#3. TennCare Resolution 2003-2004

Meredith Bellson 28 posts Aug 17, 2007 2:43 PM

#3. TennCare Resolution 2003-2004 NOTE: POST A MESSAGE TO MAKE SUGGESTIONS! WHEREAS, all Tennesseans should have access to affordable, comprehensive, medically adequate health insurance through either private or public programs; and WHEREAS, the TennCare program, instituted in 1994 as a Medicaid Waiver program, promised and made substantial improvements in health care, relieved Medicaid budgetary pressures that annually threatened Tennessee's state budget, allowed over 400,000 citizens who were uninsured and uninsurable to receive timely primary and preventive health care, and extended to all TennCare children access to a full array of Early and Periodic, Screening, Diagnosis, and Treatment (EPSDT) services which were of particular importance in meeting the special health needs of children with chronic health problems or disabilities; and WHEREAS, during TennCare's nine year history, despite all its good points, both consumers and advocates, as well as service providers, managed care organizations (MCOs), and the general public, recognized management problems along with problems related to dramatic changes in policy, cuts in enrollment, and limits placed on benefits for those enrolled; and WHEREAS, many critics cite the following specific problems: • the failure of the state to adequately regulate managed care organizations (MCOs) administering the program; • the financial instability of several MCOs which created problems with access to essential care for many enrollees; • the failure to pay providers in a timely and reliable manner; • numerous policy changes/reforms intended to solve problems but the changes were ineffective and actually undermined the fundamental basic design of TennCare which was to provide payments to private insurers to manage care and hold down costs through market forces; and WHEREAS, following renegotiations in 2002 with the Center for Medicare and Medicaid Services (CMS) for a continuation waiver, the changes in that waiver proved to be financially disastrous for Tennessee and programmatically harmful to the state's citizens; and WHEREAS, following his inauguration in January 2003, Governor Phil Bredesen, with his specific expertise and experience in health care, has already made progress towards improving the TennCare program, negotiating more favorable waiver terms with CMS, changing many of the policies that would have eliminated thousands of enrollees, and proposing other reforms; NOW THEREFORE BE IT RESOLVED, that TCSW continue to support access for all Tennesseans to affordable, comprehensive, medically adequate health insurance through either private or public programs; and BE IT FURTHER RESOLVED, that TCSW supports TennCare and urges that it: • be properly managed; • provide access for low-income enrollees through Medicaid; • provide coverage for uninsured and uninsurable adults and children; • include structural changes to restore financial viability to the program; • provide prompt payment and fair rates to providers; • provide a prescription drug program for all consumers; • strengthen administrative and data management systems; and • accurately determine the eligibility of enrollees; and BE IT FUTHER RESOLVED, that TCSW monitor and educate the TCSW membership about proposed changes that Governor Phil Bredesen has stated will be forthcoming over the next six (6) months concerning TennCare, and advocate for a stronger TennCare program that is open to new enrollees without access to private insurance and that meets the health care needs of the people it serves.

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