Tennessee Medicaid History and Facts

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Initial Medicaid Implementation: Tennessee initially implemented Medicaid in June of 1969, three years following the initial implementation start date. In the first few years of the program, the state struggled with physician participation. The Tennessee Medical Association stated that their doctors were seeing low-income patients but were not filing the paperwork for Medicaid. In response the state doubled the reimbursement rate to encourage participation. When the state began the their Medicaid program they did not cover people who were “medically indigent.”

Key Medicaid Political Issues: Tennessee is most known for their TennCare program which was established through a waiver in 1994. The plan eliminated the state’s fee-for-service program and would put all existing Medicaid beneficiaries in managed care plans. Originally, the plan was available to all residents that qualified for Medicaid and for state residents who could not purchase private insurance for a number of reasons including because of a pre-existing condition. The program grew rapidly and within the first year the program began limiting eligibility to people who were eligible for Medicaid or ineligible for private insurance because of a pre-existing condition and met income requirements. In 2003 after a change in Governors the TennCare program was determined to not be financially viable and in 2005 the program guidelines were changed to reduce the number of people who would be covered by the program. 190,000 people were removed from the TennCare roles. The changes also reduced the number of medical services and prescription drugs that the remaining beneficiaries could use.

Medicaid Expansion Implementation: As of January of 2019, Tennessee has not implemented Medicaid expansion. The state has debated whether to take up the Medicaid expansion several times and came close to expanding in 2015. The state has proposed work requirements for the existing Medicaid populations, primarily parents and certain adult caregivers, that would require them to work or meet community engagement requirements for a minimum of 20 hours per a week. The bill was criticized for the inclusion of a provision that would use TANF funds to pay for the administrative costs of work requirements. CMS has not approved work requirements for any state that has not expanded Medicaid. In the past, Tennessee law makers have proposed other restrictive Medicaid expansion policies including block granting Medicaid. During the initial rollout of the Affordable Care Act’s coverage expansion and HealthCare.gov the Tennessee Medicaid eligibility system faced some challenges and there were significant delays transferring applications from HealthCare.gov to be processed by the state.

General facts about Tennessee Medicaid:
Medicaid program name: TennCare
CHIP Program name: CoverKids
Separate or combined CHIP: Combination
Medicaid Enrollment: 1.38 million (2018 estimate)
Total Medicaid Spending: $9.1 billion (FY 2017 estimate)
Share of total population covered by Medicaid: 20%
Share of Children covered by Medicaid: 43% (estimate)
Share of Medicaid that is Children and Adults: 72%
Share of Spending on Elderly and people with disabilities: 54%
Share of Nursing Facility Residents covered by Medicaid: 60%
FMAP: 65.21%
Expansion state: No
Number of people in expansion: N/A
Work Requirement: Under Review

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