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How Tennessee sabotaged its own Medicaid program

Governor Bill Haslam
Photo by Jason Davis/Getty Images

Tennessee is not the only state that has refused to expand Medicaid, but it is the only state that has virtually shut down its existing Medicaid program. This is the substance of the Complaint filed recently by the Southern Poverty Law Center, the Tennessee Justice Center, and the National Health Law Program.

Since 1993, Tennessee has run its own TennCare program, but, faced with the politically unpopular Affordable Care Act, the state placed ‘bureaucratic barriers’ to insure that help through the state was a thing of the past.

From January 1, 2014, the only way to apply for TennCare is through healthcare.gov, a site politicians have taught us all to fear and hate. As of January 1, the TennCare Bureau took the Medicaid application process away from the Tennessee Department of Human Services. The DHS has its failings, but it has offices in all 95 counties and had personnel who could help people with limited literacy or computer skills apply for Medicaid. “Limited literacy or computer skills” describes most people who need to apply for Medicaid.

Then there was the Family Assistance Service Center Call Line – a great help until it was shut down in January 2014. TennCare hired Cognosante, LLC of McLean, Virginia (why the out-of-state contractors?) to run the new Tennessee Health Connection. BUT – TennCare gave Cognosante only limited access to applicant’s files and did not provide training on how to resolve a caller’s problems. All they can do is refer callers back to healthcare.gov. Many of the plaintiffs in the recently filed lawsuit have called this site multiple times without ever getting any help.

To block any possible access to TennCare benefits, the TennCare Bureau removed its employees from the hospitals where they had established ‘presumptive eligibility’ and signed up newborns. Then, in June 2014, they eliminated laid off over 100 DHS employees.
The practical mechanism Tennessee refuses to use is the Modified Adjusted Gross Income (MAGI), which is the eligibility determinant under the ACA. Northrop-Grumman apparently cannot make a computer system that can use it or interface with computers that do. Yet the Center for Medicare and Medicaid Services has offered Tennessee a method of manual MAGI processing that can be adapted for the state and has even offered funding to hire new staff to assist in application processing.

Can anybody seriously believe the current Tennessee administration truly cares about the well-being of its citizens?