In November, Tennessee officials shifted 279,000 members of Access MedPLUS, the largest health plan in the troubled TennCare system, into a plan operated by BlueCross BlueShield of Tennessee.
The state Department of Insurance seized control of Access MedPLUS after the health plan abruptly fired 300 employees without notice or severance pay, according to the Memphis Commercial Appeal. The state originally had planned to shift Access MedPLUS beneficiaries to BCBS’s TennCare Select after the Access MedPLUS contract with the state expired on January 1, 2002.
Care Won’t Be Interrupted
“We would have preferred not to do it this way. But we were getting calls from members saying they could not get services,” TennCare Director Mark Reynolds told the media. He said all state providers of health and medical services will accept Access MedPLUS member cards and approvals for services.
According to a report in the Nashville Tennessean, the state will allow Access MedPLUS members to visit their usual doctors for four months, regardless of whether those doctors participate in the TennCare Select network.
Reynolds said most primary care providers in the Access MedPLUS network also serve TennCare Select members. The state will reimburse providers who serve Access MedPLUS members based on TennCare Select rates.
More Trouble Ahead?
State officials have said little about Access MedPLUS’s financial status. The state won a court order to take over the health plan’s operations after financial reports indicated it was insolvent.
The Commercial Appeal reports “there is little left to salvage” after Access MedPLUS lost its $39 million-per-month TennCare contract, which provided 99 percent of the health plan’s revenues. The plan has more than $54 million in debt.
Thomas Kinser, president and CEO of BlueCross BlueShield of Tennessee, emphasized his firm’s commitment to TennCare, but added the state’s Medicaid managed care program needs an “overhaul” and increased funding.
In an interview with the Nashville Tennessean, Kinser said the state needs to “make market forces work in better ways than they do now” to increase the viability of the program and ensure the participation of managed care organizations.
Noting the size of TennCare, which provides “comprehensive benefits” to roughly 1.5 million people, Kinser said the state should bring into “balance the number of people covered and the way you pay providers and the delivery mechanisms of competing HMOs.”
He also called for tightening the program’s eligibility system by increasing state oversight of enrollees. “TennCare is the program of last resort, but people’s statuses change month to month, year to year. There needs to be a discipline, a rigorous review to be sure that the people on there are the right people.”