Outreach and Enrollment
TDH has undertaken several efforts to assist clients seeking services in public health departments to access public insurance or insurance available through the health insurance marketplace. In the 89 rural counties, there are at least two (and in many cases more) options for obtaining assistance with Medicaid and ACA insurance enrollment. TDH clinic management staff can provide clients with information (verbal and written) about how to access enrollment assistance for these plans.
A map was developed in 2014-15 that indicated the locations of state agencies and partners across the state who could assist with insurance enrollment and outreach. The map and list of referral sources was shared with both local and regional health department leadership. Local staff have this map and resource listing as a tool to assist patients in finding navigator and application assistance services.
Clinical Application Coordinators (CACs) are also available in 16 counties (Stewart County, Gibson County and all 14 counties of the Upper Cumberland Region) as well as in metro health departments. These CACs provide outreach and on-site enrollment services in communities across the state for marketplace plans. Additionally, the TDH Breast and Cervical Cancer Screening Program (partially funded by Tennessee’s MCH/Title V Program) and the Ryan White HIV/AIDS Program each have one CAC in each rural region to assist with outreach and on-site enrollment efforts. Care coordinators for CSS also assist with enrollment through the marketplace and with appeals for third-party payer denials.
In all clinic sites, TDH staff provides presumptive eligibility (PE) determination for Medicaid for pregnant women and for individuals diagnosed with breast or cervical cancer. TDH has begun including a checklist for those who qualify for Presumptive Eligibility or CoverKids (Tennessee’s SCHIP) enrollment. This checklist includes in simple terms what Medicaid could request to prevent their coverage from being dropped after the Presumptive period ends. The checklist includes how to sign up and use TennCare Connect so the applicant can manage their Medicaid coverage and contact information on their own. Several health departments provide lists of resources available locally for pregnant women, but this varies by county and region. Central Office reviews equity data from enrollments to determine which communities or groups are being underserved and working to provide services and outreach to those underserved groups and communities.
During FY2021 TDH served 8,273 presumptive eligibility and CoverKids applicants. TDH conducts routine training with local staff on changes in the Medicaid enrollment process to ensure that eligible persons can be served.
Healthcare Financing
TennCare services are offered through managed care entities. Medical, behavioral and Long-Term Services and Supports are covered by “at-risk” Managed Care Organizations (MCOs). All of TennCare’s MCOs have recently been ranked among the top 100 Medicaid health plans in the country. The care provided by TennCare’s MCOs is assessed annually by the National Committee for Quality Assurance (NCQA) as part of the state’s accreditation process.[1] In addition to the MCOs, there is a Pharmacy Benefits Manager for coverage of prescription drugs and a Dental Benefits Manager for coverage of services to children under age 21.
Policy Waivers and State Plan Amendments
A Katie Beckett Waiver program was signed into Tennessee state law in May 2019. TennCare subsequently submitted an amendment request to the Centers for Medicare and Medicaid Services (CMS) to implement the program in September 2019. CMS approved the request in November of 2020. The program was made available to families that same month. Within two months 849 referrals were received; 600 were received the first day. As of January 2021, 290 children have been enrolled in the program.
The Katie Beckett Program helps kids in Tennessee with disabilities and complex medical needs under the age of 18. The Katie Beckett Program provides care for children under the age of 18 with disabilities and complex medical needs whose parent’s income may make them ineligible for Medicaid.
Katie Beckett Part A assists children in Tennessee with the most significant disabilities or complex medical needs. A child must meet “institutional” level of care but want to receive care in the home. Children in Part A receive full Medicaid Benefits and also can get up to $15,000 in nonmedical services called home and community-based services. A child must have private insurance, and a premium may be required based on the family’s income.
Katie Beckett Part B is for children in Tennessee who have disabilities and complex medical needs who do not qualify for care in a medical institution. They meet “at risk” level of care. Children in Part B do not receive Medicaid. Families get up to $10,000 a year in services to care for their child. Families can spend the money in Part B in any or all of 5 different ways: a card to pay for medical expenses, paying for a child’s private insurance premium, getting paid back for certain services including non-traditional therapies, hiring your own staff to provide respite and supportive home care or having a community provider for services.
Due to the ongoing COVID-19 pandemic a new law addressing telemedicine was enacted in August of 2020 and will remain in place through April 2022. This new law requires health insurers to cover virtual care the same way they would in-person care. Specifically, the new law establishes payment and reimbursement parity between telehealth and in-person visits, removes geographic requirements on original service location and expands the list of healthcare providers who are permitted to provide telehealth services most notably, to include drug addiction counselors. These changes remove many barriers to care and help to reduce possible transmission of COVID-19 infection through person-to-person contact.
Title V/Title XIX Joint Policy Making
MCH/Title V Director and direct supervisor meeting monthly with Title XIX’s Chief Medical Officer to discuss joint efforts and brainstorm solutions common challenges. Regular meetings also occur for joint workgroups addressing EPSDT, CHANT, and PE. Over the last year these meetings have produced formal contracts between the two agencies to address the health department’s role in EPSDT services for children, care coordination for families including CSHCN (CHANT), immunization outreach, data sharing, and additional support for presumptive eligibility and care coordination for pregnant women.
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