Report: TennCare Dropped At Least 220,000 Kids Due to Incomplete or Errant Paperwork

Between January 2016 and December 2018, at least 220,000 Tennessee children lost or are slated to lose health insurance because of late, incomplete or unreturned TennCare eligibility forms, The Tennessean reports. Most participants in TennCare are automatically renewed for coverage each year; however, when important plan changes or updates are necessary, the organization until recently required families to mail hard copy forms in lieu of filing or updating their information online. Some families maintain that the process was needlessly confusing and hard to navigate, with research by the Tennessean showing that TennCare representatives were rarely able to determine if the children even qualified using the now replaced model. TennCare Commissioner Gabe Roberts said that the numbers also reflect families who likely did not complete the paperwork because they are no longer eligible for the program.

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About 128,000 Children Dropped from TennCare, CoverKids in the Past 2 Years

Almost 128,000 children were dropped from TennCare and its sister program, CoverKids, over the past two years, The Tennessean reports. Between 2016 and January 2019, approximately 1 in 8 children enrolled with the providers were purged from the system, with the agency saying that most were cut because the families did not respond to mandatory renewal forms that were mailed to them. Nashville and Memphis saw cuts of about 14,000 and 22,000 children, respectively. Cheatham County saw the most cuts per capita, with nearly 1 in every 5 enrolled children purged from the programs during that period.

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Jefferson County Man Facing Multiple Charges of TennCare Fraud

A Jefferson county man, Howard L. Cagle, has been charged in Hamblen and Greene county with multiple counts of TennCare fraud involving doctor shopping, the Tennessee Department of Finance & Administration reports. Investigators have revealed that Cagle used TennCare to acquire hydrocodone prescriptions in at least five distinct instances all within a short period of time. Each felony charge of TennCare fraud is punishable by up to four years in prison. Since 2005, the Office of Inspector General has worked on cases that resulted in the repayment of over $3 million and an estimated cost avoidance of over $136 million for TennCare.

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Several States to Issue Waivers on Work Requirements for Medicaid Recipients

As more states impose mandatory work requirements on their Medicaid programs, some have come under fire for policies that would protect many rural residents from the impact of the new rules, Business Insider reports. In Kentucky, Michigan and Ohio, the waiver proposals would exempt the counties with the highest unemployment rates, which critics argue skew towards white, GOP-leaning residents. Some health law experts say the waivers — already approved for Kentucky, pending for Ohio, and advancing in Michigan — may violate Title 6 of Civil Rights Act of 1964, which prohibits race-based discrimination in federal assistance programs. The waiver in Kentucky, the first state to approve the work requirements, will exempt eight counties where the percentage of white residents is over 90 percent. Tennessee's work requirement bill for TennCare recipients, HB1551/SB1728, was signed into law on May 3.

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Tennessee House Approves Bill Seeking Work Requirements for Some TennCare Recipients

A bill seeking to implement work requirements for "able-bodied" TennCare recipients was overwhelmingly approved by the state House on Monday, reports The Tennessean. The proposal, sponsored by House Speaker Beth Harwell, R-Nashville, directs the state Department of Finance and Administration to seek a federal waiver to impose work requirements for able-bodied, working-age TennCare recipients without dependent children under 6 years old.
As the chamber discussed the bill Monday, several Democrats unsuccessfully introduced amendments seeking to change the measure. One amendment, sponsored by House Minority Leader and gubernatorial candidate Craig Fitzhugh, D-Ripley, would have directed the state to submit a waiver to expand Medicaid, however, this amendment was voted down. "The problem with this bill as a whole," said Rep. Mike Stewart, D-Nashville, "is that poor mothers will have less and less access to health care. This movement to take health care away from Tennesseans will not stop with these disadvantaged individuals.”
Gov. Bill Haslam has voiced support for the bill, telling the Knoxville Chamber, “We have Tennessee Reconnect. Anybody can go back to school for free… and then actually we’re really short on workforce folks now.”
“We have thousands of unmet job needs in Tennessee right now. So this is an environment where people can go fairly easily and meet those qualifications," Haslam said.
The House voted 72-23 in favor of the measure. The Senate is expected to take up its version of the bill in the coming days.

–Here is a recent amendment to SB1728 /HB1551

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Healthcare Liability Reporting Requirements

Attorneys reporting health care liability claimants are required to provide specified information related to fee arrangements and TennCare payments to the Department of Commerce and Insurance. Per the Tennessee Health Care Liability Reporting Act, the department must submit an annual report summarizing information submitted by health care providers, facilities and attorneys by March 1. Reporting requirements and instructions can be found on the department’s website

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