“We keep forgetting it's just politics, and that's what it is at this point,” Jones said.
Jones said she supports the idea of expansion even though she was appointed to her position in 2011 by former Virginia Gov. Bob McDonnell, a Republican. “Just focusing on the fiscal (reasons), it makes no sense not to expand,” Jones said. She added she is hopeful there will be more willingness to consider expanding Medicaid after the Nov. 4 election.
For the past year, Tennessee leaders have entertained a variety of scenarios for expanding Medicaid, but the ghost of the state's Medicaid troubles in the 1990s has made it difficult for state lawmakers to get on board, according to TennCare Director Darin Gordon.
In 1994, Tennessee restructured its Medicaid program and enrolled its entire Medicaid population in managed-care plans. It also extended coverage to all uninsured and uninsurable citizens regardless of income. Costs ballooned to unsustainable levels, quality of care was all over the place, and the state ultimately had start over, dramatically reducing eligibility.
“That memory is still very fresh and we need to help people to understand why this time is different,” Gordon said.
Based on alternative expansion waivers the CMS has approved so far, Gordon said he is confident he could craft a plan that would pass muster with the CMS. However, getting something through the state Legislature is a bigger challenge, he said.
The state has abandoned the idea of pursuing the alternative model adopted in Arkansas, which is using federal expansion funds to help newly eligible residents buy coverage in the state's insurance exchange.
Last month, Republican Gov. Bill Haslam hinted that the state could be ready to submit a plan to the CMS this fall.
Gordon implied that Tennessee leaders are discussing some sort of cost-sharing scenario similar to waivers approved for Pennsylvania and Michigan. Gordon said his goal is to get some of the sicker state residents to be more proactive about their care. As many as 162,000 Tennessee residents could benefit if the state expands Medicaid.
Meanwhile, federal funding for enhanced Medicaid reimbursement for primary care ends Dec. 31, and a recent Kaiser poll of state Medicaid directors found that 22 states won't continue the rate increase on their own. Another 14 states indicated they had not yet made a decision.
Fifteen states, however, indicated that they would shoulder the expense of sustaining the higher rates, at least partially: Alabama, Alaska, Colorado, Connecticut, Delaware, Hawaii, Iowa, Maine, Maryland, Michigan, Mississippi, Nebraska, Nevada, New Mexico and South Carolina.
Tennessee and Virginia will not. Gordon and Jones said the bump did not appear to entice physicians not already seeing Medicaid beneficiaries to participate in the program.
