TennCare director says settlement compliance may be impossible
NASHVILLE — Meeting the requirements of a federal court settlement ensuring children on TennCare have access to medical services may be impossible, TennCare’s outgoing director said Thursday.
Manny Martins said the settlement, which requires 80 percent of children on TennCare and 100 percent of those in state custody to undergo medical screenings, is a “laudable goal and something we are working to achieve … but I’m not sure it is achievable.”
Martins said it’s not for lack of effort, but because of numerous external barriers, coupled with a compliance rate so high no other state in the nation has met it.
“The state is doing everything it possibly can to comply,” he said.
In 2003, 62 percent of all TennCare children got the required screenings, a 14.8 percent increase over 2002, TennCare spokesman Michael Drescher said.
Martins made the comment during depositions in a class action lawsuit filed against TennCare by advocates for enrollees. The meeting was expected to continue Monday with Bredesen staff member Tam Gordon appearing before the plaintiffs to answer questions.
The Tennessee Justice Center filed a contempt motion in May charging that the state was not complying with a 1998 settlement of the John B. vs. Goetz lawsuit. The suit claims TennCare did not comply with federal Medicaid laws governing the type of care required for children.
Advocates say the governor’s planned TennCare reforms will make the situation worse.
Bredesen said he’s committed to keeping TennCare costs at 26 percent of state spending through various changes in the program, including limits on prescription drugs and the elimination of certain drugs from coverage.
Martins said the court settlement’s requirement that each child be screened on seven different medical factors before that child can be counted toward the goal percentage is a “barrier.”
Those factors include physical examinations, immunizations and vision and hearing tests, for example.
“To my knowledge no one in the nation has been able to do that at this point,” Martins said.
Martins, who will leave his post sometime next month to head the newly created Governor’s Office of Children’s Care, said poor coordination between various state departments also impedes compliance, along with a lack of understanding by parents of TennCare children.
“We see all of these things as barriers, and I am sure there are many more out there,” he said.
In his new post, Martins will try to find a better way for the state to track services provided to children and to develop better communication between various providers.
Martins also criticized the court’s method for determining whether the state was in compliance, calling it “a large amount of paperwork that is not getting us where we need to be going.”
“The process itself has frustrated my staff to the point where I’ve had individuals who are very credentialed and qualified tell me they are close to resigning,” he said. “… We’re confused, we’re frustrated and we’re not sure how the (established method) fits into the overall process of making things better for kids.”
Martins’ comments about TennCare were a contrast to testimony a day earlier by his boss, Finance Commissioner Dave Goetz, who refused to say whether the state was complying with the court mandate.
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On the Net:
TennCare, http://www.state.tn.us/tenncare/