There’s also the distinct chance some of the applicants would have slipped through the cracks and been granted TennCare when they have no business qualifying.
This wide-scale fraud is something state lawmakers did not anticipate almost 10 years ago when they first implemented TennCare with the noblest of intentions – to provide people with health insurance who would otherwise be left without it. But as so often is the case, when you try to do something positive, there are people just waiting to exploit your generosity.
That has certainly been the case with TennCare, which has been described by some lawmakers as a monster which will eat all the tax dollars Tennesseans care to throw into its cage.
State Sen. Jerry Cooper is just one of the legislators who is saying enough is enough when it comes to TennCare. Cooper wants to find a way to eliminate the fraud, waste and abuse of power that’s become synonymous with TennCare.
The Standard endorses this approach and believes an outside auditing agency is the first step toward returning our ailing TennCare system to a more healthy lifestyle. State government has proven it’s not capable of controlling TennCare on its own.
Hiring an outside agency will of course come with a cost. But Market Models proposal to match the entire TennCare enrollee file against its database for $280,000 initially and $28,000 every month after that is entirely feasible. It amounts to $588,000 for the first year and $336,000 every year after that.
That kind of money is literally pocket change when considering the $327 million of new money that’s being pumped into TennCare next year with the idea it will fix the problem.
When it comes to TennCare, this state should remain devoted to providing health insurance to people who would otherwise have no way to afford it. We should never deprive children of proper medical attention because their parents don’t earn enough to pay for it.
But we also can’t keep footing the bill for out-of-state residents who aren’t caught by TennCare’s safety nets. The state shouldn’t be responsible for middle-class citizens who have access to health insurance through their employer but aren’t taking it.
Hiring an independent agency to audit TennCare’s rolls will not be a miracle drug. It will take more than that to nurse the program back to health. Market Models will, however, likely catch thousands of TennCare recipients who have no business being on the program and should have no problem paying for itself.