TennCare seeks big budget boost

Published 4:25 pm Wednesday, November 22, 2023

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TennCare is asking for a $735.3 million budget increase between state and federal funds next year as it moves to a new Medicaid Management Information System, which carries a one-time cost of $237 million, of which $212.3 million will come from federal funds.

The budget request includes $85 million that is federally required related to increased prescription drug costs along with $10.9 million for a new Diapers for Kids program that TennCare Director Stephen Smith said still needs to be approved by the federal government.

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Smith said the TennCare III block grant has allowed the state to keep and use any cost savings in the program and allowed for a permanent extension of post-partum coverage, lactation support, increased eligibility for pregnant women, 12 months of continuous coverage for women and increasing parent eligibility.

Overall, Smith said those increases have led to 25,000 more TennCare participants.

TennCare is continuing its process of redetermining the eligibility of Tennessee residents in the program.

So far, TennCare has examined 628,128 participants with nearly 187,000 being deemed ineligible. Of those, 48,171 returned paperwork and no longer qualified so they were referred to the federal healthcare marketplace. An additional 129,000 participants were deemed ineligible for not returning paperwork, though the state doesn’t know how many of those knew they were no longer eligible. Then 62,000 are still pending a determination.

Smith said that it is a challenge both in Tennessee and across the country to get members to respond to requests for information but that is the only way they are allowed to determine eligibility for those who are not auto renewed.

Smith said that 40% of members have been auto renewed while 60% overall renewed, above the national average.

“We do have challenges and you’ll see those same challenges across the country,” Smith said.

COVID-19 health emergency rules blocked redetermination between March 2020 to March 31 but states were then required to re-start the annual process.

TennCare had estimated that process would drop its rolls from a high of 1.8 million participants down to 1.3 million. Tennessee still had 1.7 million TennCare enrollees in October.