PI Action alerts & updates ... 2004

TennCare Open Discussion

The following sign-on letter was sent by healthcare advocates, including Project Inform, to Tennessee Governor Phil Bredesen in response to his proposed reforms to TennCare, the state’s Medicaid program.

September 17, 2004

TennCare Open Discussion
c/o Governor Phil Bredesen
State Capitol
Nashville, TN 37243

Dear Governor Bredesen,

The undersigned organizations write to express our serious concerns about the Proposed TennCare Waiver Amendment released on August 19. While we have a range of specific concerns, this letter highlights some issues in the waiver that we believe are extraordinary troubling for Medicaid beneficiaries in Tennessee and nationwide.

In particular, the waiver seeks “pre-approval” for a wide range of changes that the state would be permitted to make without seeking additional permission from the Centers for Medicare and Medicaid Services (CMS). The waiver document lists possible future changes—such as reducing mandatory or optional services to the lowest level approved in any southern state; expanding eligibility; raising and/or imposing premiums or copayments on otherwise exempt populations such as optional children; and limiting benefits for virtually any Medicaid beneficiary. Even more troubling, however, is that the state is seeking virtually unfettered and unprecedented flexibility to make additional, unspecified changes through the blanket “pre-approval” provision that is sought. If this “pre-approval” provision is approved, harmful changes affecting any beneficiary or service in the program could be enacted with no due process protections for beneficiaries and no further review by the federal government—whether or not the changes comport with the intent of federal Medicaid law.

In addition, we are troubled that this unfettered flexibility is sought in the context of the state imposing a cap on its own Medicaid expenditures. Changes the state might make to abide by that cap will likely result in the loss of services, reductions in enrollment or other harmful restrictions that would compromise the access of children, parents, seniors and persons with disabilities to needed health care services. The presence of the cap ensures that the overriding goal in making such changes will be state budget certainty and not the health care needs of Medicaid enrollees.

Finally, we are extremely troubled by the state’s revised definition of medical necessity. We believe that this definition potentially undermines all beneficiaries’ ability to obtain appropriate health care services. The definition’s requirement that the “least costly alternative” that is “adequate for the medical condition of the enrollee” be used is a dangerous departure from standard definitions of medical necessity in both public and private insurance programs.

In short, we believe that fundamental changes are needed to this waiver proposal before it can be submitted for federal review. Thank you for your attention to our concerns.

Sincerely,

Advancing Independence
African American Health Alliance
Alzheimer’s Association
American Association of People with Disabilities
American Association on Mental Retardation
American College of Obstetricians and Gynecologists
American Congress of Community Supports and Employment Services
American Occupational Therapy Association
American Therapeutic Recreation Association
Association of Academic Physiatrists
Association of University Centers on Disabilities
Bazelon Center for Mental Health Law
Center on Disability Issues and the Health Professions
Children’s Defense Fund
Disability Service Providers of America
Evangelical Lutheran Church in America
Families USA
Family Voices
Generations United
HIV Medicine Association
Institute for Reproductive Health Access
National Academy of Elder Law Attorneys
National Association for the Advancement of Orthotics and Prosthetics
National Association of Protection and Advocacy Systems
National Association of School Psychologists
National Citizens’ Coalition for Nursing Home Reform
National Committee to Preserve Social Security and Medicare
National Council for Community Behavioral Healthcare
National Council of La Raza
National Council on Independent Living
National Family Planning and Reproductive Health Association
National Health Law Program
National Medical Association
National Mental Health Association
National Senior Citizens Law Center
National Women’s Law Center
Planned Parenthood Federation of America
Project Inform
Racial and Ethnic Health Disparities Coalition
RESULTS
The Arc of the United States
United Cerebral Palsy
United Jewish Communities
United Spinal Association
USAction
World Institute on Disability