TennCare Reform Moves Ahead

Published January 1, 2002

Starting last December, Tennessee officials were allowed to begin removing ineligible enrollees from TennCare, the state’s troubled Medicaid managed care program, under a compromise agreement reached in federal district court.

After two days of negotiations between the state and the Tennessee Justice Center, which is representing TennCare enrollees, U.S. District Judge William Haynes approved a “reverification” plan that will allow the state to begin sending enrollment termination notices that outline “appeal rights” to 52,000 people already deemed ineligible, and eventually to all 600,000 Medicaid-ineligible enrollees.

Under the agreement, termination notices will be sent to enrollees who have not paid their premiums for the past four months, unless they have one of two specific mental conditions. Those conditions were not revealed.

State officials have identified 25,000 TennCare beneficiaries with “invalid addresses” and another 27,000 who have failed to pay their TennCare premiums for at least four months. Rather than being dropped from the program immediately, enrollees will have 30 days to contact the state and begin paying premiums—missed payments may be made up over a 10-month period.

TennCare will also begin consulting with other state agencies and managed care organizations to “identify the whereabouts” of enrollees with invalid addresses. Once enrollees are located, termination notices, which explain the appeals process, will be sent to them.

TennCare spokesperson Lola Potter explained the reverification process will then expand to the entire TennCare population. At first, the state projects it will complete 8,000 to 10,000 verifications per month, but eventually hopes to reverify 40,000 to 60,000 enrollees a month.