TennCare Purges Enrollees Who No Longer Qualify, Slashes Rolls By 100K | Nashville Public Radio

TennCare Purges Enrollees Who No Longer Qualify, Slashes Rolls By 100K

Nov 12, 2018

More than 100,000 people have lost coverage from TennCare over the last year, according to monthly figures kept by the agency. The state's Medicaid program has been playing catch-up in purging people who no longer qualify for benefits.

The regular process is called "redetermination," but it was put on hold four years ago because of computer network problems that still haven't been resolved. TennCare eventually found a manual workaround, though it's not as precise as it should be and includes a ream of paperwork that even the Tennessee Comptroller thought needs to be streamlined.

"Due to the manual nature of the process, we found that it, generally, takes us longer to reverify members’ cases," TennCare deputy director Sarah Tanksley says in an email. "This fact, along with the build-up of a large inventory of members needing to be reverified due to the 2014 pause, caused us not to be current in our reverification efforts for a period of time."

MORE: Investigators Blame TennCare's Dense Paperwork For Bumping Vulnerable Enrollees

But patient advocates feel like the numbers have dropped too far, too fast, even with the strong economy. Michele Johnson of the Tennessee Justice Center notes that half the reduction is children. That's a striking figure considering TennCare qualifications allow families to have much higher incomes and still keep their kids enrolled.

"Unless they won the lottery or something, you don't see that much change in children's coverage," Johnson says. "And if you look year over year for the last 22 years, which we've been doing, you don't see that sort of dramatic change."

There are roughly 1.3 million Tennesseans on the state's Medicaid program — down from a high of 1.5 million when the Affordable Care Act took effect and most people were required to have insurance, which resulted in some discovering they qualified for TennCare.