The struggle to resolve Medicaid's fiscal crisis came into sharp focus in Tennessee on Jan. 10, when Gov. Phil Bredesen announced he will eliminate nearly half of all adults from TennCare, the state's Medicaid program, this spring.
Bredesen's cuts mean Tennessee physicians no longer will receive reimbursement for the care they provide to 323,000 otherwise uninsured adults who had received Medicaid. Moreover, for most of the 396,000 adults who maintain Medicaid coverage, the revised program will limit doctor visits to 12 per year, prescriptions to four per month and hospitalizations to 20 days per year. Neither patients nor doctors will be able to appeal the limits.
In 1993, TennCare expanded Medicaid beyond federal standards. In addition to covering the poor and disabled, TennCare offered coverage to patients with catastrophic illnesses that would otherwise bankrupt them or who were refused private health insurance because of their chronic illnesses. It is this group who will receive letters explaining they will be dropped from TennCare rolls this spring.
Once implemented, the cuts will highlight the precarious balance family physicians and their medical peers must keep between maintaining their practices' fiscal health and ensuring their patients receive appropriate, high-quality care. Georgia's FPs faced similar challenges in 2003 when that state changed Medicaid eligibility and dropped patients from its rolls. The result: Georgia physicians who were actively treating patients lost reimbursement for ongoing care after the patients lost Medicaid coverage.
In response, the 2004 AAFP Congress of Delegates in October approved a resolution calling on CMS to require continued Medicaid coverage until soon-to-be-dropped patients complete treatment for pregnancy, inpatient care or rehabilitation.
By cutting Medicaid rolls and limiting coverage, Bredesen expects TennCare to increase spending by $75 million in the next fiscal year, rather than by $650 million without the changes. All 612,000 children in the program will still be covered. State taxpayers foot nearly a third of TennCare's bill. The federal government picks up the rest of the cost.
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