Children's issues may slow TennCare cuts

By BONNA de la CRUZ
Staff Writer for Tennessean.com

August 11, 2004


Some fear delay in implementation will hamper state budget

Gov. Phil Bredesen intends to make public in the next 10 days details of his cost-saving changes to TennCare, but a January implementation date could get delayed.

Already, the state is about two months off schedule in filing the plan with the federal government. It is now likely to happen in mid-September, and legal developments this week could cause further delay.

The governor is watching the clock carefully and believes he is still on track to meet the January deadline, spokeswoman Lydia Lenker said.

Plaintiffs in a court case that faults the way TennCare treats children are doubtful.

''If his plan denies medicine children need, there will be a problem,'' said Michele Johnson, an attorney with the Tennessee Justice Center, which advocates for the 1.3 million Tennesseans on the public health insurance program. There are about 650,000 children on TennCare.

Meanwhile, she said, it's difficult to explain to enrollees she meets what their future holds.

''It's terrifying for enrollees,'' Johnson said.

The governor's TennCare plan proposes limiting doctor visits, monthly prescriptions and other benefits in an effort to save $2.5 billion over the next four years. TennCare is the state's $7.8 billion program that provides health insurance for those on Medicaid, the disabled and some uninsured residents.

Any delay in implementing the cost-saving measures could throw the state budget off balance, Lenker said.

''We are watching that very carefully,'' she said.

The plan has gotten caught up in a court case known as ''John B.'' that dates back to 1998 and deals with the services that children get.

On Monday, U.S. District Judge John Nixon surprised the state and the Justice Center when he said he would like to see the case move forward, with a ''special master'' writing a compromise plan. Richard Carter was appointed special master three years ago.

The special master's plan could, among other things, make sure that children on TennCare with mental health problems have immediate and accessible treatment, one of the ongoing shortcomings of TennCare, Johnson said.

Yesterday, the Justice Center filed court motions requesting that Nixon set a 60-day period for Carter to write the plan.

Meanwhile, the state wrote a letter to Nixon saying that it appreciated the court's ''constructive, forward-looking spirit'' but was withholding further response until it sees the Justice Center's motion.

Johnson viewed that as ''buying time'' by the state and said it does not signal that Tennessee is trying to move the process forward, she said. Lenker said the letter speaks for itself.

Johnson said she does not see how Bredesen can move forward with the changes because components of it appear to affect treatment of children.

Among them, she said, children could be harmed by:

• The way Bredesen redefines ''medical necessity,'' which determines whether TennCare will pay for certain medical treatments and services.

• The proposed elimination of prescription allergy and gastric-acid-reducing medicines.

• A limited drug formulary.

Bredesen initially said he thought the plan would be ready to go to the federal agency that regulates TennCare in July. Now he plans to have drafts available to the public, the Justice Center and the TennCare Oversight Committee in the next 10 days.

A final copy will be filed with the Centers for Medicare and Medicaid Services 30 days later. The proposed changes gained legislative approval earlier this year.

State Sen. Mark Norris, R-Collierville, said any delay in cutting costs for TennCare will have a negative effect on the state budget.

''This is a last-ditch effort. The state may no longer be able to afford it,'' Norris said. ''TennCare's days have been numbered for a long time. Time is running out.''