TennCare has submitted a proposal to the Centers for Medicare & Medicaid Services (CMS) to add work reporting requirements to the state's Medicaid program. Under these requirements, enrollees must report on a monthly basis that they have engaged, for at least 20 hours per week, in a qualifying activity (including work, education, or community service) or that they meet an exemption. This change would be a fundamental shift away from Medicaid's core purpose of providing health insurance to low-income people.
There is a common misconception (particularly by the State Legislature that directed TennCare to seek this waiver) about who benefits from Medicaid in this state. TennCare provides health insurance to low-income people who also fit into one of the following eligibility categories: (1) children, (2) parents/caretaker relatives, (3) people with disabilities or specific medical conditions, and (4) elderly people. Currently, over 1.3 million people rely on TennCare to meet their healthcare needs. Because Tennessee is one of only 14 states that have not expanded Medicaid to cover adults with incomes between 100 percent and 138 percent of the federal poverty level, the only non-disabled, non-elderly adults on TennCare are caregivers. This proposal aims to spend $44 million in order to save $10 million by disenrolling 2.8 percent of all TennCare beneficiaries.
Medicaid is a federal-state partnership, with the federal government paying 65 percent of costs and Tennessee paying 35 percent of costs. So, by reducing Medicaid enrollment, Tennessee would not only spend more money to cover fewer people, but it also would leave additional money on the table by foregoing the federal matching funds. Such a reduction in enrollees will cause the state to lose millions in federal Medicaid dollars, leading to ripple effects in every department that uses this funding.
Beyond the direct benefit to over 1.3 million enrollees on TennCare, the state relies on federal Medicaid money to partially fund administration and/or direct services in the following departments: (1) Children's Services, (2) Health, (3) Human Services, (4) Intellectual and Developmental Disabilities, and (5) Mental Health and Substance Abuse Services. For every dollar the state spends in its overall budget, 20 cents come from federal Medicaid match funding.
A recent report notes that if this proposal is approved, an estimated 68,000 parents will lose their insurance coverage, based on coverage losses in Arkansas - the only state to implement work reporting requirements to date. In Arkansas, only 15 percent of those who were subject to reporting were able to overcome computer and bureaucratic problems to document their compliance. The problem will be much worse here, since unlike Arkansas, Tennessee doesn't exempt parents of minor children, doesn't have a functional computer system, and doesn't have county Medicaid offices where people can get in-person assistance.
Despite Tennessee being the only state that does not have its own functioning computer system to determine Medicaid eligibility, TennCare will endeavor to assess member compliance every six months. Members who have not demonstrated compliance (by documenting that they have engaged in qualifying activities or that they meet an exemption) for at least four months of the six-month reporting period will be subject to suspension of benefits. Meaning they will no longer have insurance coverage for doctor's visits, hospitalizations, prescriptions, or any healthcare services that are vital to maintain well-being and be healthy enough to work.
Tennesseans need to be aware of the consequences of this proposed change, including:
(1) Coverage losses will occur, even among those who have qualifying activities or meet an exemption, due to administrative glitches and burdensome reporting;
(2) Demand on emergency rooms (and uncompensated care) will increase;
(3) Families will be harmed because when parents lose coverage, their children are less likely to access healthcare services, and financial security is compromised with the threat of medical debt and bankruptcy; and
(4) Lack of affordable childcare, transportation, or employment opportunities will be impossible for many parents to overcome.
Even if parents overcome all obstacles and become employed, they may earn too much to qualify for TennCare, but their job is unlikely to offer affordable insurance. Only about half of businesses in Tennessee provide health insurance to their employees.
For all these reasons, work reporting requirements just don't work.
I urge Tennesseans to attend this forum on February 5, 2019 from 6:30-8 pm at the First Amendment Center to hear from an expert panel about how these requirements will jeopardize the well-being of Tennesseans and our economy and to submit a comment opposing these harmful requirements by February 7, 2019 using this survey.