On Jan. 12, 2005, the Governor announced that he is planning to terminate 323,000 people from TennCare. (Number of people proposed to be cut in each county.)

On March 24, the Governor received approval from the federal government (See letter) to terminate 323,000 people, most of whom have serious medical conditions.

• 226,000 enrollees will likely be cut from the TennCare program altogether and most of these will join the ranks of the uninsured;

• 97,000 enrollees will be subject to draconian benefit limits and their coverage will terminate over the next year;

• 396,000 enrollees, no matter how sick, will have drastically limited health care services and treatments; and

• Every single person who remains on the program will face a new definition of “medical necessity” that will limit their ability to obtain needed care.

1. 67,000 people who were too sick to obtain private health insurance;

2. 121,000 people who are uninsured and have “bought-in” to TennCare insurance; and

3. 38,000 people who have both Medicaid and Medicare.

• doctor’s visits will be limited to 12/year

• lab and x-ray services will be limited to 10 per year;

• inpatient hospital days will be limited to 20 per year;

• outpatient hospital visits will be limited to 8 per year;

• prescription drugs will be limited to 5 (2 brands, 3 generic) per month; and

• no private duty nursing or convalescent care.

• l no prescription drug coverage at all;

• inpatient hospital days will be limited to 5 per year; and

• outpatient hospital visits will be limited to 3  per year.

• Redefining Medical Necessity: People in TennCare only get services if they are determined to be “medically necessary.” The Governor’s plan puts bureaucrats—not doctors—in charge of making decisions about which treatments are needed and which aren’t.  Just as bad, his plan only allows coverage for the cheapest treatments that are “adequate”- not the best or most cost-effective treatments.

• Appeal Process Changes: TennCare enrollees will no longer be entitled to a hearing when they appeal.  The State will determine whether the State thinks the enrollee has a “valid factual dispute” and only those who the State believes have claimed a valid dispute will get a hearing.

• Limiting Care in Crisis Situations: Once a TennCare enrollee has reached their benefit limit, no additional services will be covered even in the case of a medical emergency. TennCare will cover only the cost of the initial evaluation and stabilization of an enrollee that has reached the benefit limit. After that, enrollees will have to make a terrible choice-pay for expensive medical care out of their own pockets or not get the care they need.

• Unlimited Program Changes: Governor Bredesen is asking the federal government for pre-approval to make any additional cuts in the TennCare program that he wants. These changes could include further cuts in access to health care services.