Policy leaders and community advocates came together at the 2023 Tennessee State of Reform conference last month to discuss coverage retention efforts during the Medicaid unwinding, and what the healthcare system is doing to support Tennesseans through the process.
The Division of TennCare is currently working its way through the federally required Medicaid redeterminations. The unwinding began in April after the end of continuous enrollment, though states had different timelines for when their first redeterminations occurred.
Drew Staniewski, deputy director at the Division of TennCare, gave an overview of how the redeterminations work.
“We have an obligation to do this. That exception (continuous Medicaid enrollment) that Congress put into place is now lifted, and all the states are now having to figure out how we go forward. So what makes the unwinding unique, if we’re having to do annual redeterminations on a normal course? Really, it’s about volume.”
— Staniewski
He said that before the pandemic, there were around 1.4 million people on Medicaid in Tennessee. During the pandemic, the highest number was around 1.8 million people. TennCare expects the number to drop back down during redeterminations to its pre-pandemic number.
As of Dec. 14th, approximately 387,400 (67 percent) of redetermined Tennesseans have had their coverage renewed, while 33 percent, or about 187,000, of the redeterminations have ended in disenrollment, according to Kaiser Family Foundation’s (KFF) Medicaid unwinding tracker.
Staniewski emphasized that it is difficult to compare data between states, because, “the reality is, every state is approaching this a little bit differently.”
“From the Tennessee perspective, we have been really running as close to a normal redetermination process as possible,” he said. “We’re one of a handful of states that, since the beginning of even the planning stages, we have not been under a mitigation plan from [the Centers for Medicaid and Medicare Services (CMS)]… That really enables us to run the process as designed as opposed to having to make alterations.”
Amanda Newell, vice president of financial policy at the Tennessee Hospital Association, spoke from the hospitals’ point of view about the redeterminations.
“It has been a pretty smooth process because of all the front work TennCare did and I think it goes back to their past experiences with redeterminations,” Newell said.
A top priority she sees is just making sure TennCare beneficiaries are prepared and understand the redeterminations. She pointed to the workforce shortage as an issue, as high staff turnover makes it difficult to ensure all the staff in an office or hospital are trained and able to educate patients about the unwinding.
Newell emphasized the important role hospitals can play in spreading the word about redeterminations.
“Hospitals continue to work with communities; making sure churches know, putting flyers out, sending their own information,” she said. “TennCare gave us a lot of resources that we have then pushed out to our providers.”
Judy Roitman, executive director of Tennessee Health Care Campaign (THCC), a volunteer-led nonprofit whose main goal is to increase access to affordable healthcare, said her organization helps people find a direct source of affordable health coverage either in the marketplace or in TennCare.
Roitman expressed concern about procedural disenrollments, which happen when the division does not receive the necessary paperwork to process a renewal, even if the person is eligible.
“Everybody, I would hope, would want to avoid that kind of turn where people who are eligible are not getting services, [and] they’re not finding out until they show up at the hospital where the doctors say they have been disenrolled,” Roitman said.
Of the disenrollments that have occurred in Tennessee, 74 percent were procedural disenrollments. According to KFF, the US average is 71 percent.
The TennCare unwinding facts page says anyone who was disenrolled from TennCare can immediately reapply, and if re-enrolled, their coverage would date back to the date of their application. For children and pregnant women, the coverage may extend back up to 90 days before the application.
Staniewski also explained the process of nudging, which is when the state conducts an extra push to remind people of their redeterminations. Nudges may involve calls, texts, mail, or push notifications.
“Nudges that go out create strain on the call center volume,” Staniewski said. “… We’ve been staffing up more in the call center trying to make sure that we’re catching everybody.”
He said Tennessee is also taking advantage of some of CMS’s temporary flexibilities to aid in the process, like using Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families data to determine eligibility, and using data from sources like the post office to be sure beneficiary addresses are up to date.
These flexibilities are meant to promote ex parte—automatic—renewals, which lessen paperwork burden on both the division and the TennCare beneficiaries.
When people are ultimately disenrolled from Medicaid, the division moves them to the federal marketplace.
BlueCross BlueShield of Tennessee (BCBST) sent a statement to State of Reform discussing what the redetermination process is like from the insurance provider perspective. BCBST is one of the many health insurance providers in the state and it is a Managed Care Organization. Their Medicaid program in Tennessee is called BlueCare.
“Working with TennCare, we’ve been able to proactively communicate with members affected by this redetermination. The most important message is that these members may be eligible to sign up for marketplace plans. Many people who think they can’t afford a marketplace plan may be surprised. Up to 90% of Americans losing their Medicaid coverage may qualify for government help that lowers their monthly cost.”
— BCBST statement, Dec. 6th. 2023
In 2024, BCBST is introducing new lower-priced plans.
For those who have not had their Medicaid redetermined, TennCare’s unwinding facts page says beneficiaries can be proactive to confirm and aid their renewal. These people should verify their contact information and find their renewal date through TennCareConnect or by calling 855-259-0701.
The division advises beneficiaries to open and respond to any texts, emails, or mail they receive from TennCare. They can update their communication preferences when they create a TennCareConnect account, and access the information more quickly if they download the TennCareConnect app.