TennCare is Tennessee’s Medicaid program which provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of dependent children and elderly and disabled individuals. It is part of the state agency called Health Care Finance and Administration and operates with an annual budget of approximately $10.5 billion. TennCare provides health coverage to approximately 20 percent of the state’s residents and 50 percent of the state’s children. Current enrollment is approximately 1.5 million Tennesseans.
TennCare provides health insurance coverage through the use of managed care. While many states use managed care, TennCare is currently the only state that enrolls its entire Medicaid population into managed care. Our experience has shown that managed care allows for better coordinated, more efficient, and higher quality care. It also reduces avoidable emergency room visits and hospital stays.
TennCare contracts with three health plans – also called Managed Care Organizations (MCOs) – to manage and coordinate care and maintain a network of health care providers for TennCare members. TennCare’s health plans are AmeriGroup (part of Anthem), BlueCare (part of Blue Cross and Blue Shield of Tennessee), and United Community Healthcare (part of UnitedHealthcare). Pharmacy services are provided by Magellan Health , and dental services for TennCare’s more than 850,000 children (under age 21) are provided by DentaQuest.
TennCare was the first state in the country to require its health plans to be NCQA accredited. NCQA is an independent, nonprofit organization that assesses and scores managed care organization performance in the areas of quality improvement, utilization management, provider credentialing and member rights and responsibilities.
TennCare also contracts with an independent third party to track the satisfaction of TennCare members. Satisfaction ratings have been above 90% since 2009.
In 2010, the TennCare CHOICES in Long-Term Services and Supports (LTSS) program was implemented. This fundamentally changed the way LTSS were delivered to TennCare members by allowing more members to receive services in the home and bringing LTSS into the managed care model. This program has been recognized nationwide as an example of how giving those in need of LTSS more choice can lead to better quality of life for members while at the same time reducing the per person cost of care which allows more people to be served.
TennCare is constantly working on ways to improve services and reduce costs. One project that is currently getting a lot of attention is payment reform. TennCare has obtained a federal grant to develop models that promote quality of care delivered rather than number of procedures billed.
Individuals can apply for TennCare online at www.healthcare.gov, or by calling 1-800-318-2596. Individuals applying for long-term services and supports (LTSS) can find out how to apply at http://www.tn.gov/tenncare/topic/how-to-apply-ltss. Eligibility information can be found at http://www.tn.gov/tenncare/article/categories.