State Senator Wants Another Option If TennCare Cuts Not Approved

To be able to pull $200 million out of TennCare to help balance next year’s budget, Governor Phil Bredesen will have to get the approval of the federal government. One state Senator questions whether the answer to that request will come as quickly as the state needs it to.

TennCare operates under rules set by the federal Center for Medicare & Medicaid Services. Memphis Senator Mark Norris, the Republican leader in the upper house, wants the governor to come up with a contingency plan if CMS doesn’t approve the changes.

“This budget hinges upon an assumption that there will be significant reductions in TennCare. Yet those reductions have not been approved by Washington yet. In fact they haven’t even been submitted.”

State Finance Commissioner Dave Goetz says the application will be turned in this week and says it couldn’t be made until the budget was presented. But Norris says no one knows how long it might take the federal agency to respond and the state needs to have a plan in place if CMS says no.

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Norris says the timing could be key.

“If it only took one year, maybe reserves would cover it. But do you really want to premise an entire budget on that presumption when it may not come to pass?”

Meanwhile, health care providers began to mull over the impact of the proposed TennCare cuts. The governor acknowledged Monday that a new cap on hospital stay reimbursement would hurt large hospitals.

Christi Grandstaff, deputy director of the Tennessee Primary Care Association, says the cuts would also affect walk-in clinics.

“We have looked at those cuts and we are concerned especially with the limits they are proposing on outpatient visits. To some people, eight visits a year might seem very reasonable. But again if you have a complicated diagnosis, maybe you have both diabetes and cardiovascular disease, which is really common in this state, you are really in need of seeing your health care provider more than that on an annual basis.”

Grandstaff says the walk-in, primary care clinics are often the only health care available to people without insurance. She says bout 35 percent of clinic patients are TennCare recipients.

“There are also people on certain medications, that require checks on the medication levels, just really checking in more frequently with their doctor, so we’re in particular concerned about that.”

Grandstaff says the clinics create a safety valve for people who would otherwise go to emergency rooms.