Advocates fear vulnerable group will lose medical benefits

By CLAUDIA PINTO • Staff Writer Tennessean) • May 11, 2008 Healthcare advocates fear that 140,000 TennCare enrollees will lose their benefits in the coming year, and they are urging legislators to create a safety net now. The Tennessee Health Care Campaign calls for using up to $125 million of existing TennCare budget money to treat the sickest of these enrollees, who have been exempt from annual eligibility checks and are expected to face re-evaluation. The funds would be used to treat about 20,000 people with severe mental illness and life-threatening conditions, such as transplant patients needing anti-rejection drugs and cancer patients undergoing radiation treatment. “We are not asking to take care of all those who could be cut, just the 20,000 whose medical conditions are so serious that it could jeopardize their lives or the lives of others,” said Tony Garr, executive director of the Tennessee Health Care Campaign, a health care advocacy group. “As a caring civilized group of people we need to make sure we don’t place people’s lives at risk.” However, Marilyn Wilson, TennCare’s spokeswoman, said providing medical care for these enrollees and not others, who have been found to be ineligible, wouldn’t be fair. She said in an average month 20,000 people lose TennCare, the state’s insurance program for the poor and disabled, because they are no longer eligible and another 22,000 new enrollees are added. “Every dollar you use to serve someone who isn’t eligible, you take away from someone who is eligible,” Wilson said. “Those taxpayer dollars are meant to provide care for people who are eligible for the program.” Furthermore, Wilson said it’s premature to speculate on how many people will lose coverage before a re-evaluation process takes place. Those at risk of losing coverage are in two different TennCare categories: the Daniels class, made up of 150,000 people who used to receive Supplemental Security Income; and those in “Standard Spend Down,” about 50,000 who were bankrupted by medical bills. Garr estimates that about 100,000 people in the Daniels class will be found ineligible for coverage and about 40,000 in the spend down category will lose coverage. Kathryn Corley fears that her 19-month old daughter, Anna, will be one of those cut. Anna has born with Down syndrome and a host of medical conditions, including a form of leukemia and two holes in her heart. Corley, of Signal Mountain, said her family has private insurance, but that it would fall far short of covering the multiple surgeries that Anna will need in the future. “It will cost thousands and thousands of dollars even though we have insurance,” Corley said. “It will reduce our family to poverty.” Like others in the Daniels class, Anna used to receive federal Supplemental Security Income, a monthly stipend for people who are disabled. Being SSI-eligible in Tennessee makes you eligible for TennCare, even if SSI benefits are lost at a later date because a recipient gets better or, as in Anna’s case, the family or enrollee makes too much money to qualify. The reason this group hasn’t been able to lose TennCare coverage goes back to a 21-year-old court decision. In 1987, the courts found that the state was cutting people off the Medicaid program when they lost SSI benefits without checking first to see if they met other criteria that would still make them eligible. As a result, there was a ruling that the state could not cut any one off the program until a plan was in place to see if they were eligible for Medicaid based on different criteria. TennCare officials say the program now has such a process in place and in January they asked a federal judge to make people in this group go through same annual eligibility checks that other enrollees are subject to. A decision is expected in the coming months. Those in the spend down category have been exempt from annual eligibility checks for a different reason. That category was frozen in April 2005 as part of TennCare changes designed to save the state money. Now that the program is expected to reopen in the fall, the 50,000 people currently in it are required to reapply to see if they are still eligible. When the program is reopened it’s expected to be capped at 100,000 enrollees. Although that cap could be lowered because the state’s budget situation.