Michigan ruling could help TennCare and children
Michigan ruling could help TennCare and children
Officials of Tennessee’s beleaguered TennCare program are said to be monitoring a federal court ruling in Michigan that could have an impact on a decision issued by a Tennessee court last year that ordered the state to shift 550,000 children enrolled in TennCare into a separate program.
U.S. District Court judge Robert Cleland ruled last March that Medicaid benefits were part of a contract between Michigan and the federal government, and that Medicaid beneficiaries "have no right to enforce the contract in court" by suing over their benefits.
Disastrous consequences
Mark Reynolds, TennCare director, told the Nashville Tennessean that if the Michigan ruling stands, it could change the way that people are able to sue states over Medicaid entitlements and affect a December ruling by federal court judge John Nixon ordering the transfer of enrolled children after finding that TennCare had failed to provide adequate early periodic screening, diagnosis, and treatment services to them.
Reynolds has said that Mr. Nixon’s order could end the managed care aspect of TennCare, effectively terminating the state’s waiver and forcing a return to a traditional Medicaid program.
Is the decision fair?
TennCare officials say they are moving forward with plans to implement Mr. Nixon’s order, while still watching what happens in Michigan.
An attorney with the Tennessee Justice Center who filed the 1998 suit that led to Mr. Nixon’s order described the Michigan decision as "an aberration" and said, "There have been numerous rulings that explicitly said poor people can bring these kinds of lawsuits."
Although the state had agreed to improve service delivery, the Justice Center last year asked Mr. Nixon to find the state in contempt for failing to live up to its commitment.
During three weeks of testimony last summer, Mr. Nixon heard from 20 parents who said their children were unable to get needed services.
In a 50-page ruling, Nixon described TennCare as "a failed experiment" and said it was a system that "had indeed broken down."
Former and current TennCare officials told the Tennessean it was inevitable that the state would violate a 1998 agreement to provide the health screening for children enrolled in TennCare.
Good intentions not enough
One legislator claimed that while state officials had good intentions, there aren’t enough pediatricians in the state to provide the required services. "If all pediatricians did nothing else," said state Rep. Gene Caldwell, "they still couldn’t get them done."
Craig Becker, Tennessee Hospital Association president, says implementation of Mr. Nixon’s order would cause TennCare to collapse and put rural hospitals at risk.
Mr. Becker also says that going from managed care back to fee-for-service Medicaid would "force" hospitals to provide "millions of dollars" in charity care and that 600,000 TennCare beneficiaries would lose their coverage.
Saving TennCare
Editorially commenting on the decision and its possible ramifications, the Tennessean said that rather than dismantle TennCare and revert to a fee-for-service Medicaid program, the state needs to "leverage" its purchasing power to cover more people through managed care.
The newspaper said that for all its faults, TennCare has held costs down, while at the same time covering more people and providing financial stability to hospitals and clinics. "In the search [to resolve] Tennessee’s budget problems, TennCare, if properly administered, can still be one of the solutions," the newspaper said. n
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.