Breaking TennCare to Fix It.
Bredesen begins to Add-Back programs to Tennessee Medicaid.

By Tim Wheat

Independent reporter Sharon Cobb told us long before the actual TennCare cuts took effect in August that the Bredesen Administration’s purpose in dumping so many citizens off TennCare was to have time before the 2006 election to “add-back” programs and appear to be a Medicaid reformer. The Associated Press reported yesterday that the TennCare Bureau was likely to include home and community options to the current state waiver.

Home and Community-based services (HCBS) are an efficient and effective way to cut the state Medicaid match. Medicaid programs like TennCare are made up of mostly federal money, matched with state money, but to get the federal funds the state programs must meet federal requirements. Nursing homes and other long-term care institutions are expensive and undesirable, but the federal law requires them. States must write a waiver to their state Medicaid programs to provide for the cost-effective home and community-based services that give citizens the option to remain at home or in the workforce.

Tennessee lags behind every other US state in offering home and community-based services. The bloated Medicaid payments to facilities show the waste of the Tennessee public policy. The state of Washington, next to Tennessee in population, serves 50,757 citizens with personal attendant services at about $10,800 a person while Tennessee spends more than $30,000 per individual on institutional care. 

The move toward home and community services is a positive one, however, the Governor’s add-back was an available tool three years ago when he promised to fix TennCare. Using HCBS as an add-back is more of a political tool than a solution to poor public policy. In order to really see savings from alternatives to nursing homes there must be real options that keep Tennesseans out of institutions and help them get out and stay out of nursing homes.

The administration is only suggesting HCBS as an option for less than a thousand citizens. Without making a real commitment to build an infrastructure of home and community choices, the governor will only move some people out of nursing homes to see those beds filled by others. The public policy must also close the back door of the institutions or the Medicaid payments will continue to be swallowed by inefficient and undesirable facilities. Nursing home revenues go up and the Governor appears to be working for the home and community-based services that advocates support.

Tennessee ADAPT has supports a Money Follows the Person plan for Tennessee and demanded Governor Bredesen adopt a no-cost effective plan for our state. Similar state proposals have diverted thousands of individuals from expensive institutions in other states. This simple proposal gives anyone facing going into an institution the option to remain at home and receive services. No waiver needs to be written, and the plan does not cost the state. 

Unfortunately, without building a real structure for home and community-based services, individuals will not escape expensive facilities. Currently in Tennessee, many home health providers do not offer services on weekends or after business hours. Before the state can truly move people out of nursing homes, people with disabilities must be able to get the services they need seven day a week. 

The rewards of such a system are enormous. Tennesseans may choose if they want institutional long-term care, or home and community services. The state saves money, and has the ability to serve more people. People with disabilities may remain taxpayers and support employment of more homecare workers. Every other US state has made strides in this direction, Tennessee still spends over 95 percent of long-term care funding on expensive and inefficient institutions.

The governor’s add-back is designed to appear progressive, but the step toward HCBS is long overdue. Tennessee citizens need a real commitment to fix TennCare, and we need a real commitment to Money Follows the Person and HCBS. 

- Tim Wheat