State faces third-party plan for TennCare children
NASHVILLE — Gov. Phil Bredesen’s proposed reforms of TennCare face a major hurdle in Tennessee before being submitted to the federal government for review.
U.S. District Judge John Nixon said Monday he wants to have the court’s special master in the John B. case devise a plan to bring the state into compliance with a consent decree it signed in 1999.
The case involves more than 600,000 children who receive their health care through TennCare, Tennessee’s expanded Medicaid program for the poor, disabled and otherwise uninsured.
Those children represent nearly half the program’s 1.3 million enrollees, although they would not account for nearly that much of its $7.8 billion cost.
Having the special master — Dr. Richard Carter — draft the plan would seem to remove control over some aspects of TennCare from the state’s hands, possibly jeopardizing Bredesen’s overhaul of the program.
After Nixon suggested having the special master formulate a plan for bringing the state into compliance, he gave both sides 24 hours to respond to the idea.
The state answered with a two-paragraph letter sent Tuesday that says very little.
The state is concerned about the “further relief” being requested by the Tennessee Justice Center, which brought the John B. lawsuit on behalf of the children in TennCare, and about the process by which that relief would be decided upon, it says.
The state is “therefore unable to formulate a substantive position at this time.”
The letter was sent with the signature of Washington, D.C., lawyer Charles Cooper, whom the state brought in to help with this case.
Michele Johnson of the Tennessee Justice Center said she was “kind of perplexed” by the state’s response.
In its response to the court, the TJC said it would go along with a plan created by the special master if there were reasonable time limits in it, and if the state “adopted it as its own.”
If that were to happen, the TJC brief said, then the center’s motion for a contempt-of-court hearing against the state could be held in abeyance until the plan had a chance to work. That is essentially what Nixon suggested.
The plan would “have to get the state into compliance with the law, which is to get children the health care they need, whether they have asthma or cancer,” Johnson contended.
Among the potential areas of conflict between the consent decree and the TennCare reform, proposed by Bredesen and authorized by the Legislature, is his stated intention of removing two classes of drugs from TennCare coverage. Those are gastric acid reducers, for indigestion and acid reflux, and antihistamines for allergies and respiratory problems.
According to Johnson, those medicines have to be provided to children under the consent decree in the John B. case. Whether that can be reconciled with Bredesen’s reform plan, which is not yet finalized, remains unclear.
“I just hope they can focus on the children and stop focusing on who gets the most points,” Johnson said Tuesday. “I’d hoped for some assurances that we are on the to the next stage in their filing today, but did not receive them.”
Bredesen spokeswoman Lydia Lenker said the administration was not prepared to respond to the potential implications the court action may have for the reform plan.
“We just don’t know yet,” she said.