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TennCare Timeline

Date Action
January 1, 1994 TennCare was implemented, replacing the state's Medicaid program. TennCare covered three groups:
  • Group 1: Medicaid eligibles
  • Group 2: Uninsured people who lacked access to insurance as of a prior date (March 1, 1993) and who continued to lack access
  • Group 3: Uninsurable people, meaning people who had been turned down for health insurance because of a health condition
Manny Martins, who had been Director of Medicaid since 1987, became the new Director of TennCare.
December 31, 1994 Because TennCare enrollment was approaching capacity, the "Uninsured" category (Group 2, above) was closed. No more new Uninsured people were allowed to enroll, although persons whose Medicaid was ending and who met the "Uninsured" criteria were allowed to stay in the program. The "Uninsurable" category (Group 3, above) remained open, as did Medicaid.
April 1995 Rusty Siebert was named new TennCare Director.
May 1996 Theresa Lindsey was named new TennCare Director.
July 1, 1996 TennCare Partners, a carveout for mental health and substance abuse services, began.
August 26, 1996 An Agreed Order, known briefly as Grier, was entered modifying an already existing Consent Decree from 1979 known as Daniels. The order dealt with appeals of service denials.
April 1, 1997 Enrollment was re-opened to uninsured children under the age of 18. There was no income limit for eligibility in this category. Cost-sharing was required of those in this category who had incomes over the poverty level.
May 21, 1997 Enrollment was opened to "dislocated workers," who were defined as persons losing employment through a bona fide plant closing. There was no income limit for eligibility in this category, and the fact that these persons may have had access to COBRA did not disqualify them. Cost-sharing was required of those in this category who had incomes over the poverty level.
January 1, 1998 The age limit for uninsured children was extended to the 19 th birthday. In addition, children living in families with incomes below 200% poverty could enroll in TennCare even if their parents had access to insurance, as long as the available insurance was not purchased. Cost-sharing was required of those in this category who had incomes over the poverty level.
March 1998

John B . Consent Decree was signed.

Dr. Wendy Long was named Interim TennCare Director.

July 1998

The Rosen lawsuit, which dealt with due process rights for people being terminated from TennCare, was filed in federal court.

Pharmacy benefits were carved out of the BHO program and provided directly by TennCare.

December 7, 1998 Newberry, a lawsuit dealing with delivery of home health services, was filed in federal court.
January 14, 1999 Glen Jennings was named Acting TennCare Director.

February 1, 1999 Brian Lapps was named new TennCare Director.
March 31, 1999 Xantus, the third largest MCO, was placed in receivership.
June 1999 Prudential, the second smallest MCO in TennCare, gave notice that it would be leaving TennCare effective December 31, 1999 . Prudential served only residents of Shelby County .
September 27, 1999 John Tighe was named Acting TennCare Director.
October 16, 1999 A Revised Consent Decree Governing TennCare Appeals, which was a follow up to Grier, was filed in federal court. This consent decree outlined improvements in the appeals process.
November 1999 The state provided Xantus with a $26 million loan for the purpose of paying providers owed money by Xantus.
December 15, 1999 Blue Cross, TennCare's largest MCO, gave notice that it would be leaving TennCare effective July 1, 2000 . Blue Cross subsequently withdrew its notice of termination.
January 2000 Governor Sundquist appointed a 17-member Commission on the Future of TennCare to make recommendations about what should be done when the TennCare waiver expired in December 2001.
January 5, 2000 An Agreed Order Governing TennCare Appeals for Children in State Custody, which was a follow up to Grier, was filed in federal court.
March 2000 Governor Sundquist hosted a Summit on the Future of TennCare to gather ideas from doctors, hospital executives, managed care executives, and Tennessee lawmakers about future directions for the program.
May 2000

John Tighe presented a proposal for "TennCare II" to the legislature. This proposal outlined a new business model for TennCare that called for greater accountability in the program. As a part of TennCare II, active recruitment was initiated to bring new MCOs into the program.

Access MedPlus was placed under the administrative supervision of the Tennessee Department of Commerce and Insurance, primarily for failure to meet prompt pay requirements.

A Remedial Plan was entered with the federal court regarding provision of TennCare services to children in state custody.

June 1, 2000 Mark Reynolds was named new TennCare Director.
July 2000

Pharmacy benefits for dual eligibles were carved out of the MCO program.

Blue Cross ended its participation as a risk-bearing entity and began operating under the exigency provisions of its contract.

John Deere, TennCare's next to smallest MCO after Prudential had left the program, gave notice that it would exit the program effective January 1, 2001 . This notice was later withdrawn.

July 31, 2000 The Revised Consent Decree Governing TennCare Appeals of October 16, 1999 , also known as Grier, was modified to clarify its terms and allow more time for full implementation.
September 2000 A three-judge panel of the Sixth Circuit Court of Appeals denied a request for a stay of implementation of Grier pending appeal. The stay had been requested by a number of organizations who had requested intervention in the lawsuit. These organizations included six TennCare MCOs, the Tennessee Association of Health Maintenance Organizations, the Tennessee Hospital Association, and the Tennessee Pharmacists' Association.
November 2000 The Commission on the Future of TennCare presented its recommendations to Governor Sundquist.
January 2001 The Tennessee Justice Center filed a complaint in federal court regarding allegations of contempt in John B.

July 2001 Two new MCOs, Better Health Plans and Universal Care, began operating.
October 2001 Contract with Access MedPlus was terminated.
December 20, 2001 An Order was issued in the John B. case that called for a Special Master.
June 24, 2002 Manny Martins was named new TennCare Director.
July 1, 2002

TennCare was revamped with the intention of dividing it into three programs: one for Medicaid eligibles (TennCare Medicaid), one for demonstration eligibles (TennCare Standard), and one for low income persons who needed help in purchasing available insurance (TennCare Assist). Each of the programs was to have a separate benefit structure.

TennCare Assist has not yet been funded, and the TennCare Standard benefit package has not been implemented due to a settlement agreement reached in Federal Court. All persons enrolled in TennCare currently have the same package of benefits.

Eligibility changes in the new program included the following:

  • A new Medicaid eligibility category was added. This category covered uninsured women under the age of 65 who had been determined by a Centers for Disease Control (CDC) site to be in need of treatment for breast or cervical cancer. There was no income limit on this category for Medicaid, although CDC required that women receiving screenings at a CDC site have incomes below 250% poverty. Medicaid eligibles have no cost-sharing requirements.
  • The category of "Uninsurables" was replaced by a category called "Medically Eligibles." New persons can enroll in this category if they do not have insurance, they meet "ME" criteria, and their incomes are below the poverty level. Medical eligibility must be proven through a medical underwriting process, rather than being proven simply by a "turn-down" letter from an insurance company.
  • The definition of "Uninsureds" was tightened by providing a more restrictive definition of the term "insurance." Certain groups of uninsured people who were already on TennCare were "grandfathered" into the new program.
  • Persons losing Medicaid eligibility or already enrolled in TennCare in some other category on July 1, 2002, were allowed to remain on the program if they were uninsured AND their incomes did not exceed 100% poverty for adults and 200% poverty for children OR if they were determined to be "medically eligible" at any income level.
  • New enrollment in the Uninsured category was closed. Provisions were made for an annual open enrollment period for low-income people in this category, depending upon the availability of legislative appropriations.
  • A process called "reverification" was begun whereby all persons in the demonstration population were asked to make appointments at the Department of Human Services so that DHS could determine whether these individuals were eligible for Medicaid, eligible for TennCare under the new criteria, or no longer eligible for TennCare under the new criteria.
October 2002 A dental carveout program was initiated.
January 1, 2003 Benefit reductions were scheduled to go into place for Medicaid adults and TennCare Standard enrollees. A "pharmacy-only" program was scheduled to go into effect for TennCare/Medicare dual eligibles who had been grandfathered into the new program. New copays were scheduled to go into effect. Because of litigation, none of these changes was implemented.
March 28, 2003 The Governor announced that benefit reductions scheduled to go into place for Medicaid adults and TennCare Standard enrollees would take place on April 1. A "pharmacy-only" program was scheduled to go into effect for TennCare/Medicare dual eligibles who had been grandfathered into the new program. New copays were scheduled to go into effect. The benefit reductions did not occur because of progress occurring on a Settlement Agreement.
June 1, 2003 Contract with Universal was terminated and Universal's enrollees moved to TennCare Select.
July 1, 2003 All pharmacy services were carved out to a single Pharmacy Benefits Manager.
August 26, 2003 The state and the plaintiffs entered into a joint motion providing for a grace period for persons who had lost coverage under the new criteria, withdrawing proposed benefit reductions and cost-sharing increases, maintaining EPSDT coverage for non-Medicaid children eligible for TennCare, and modifying the circumstances in which enrollees could receive prescription medications without authorization.
August 1, 2003 The state's contract with Xantus was terminated and Xantus's enrollees moved to TennCare Select.
October 6, 2003 A Settlement Agreement was reached with the plaintiffs in four TennCare lawsuits.
December 11, 2003 McKinsey and Company released the first of two reports analyzing the status of TennCare and identifying options for consideration.
February 11, 2004 McKinsey and Company released the second of its two reports analyzing the status of TennCare and identifying options for consideration.
February 17, 2004 The Governor announced his proposals for "TennCare Transformation." Work groups were put together in key areas and tasked with developing specific recommendations to implement the Governor's direction.
July 12, 2004 J. D. Hickey, formerly of McKinsey & Company, was appointed new Director of the TennCare program.
August 19, 2004 A draft of a request for a waiver amendment to CMS was released for public comment. The waiver amendment would effectuate the Governor's recommendations for TennCare and significantly restructure the program.
September 24, 2004 The waiver amendment was formally submitted to CMS.
November 10, 2004 Acknowledging that the proposed reform effort of September 2004 could not proceed without significant modification of the Consent Decrees, Governor Bredesen announced that he was setting in motion a process to end TennCare and return to Medicaid.
January 10, 2005 Governor Bredesen announced that he was making a strong effort to preserve some vestiges of the TennCare program, but that doing so would require removing adult Uninsured and Uninsurable persons who were currently on the rolls, as well as closing the non-pregnant adult Medically Needy categories. Children were to be protected. Some benefit restrictions for adults were also proposed.
March 24, 2005 CMS announced that it had approved the state's request to disenroll Uninsured and Uninsurable adults and to close the non-pregnant adult Medically Needy categories.
April 29, 2005 The state closed new enrollment into the non-pregnant adult Medically Needy categories.
June 8, 2005 CMS approved a waiver amendment allowing the state to place a limit on coverage of prescription drugs for non-institutionalized adults and to make certain other benefit changes.
August 1, 2005 The new limits on prescription drugs for non-institutionalized adults were implemented. Coverage of emergency dental services for adults was eliminated. Coverage of methadone clinics for adults was eliminated.
December 6, 2005 Governor Bredesen announced plans to re-open the non-pregnant adult Medically Needy category, except that the category would be covered under the waiver as a demonstration population rather than a Medicaid population.
January 11, 2006 The state submitted a waiver amendment to CMS to be able to enroll 100,000 non-pregnant adult Medically Needy individuals as a new demonstration population.
April 7, 2006 RFPs were used for the first time to recruit new MCOs to the TennCare program. An RFP was issued for MCOs to serve enrollees in Middle Tennessee, using an integrated medical and behavioral services model.
May 21, 2006 A proposal was submitted to CMS to consolidate the state's three HCBS programs for aged and disabled individuals into one program.
June 15, 2006 The state requested an extension of the TennCare waiver, which was scheduled to expire on June 20, 2007.
July 17, 2006 Darin Gordon, former Chief Financial Officer of TennCare, was named the new TennCare Director.
November 14, 2006 CMS approved the "Standard Spend Down" program, which was the name given to the new program to cover non-pregnant adult Medically Needy persons as a demonstration population under the waiver.
December 31, 2006 Active MCOs had been given a deadline to obtain NCQA accreditation by this date or be terminated from TennCare. TennCare became the first Medicaid program in the country to have all of its MCOs NCQA-accredited.
April 1, 2007 Two new health plans began operating on an "at risk" basis to provide both medical and behavioral services to enrollees in Middle Tennessee.
June 30, 2007 This was date when the TennCare waiver was due to expire. CMS had still not completed its approval of Tennessee's request for an extension.
October 5, 2007 After six short-term extensions, CMS granted an extension of the TennCare waiver until June 30, 2010.
November 2007 The state conducted an ex parte review of eligibility for persons in the non-pregnant adult Medically Needy categories who had been held on TennCare since the category was closed on April 29, 2005. Plans were completed to begin mailing Requests for Information (RFIs) to persons not found to be eligible through the ex parte review process.
December 1, 2007 The state ended collection of new premiums for TennCare Standard members with incomes at or above 100% of poverty.
February 1, 2008 The state entered a motion in federal court asking permission to begin reviewing the eligibility of Daniels class members and terminating the eligibility of those who were found not to be eligible for TennCare.
February 29, 2008 The state submitted a waiver amendment to CMS ("Amendment #6") that would allow limits to be placed on home health and private duty nursing services for adults.
March 6, 2008 Governor Bredesen announced details of his proposed "Long-Term Care Community Choices Act of 2008," which would consolidate long-term care services for elderly and disabled individuals and bring those services for TennCare eligibles under managed care.
April 2008 TennCare awards SXC with the contract for Pharmacy Benefits Manager after a competitive bid process. First Health and ACS also bid for PBM. SXC begins functioning as PBM October 2008.
July 11, 2008 The state submitted a concept paper to CMS outlining the concept of the Long-Term Care Community Choices program that would be submitted in a waiver amendment.
July 22, 2008 CMS approved "Amendment 6" allowing limits to be placed on home health and private duty nursing services for adults.
September 2008 After receiving approval from CMS, TennCare implements adult home health and private duty nursing benefit limits.
October 2008 The state submitted "Amendment 7" to CMS. This amendment would allow long-term care services for elderly and disabled individuals to be brought under the managed care program.
November 2008 Two new MCOs began serving TennCare enrollees in West Tennessee. These MCOs, AmeriChoice and BlueCross/BlueShield, were both selected by the state through a competitive bid process in the spring and are operating in a full-risk capitated arrangement.
January 2009 AmeriChoice and BlueCross/BlueShield were implemented as new MCOs in East Tennessee after being selected through a competitive bid process. This marks the Bureau's return to full financial risk for the program's MCOs statewide.
January 2009 The Sixth Circuit Court of Appeals relieved the state from the court order known as Daniels that prevented TennCare from re-verifying the eligibility of approximately 147,000 enrollees known collectively as "the Daniels class". The Daniels class is made of individuals who at one time received SSI cash payments but no longer do.
May 2009 TennCare begins the Daniels re-verification process. Enrollees in the Daniels class are asked to fill out the re-verification form all other enrollees must complete annually to determine whether they are still eligible for the program.
June 2009 The State requests a 3-year extension of the TennCare II waiver. The current waiver expires on June 30, 2010. The extension will cover the period from July 1, 2010, through June 30, 2013.
July 2009 Amendment #7 is approved by CMS. The amendment allows TennCare to incorporate long-term care services into managed care. This will allow the state to provide more home and community based services to those who qualify for Medicaid Long-term Care.
September 2009 Waiver amendment #8 was submitted to CMS. Its purpose is to ensure compliance with the Mental Health Parity requirements of the Emergency Economic and Stabilization Act of 2008 by removing, effective January 1, 2010, the current limits on inpatient and outpatient substance abuse treatment benefits for adults.
September 2009 TennCare completes program-wide integration of medical and behavioral health services after TennCare Select takes over the behavioral health services for its enrollees. TennCare Select is operated by Blue Cross and Blue Shield and serves approximately 72,000 children - foster children, children receiving SSI, and children under 21 in a nursing facility or ICF-MR. TennCare Select also serves as the state's back-up MCO.
December 2009 CMS approves the State's request for a 3-year extension of the TennCare II waiver. The approval includes an approval of Amendment #8. The extension is for the period of July 1, 2010, through June 30, 2013.
January 2010 TennCare completes the Daniels re-verifications process. In all, approximately 100,000 individuals were found to be on the program who were unable to verify eligibility. More than 60 percent of those who lost eligibility retained health coverage through Medicare.
February 2010 The Affordable Care Act is passed by Congress and signed into law by the President. This law will greatly change Medicaid programs like TennCare in the coming years.
February 2010 TennCare submits Amendment #9 to CMS. Amendment #9 contains requests for certain benefit reductions and eliminations for most adults participating in TennCare.
March 2010 The TennCare CHOICES in Long-Term Care program begins in Middle Tennessee. The CHOICES program is part of the Long-Term Care Community Choices Act of 2008 provides home and community based services for more individuals in need of long-term care.
March 2010 TennCare begins shift to an annual MCO change period based on grand region: West TN - March; Middle TN - May; East TN - July.
May 2010 The General Assembly passes a hospital assessment for hospitals that will generate significant new revenue for the TennCare program, postponing budget reductions brought on by the recession.
May 2010 TennCare submits Amendment #10 to CMS. This amendment recognizes the additional revenues made available to TennCare from the hospital assessment fee, thereby rendering most of Amendment #9 unnecessary.
June 2010 TennCare begins to transition individuals in MR waiver programs to a special nurse care management program offered through TennCare Select.
July 2010 TennCare submits Amendment #11 to CMS. This amendment expands the Public Hospital Supplemental Payment (PHSP) pool and adds Nashville General Hospital as a participant.
August 1, 2010 The TennCare CHOICES in Long-Term Care program is implemented statewide.
December 16, 2010 CMS approves Amendment #11, expanding the Public Hospital Supplemental Payment (PHSP) and adding Nashville General Hospital as a participant.
January 2011 On January 1, 2011 AmeriChoice officially changed its name to UnitedHealthcare Community Plan.
January 2011 TennCare opens registration for the Electronic Health Record (EHR) Provider Incentive Program. Tennessee is one of only eleven states to launch this program on January 3. The program awards cash grants to Medicare and Medicaid providers to demonstrate "meaningful use" of electronic health record technology.
May 2011 The General Assembly passes the hospital assessment fee, once again postponing budget reductions.
February 2011 TennCare submits Amendment #12 to CMS. This amendment proposes several changes to the TennCare benefit package for adults to bring TennCare's budget into line with state revenues.
July 2011 TennCare extends Middle Tennessee contracts with Amerigroup and UnitedHealthcare Community Plan through December 31, 2014.
July 1, 2011 The Bureau of TennCare began covering medically necessary smoking cessation products for all enrollees. Previously the benefit was only available to pregnant women and enrollees under the age of 21.
September 12, 2011 The TennCare Standard Spend Down Program opened enrollment for the third time accepting new enrollees.
November 15, 2011 The Center for Business and Economic Research at the University of Tennessee released results from its study "The Impact of TennCare: A Survey of Recipients 2011" finding that 95 percent of TennCare recipients continue to express satisfaction with the program.
February 7, 2012 The TennCare Standard Spend Down Program opened enrollment for the fourth time accepting 2,500 new applicants.
May 2012 The General Assembly once again passed the hospital assessment fee.
August 3, 2012 The state issued a request for proposals for a new Pharmacy Benefits Manager. The contract between TennCare and Catamaran (formerly SXC Health Solutions) expires on May 31, 2013.
September 13, 2012 The TennCare Standard Spend Down Program opened enrollment for the fifth time accepting more than 2600 new applicants.
November 6, 2012 TennCare named Magellan Health Services the program’s new Pharmacy Benefits Manager. Magellan will replace Catamaran, which has held the role since 2008.
December 19, 2012 TennCare announced its decision to join Catalyst for Payment Reform (CPR). CPR is a national independent organization led by large purchasers of health insurance with active involvement of providers, health plans, consumers, and labor groups working to improve health care quality and reduce costs by identifying and coordinating workable solutions to improve how health care is paid for in the United States.