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TennCare: Issue Briefs

Why the Governor’s latest TennCare promise is misleading

On December 6, 2005, Governor Bredesen said that he would open TennCare enrollment to 100,000 of the sickest and neediest Tennesseans. However, a closer look reveals that instead of meeting the needs of these citizens, this latest TennCare change is a very misleading promise. The state has created a funnel of eligibility so narrow that only a few will squeeze through it to receive the assistance that the Governor promised.

Limits on Who Qualifies
The Medically Needy program that the Governor is talking about is a complex Medicaid category. It has been in existence in Tennessee for decades. In order to qualify for the program, a person must be:

• Over 65
OR
• Single parent of a child under 18
OR
• totally disabled by Social Security’s standards

If a person does not fit into one of these categories, he or she cannot get onto the new program announced by Governor Bredesen on December 6. Period.

Financial Qualifications
If you meet one of the criteria listed above, the next challenge is to accrue large medical bills within a short time period. This is challenging even if one has serious health needs because most medical providers will not provide care on credit. Your medical bills must be no more than 90 days old under the state’s new rules. That is much more restrictive than federal law or what 35 other states permit, which is to count any medical bills still owed.

Also, by federal law, and prior to the Governor’s TennCare changes, if a medical bill was owed for anyone in a family, TennCare allowed the bill to be used to meet the financial requirements to qualify for the Medically Needy category. For instance, if a wife applied to TennCare and the wife and the husband both had outstanding medical bills, they could use the family’s total bills to qualify the wife. State documents indicate that this policy is being changed so that only an individual’s medical bills will be considered in qualifying for the Medically Needy program.

Both of these changes are inconsistent with the law as found on the CMS website. These changes present gigantic obstacles to families who are currently enrolled in the Medically Needy program and to uninsured families who seek to qualify.

More People Will Lose Health Care Coverage
For the past decade, the number of Tennesseans on the spend-down Medicaid program has remained consistent at 90,000 to 100,000 people. This has been true despite fluctuations in the economy and in the TennCare policies. It has been consistent because the program is restrictive and only a small fraction of those in need qualify in the best of circumstances.

Because of changes already made to the TennCare program, 37,000 of those who were in the Medically Needy category lost coverage permanently on January 1, 2006. These individuals will get limited medical coverage from Medicare; however Medicare will not meet the critical health needs of many people. For instance, it will not cover extended home health or mental health case management that is so important for the severely mentally ill.

Money Appropriated, but Won’t Assist Medically Needy
The Tennessee State Legislature appropriated the funds to cover 100,000 Medically Needy people. However, the Governor is now severely restricting eligibility for the Medically Needy program. During 2006, many people already in the Medically Needy category will lose their coverage. Thousands of others who apply will not be accepted into the program. If the state really wants to cover 100,000 Tennesseans, they must broaden eligibility not restrict it.

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