Posted on 06/01/2002 6:07:04 AM PDT by GailA
Feds sign off on overhaul of TennCare By Paula Wade wade@gomemphis.com June 1, 2002
NASHVILLE - Federal officials Friday approved a sweeping rewrite of the state's TennCare program, and now the question is whether the General Assembly will fund the reforms or strip health coverage from as many as 400,000 current TennCare enrollees.
Tennessee's new 5-year TennCare waiver will split TennCare into two health plans. TennCare Medicaid will cover Medicaid-eligible enrollees with benefits similar to the existing TennCare program, but the second program, TennCare Standard, is an HMO-style program whose availability will be subject to funding by the Tennessee General Assembly, which is wrestling with a $1.2 billion gap in next year's budget.
TennCare, the state-federal program that insures 1.4 million Tennesseans, has been a favorite whipping-boy in the state's budget struggles, with lawmakers demanding TennCare's reform before they'll vote for new taxes. "This gives the program the integrity that people have wanted for years. TennCare is fixed, and now the ball is in their court," said Deputy Commissioner John Tighe, who negotiated the new waiver with federal officials.
"They (the General Assembly) have to fund Medicaid - that's required - and then this allows us to cover other people within various income ranges according to the funding available."
"I think you should be proud of what you've done," said Tom Scully, director of the Centers for Medicare and Medicaid Services, who praised Tennessee for having the "most comprehensive low-income health care program in the country," costing the state and federal governments no more money than traditional Medicaid would have cost. "I've thought for 10 years that TennCare is a model for the country, and I think this is an even better model for other states to copy."
Scully traveled to Nashville Friday for a signing ceremony for the new waiver agreement, hosted by Gov. Don Sundquist, Tighe and top state officials. "We'd be happy to give this authority to other states if they did it as rationally as Tennessee has," Scully said. "I think the federal government is getting a pretty good deal . . . Tennessee has really done some very smart things with the money."
Scully, who negotiated the original TennCare waiver with then-Finance Commissioner David Manning a decade ago, said the new waiver "is much more flexible and won't create the unexpected fiscal problems that you've had before."
TennCare Standard would be available to people who have no access to employer-sponsored health coverage and who are either below 200 percent of the federal poverty level or medically uninsurable based on a review of medical records. It would also be available to those who are now eligible both for Medicare and TennCare and are "grandfathered" into the program. Tighe said the General Assembly will have broad latitude to limit TennCare Standard, define which populations will get priority and cut groups or add groups to the program - a two-edged sword in political terms.
"The criticism has been that the General Assembly hasn't had a say in TennCare," said Tighe. "Now they'll have a lot to say about who is in." Sundquist's budget, in fact, asks for $114 million in additional money for TennCare but does not fund TennCare Standard completely. Sundquist's budget would eliminate about 75,000 current TennCare enrollees, most of whom are adults whose earnings exceed the poverty level, but who will not qualify as uninsurable under the new requirements.
The new waiver essentially redefines TennCare, and achieves many of the reforms that state legislators have wanted for years:
Eligibility as an "uninsurable" is based on a review of medical records, not on a letter of denial from an insurer.
People not on Medicaid will have to sign up for coverage annually, with enrollment open only once a year.
There are modest co-payments for prescription drugs, even for Medicaid-eligible members.
Benefit level in TennCare Standard will be the same as commercial HMO coverage.
More substantial proof of income, insurance status and residency is required.
The new waiver goes much further than any of the many "reforms" tried previously by Sundquist, chiefly because those reforms had to be made within the context of the original TennCare waiver agreement.
Craig Becker, executive director of the Tennessee Hospital Association, said he fears what will happen if TennCare Standard goes unfunded. "It will be disastrous for the hospitals. Our charity care has been rising steadily, but if that happens it will just go through the roof."
"What it means is that folks will not seek help until they're in dire shape, and that's when the hospital will see them. Patients won't get primary care, and it will be a lot more expensive to help them - no doubt about that," said Becker.
Russ Miller, senior vice president of the Tennessee Medical Association, said the new waiver incorporates many of the reforms doctors have wanted. "But as with any program, especially TennCare, the devil is in the details."
Tighe said state officials will begin reverifying all TennCare enrollees July 1, first to see if they qualify for Medicaid. If they do not, they will get an application packet for TennCare Standard, which will require submission of medical records for those who claim they are uninsurable. The two separate programs begin Jan. 1.
Some health care advocates said the new system will leave significant gaps for the sick, the disabled and children.
Tony Garr, director of the Tennessee Health Care Campaign, said the plan will eliminate dental and vision coverage for non-Medicaid children, will bar entry of disabled and elderly low-income Medicare recipients to TennCare's pharmacy coverage and will create gaps for people who are seriously ill.
"With only one enrollment period, a person who is uninsured and has cancer would have to wait as long as 14 months to be covered and receive treatment," said Garr, who points out that the current TennCare system would allow that person immediate coverage.
Tighe responded that the state's charitable health institutions "will have to gear up again" to take care of that need.
In approving Sundquist's rewrite, the Centers for Medicare and Medicaid Services also agreed to allow the state to draw down up to $16.5 billion in federal funds over the next five years for the medical-surgical component of the program - an amount that Tighe said is clearly advantageous to the state. That total budget does not include the state's nursing home program or other Medicaid waiver programs.
The waiver also allows the state to enact Sundquist's proposed 18-month "stabilization" of TennCare, during which the state would assume all medical risk now borne by TennCare managed care organizations. Some lawmakers have criticized the plan as a potential budget-buster that could leave hundreds of millions of dollars in cost overruns for the next governor. Sundquist's term ends in January.
The waiver also allows for the creation of a premium assistance program, called TennCare Assist, in 2003. That program would use state and federal TennCare funds to help low-income working families purchase employer-sponsored health coverage. Its existence will depend on funding by the General Assembly as well.
Contact Nashville Bureau reporter Paula Wade at (615) 242-2018.
State, federal governments agree to TennCare overhaul
By GARREN SHIPLEY
TennCare is going into the shop for a major overhaul - one that will clamp down on fraud but is likely to cut benefits to nearly 25,000 enrollees.
Gov. Don Sundquist announced Friday that the state has received a five-year federal waiver to institute major changes to the state's health insurance program for the poor and uninsured.
Under the new agreement, TennCare will become three programs.
One is for people eligible for Medicaid, the federal-state health care program for the poor and disabled.
Another is TennCare Standard, a package "comparable to a commercial HMO product" with benefits similar to Medicaid.
The third is TennCare Assist, where the state will help pay premiums for the those who have access to group health insurance but can't afford it.
"I thought TennCare was a great model 10 years ago when it was created, and it's an even better model today," said Tom Scully, administrator of the federal Centers for Medicare and Medicaid Services.
"Tennessee has chosen to keep TennCare fiscally sound and has the most comprehensive health care coverage in the nation," Scully told the Associated Press. "You should be proud of what you've done."
Scully said Tennessee is "the most aggressive state in the nation" in using its Medicaid funds to cover a broader range of people.
Legislators won't have to appropriate any more money for the program, said Sundquist, since the new waiver was designed to be "budget neutral."
But the changes will likely force about 24,500 people on TennCare rolls out of the program since they'll no longer meet the income requirements or not qualify as uninsurable under tighter medical guidelines.
Beyond those enrollees, the governor's office expects about 70,000 more people to lose their coverage due to a new annual recertification process where the state will re-evaluate enrollees' income, access to insurance and other criteria.
The new waiver also allows for tighter controls over who gets into the program.
Applicants will have to show proof of income, residency, citizenship status and access to insurance, among other things. Those who cannot supply such proof will not be enrolled.
Another change officials said they hope will drive down costs is the inclusion of a prescription drug co-pay for both TennCare Standard and TennCare Medicaid.
Advocates for TennCare enrollees were critical about the revamped program.
"We estimate 150,000 people will lose coverage by the end of the year," said Tony Garr, director of the Tennessee Health Care Campaign. "Seniors will lose prescription drug coverage, and children in near poverty will be hurt. It's a terrible design."
TennCare will begin evaluating enrollees for continued coverage on July 1 and should be done by the end of the year.
About 1 million of the state's roughly 1.4 million TennCare enrollees are Medicaid eligible, while the rest either don't have access to health insurance or have "uninsurable" medical conditions.
Friday's announcement comes at an interesting political time - a revenue crisis and a debate over new taxes.
Sundquist said those who have been saying "fix TennCare" before attempting to raise taxes should now have confidence that TennCare is fixed.
"The citizens of Tennessee should have confidence it's a better system," Sundquist said. "Those who have said TennCare is the root of our budget problems have been wrong, and they are wrong. It's a political issue being used inaccurately."
Locally, some legislators said the new waiver is good news, but its impact on the state's revenue troubles will be minimal.
"Money is money, and money is good," said Rep. Ken Givens, D-Rogersville.
But Givens hastened to add that anyone who thinks the new waiver eliminates the need for new revenue is badly mistaken.
Tennessee spends just under $2 billion per year on TennCare, while the federal government picks up the remaining $3.5 billion.
State cleared to carve three coverage levels into TennCare Some components subject to funding
By Tom Sharp, Associated Press June 1, 2002
NASHVILLE - A comprehensive reshaping of the TennCare program was signed Friday by Gov. Don Sundquist and representatives of the federal government.
Tennessee's new waiver of the Medicaid rules, which defines the TennCare program, will carve TennCare into three parts.
"This program gives the kind of integrity people have been asking for," said TennCare chief John Tighe. "And it gives the Legislature the ability to decide how much of the program it wants to fund."
One of the new TennCare sections is for people eligible for Medicaid, the federal-state health-care program for the poor and disabled. Another is TennCare Select, a reduced package of benefits for poor people ineligible for Medicaid or private insurance. The third is TennCare Assist, in which the state will subsidize premiums for people with access to private insurance who cannot afford the entire cost.
"I thought TennCare was a great model 10 years ago when it was created, and it's an even better model today," said Tom Scully, administrator of the federal Centers for Medicare and Medicaid Services, before the signing ceremony at the state Capitol.
"Tennessee has chosen to keep TennCare fiscally sound and has the most comprehensive health-care coverage in the nation. You should be proud of what you've done."
Scully said Tennessee is "the most aggressive state in the nation" in using its Medicaid funds to cover a broader range of people.
An estimated 1 million of TennCare's 1.4 million enrollees are eligible for Medicaid. The rest are what is known as the "expansion population," people who otherwise might not have health care because they are too poor or too sick to get private insurance.
Besides breaking the program into three parts, the new waiver makes all components above Medicaid levels subject to funding by the Legislature. That means the annual appropriations act will determine the size of TennCare.
For instance, Sundquist recommends providing TennCare Select for people who make up to 200 percent of the federal poverty level, which is about $17,000 for a family of four.
The Legislature could fund the governor's proposal, or fund the program to encompass people up to 180 percent of the federal poverty level, or 150 percent or something less.
If the Legislature funds only up to the federal poverty level, Tighe said, about 70,000 people might come off the rolls.
The original TennCare model proposed to lower costs for the Medicaid population by instituting managed care and then using the savings to extend coverage to the expansion population.
Scully said the original model had begun to pose fiscal problems primarily because of increasing prescription drug prices. He said the new program gives the state more flexibility in responding to changes in the health-care market.
"There is no question overall it has saved the state money and covered a lot more people in the process," Scully said.
TennCare is a favorite target of anti-tax forces inside and outside the Legislature. Sundquist said those who have been saying "fix TennCare" before attempting to raise taxes should now have confidence that TennCare is fixed.
"The citizens of Tennessee should have confidence it's a better system," Sundquist said. "Those who have said TennCare is the root of our budget problems have been wrong and they are wrong. It's a political issue being used inaccurately."
Sundquist's budget includes an additional $114 million for TennCare; to fully fund the waiver, Tighe said, would require $100 million more.
Given the state's financial difficulties, fully funding the waiver seems unlikely.
The waiver changes resulted from two years of study by the Commission on the Future of TennCare appointed by Sundquist. The new waiver follows many of the commission's suggestions.
Advocates for TennCare enrollees were less enthusiastic about the new program.
"We estimate 150,000 people will lose coverage by the end of the year," said Tony Garr, director of the Tennessee Health Care Campaign, who said half those would be through eligibility reverification and the other half through curtailed offerings by the program. "Seniors will lose prescription drug coverage, and children in near poverty will be hurt. It's a terrible design." TennCare is costing $5.7 billion this year, with the state's share totaling $1.8 billion. The rest comes from the federal government, co-payments, premiums and drug rebates.
I think of Sundquist as the root of our budget problems!
Anybody besides me remember this during the POTUS campaign? I think Tazquist is DC bound early next year.
Georgewbush.com
August 17, 1999
Tennessee Governor Becomes 22nd To Endorse George W. Bush
AUSTIN – Tennessee Governor Don Sundquist today endorsed Governor George W. Bush for President.
"I am pleased to join Governor Bush’s campaign and will work hard in Tennessee to help him win the nomination and the Presidency," said Governor Sundquist at a Nashville news conference. "I have known Governor Bush and his family for many years, and I know how important public service is to them."
"As a colleague of Governor Bush’s, I have watched him become one of the strongest governors in the country. His record in Texas is outstanding, and many of his innovative programs have served as models for the nation. Governor Bush is a proven leader who has the unique ability to unite people and accomplish success. I look forward to working with him and his team, as we gain support from Memphis to Mountain City for this dynamic leader," added Governor Sundquist.
"Governor Sundquist is a valued colleague and a good, close friend, and I am honored to have his support" said Governor Bush. "Don is devoted to welfare reform and better education for the people of Tennessee. His help will be important to my campaign in the Volunteer State. I intend to wage a vigorous, winning effort in Tennessee, not only in the primary, but the general election as well."
Re-elected to a second term last year with a record 69 percent of the vote, Governor Sundquist has initiated unprecedented reforms in Tennessee in the areas of welfare, government and crime, while placing a special emphasis on Tennessee children. Under his watch, the growth of government spending has been cut by more than half; the number of employable adults on welfare has been reduced by 60 percent; and Tennessee became the first state in the nation to connect every public school and library to the Internet and to offer universal health care coverage to all children.
Ok. But that looks good to me.
Everything that glitters isn't gold. Look in the Tennessee Locale at the messages or try looking up Tennessee State Income Tax, Tenn Care ect. The locale though will yield quicker results. We are in a so called state budget crisis due to Hillary Care. This man has had 8 years to do something about it. His only sucess in office has been to literally split the GOP in this state in half. Conservatives vs Sundquist. Tenn Care is in part welfare and it's gone from widows and disabled to all uninsured. That means the insurance companies are dumping supposed high risk patients in gross mass on the state taxpayers. It's a complicated mess but an education on the dangers of the way our current national health care is headed as well. In 1999 all was well in 2000 & 2001 all was lost as far as the budget goes.
No problem. (And sorry for my sarcasm.)
This income tax battle in Tennessee has been an ongoing eye-opener for over a year. The scumbag forces of evil are pulling out every scumocrat trick in the book to railroad an income tax down the throat of Tennessee. There are a lot of threads about this, going back nearly two years. And the most disgusting part is that the battle to PASS the income tax is being led by Republican Governor Sundquist, who campaigned on a promise to STOP the income tax. The guy is a liar and a scumbag.
Regards,
LH
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