Doctors leery about Tennessee plan to overhaul Medicaid

Limits on hospital and office visits could hurt the most medically vulnerable TennCare participants.

By Brian Vastag, AMNews correspondent. Sept. 13, 2004.

Washington -- Some good and a lot of bad. That's how physicians are rating the proposed overhaul of TennCare, Tennessee's Medicaid program, which provides care for some 1.3 million poor, disabled and uninsured state residents.

While physicians applaud the plan's commitment to improving the quality of care and reducing prescription drug spending, they worry about new limits on services.

"As a taxpayer, I understand the need to curb costs," said David McKee, MD, a Nashville reconstructive surgeon who treats TennCare recipients. "But after patients use up their hospital days and office visits, they might need more care. It's ultimately the providers who will end up paying."

If the overhaul is approved by federal Medicaid officials, roughly 270,000 beneficiaries will see limits on outpatient hospital visits (eight per year), hospital stays (45 days per year), office visits (10 per year) and prescriptions (six per month). The plan, unveiled in August, also introduces co-payments for certain services and for prescription drugs on a sliding scale from $1 to $250. Over-the-counter drugs will be eliminated from coverage, as will prescription antihistamines and gastric-acid reducers.

Tennessee Gov. Phil Bredesen says the limits are needed to prevent the $7.6 billion program from bankrupting the state. The state pays about one-third of the costs; the federal government pays the balance. TennCare accounts for one of every four state dollars, a proportion projected to increase over the next four years. The governor's office says that without the overhaul, TennCare will consume 80% of all new state tax revenue between now and 2008.