All hospitals with at least 75% of visits covered by Medicaid must participate or the state will revert to its zero visit policy.
Tennessee has also attempted to limit ED visits by Medicaid patients, said Dr. Sanford H. Herman, immediate past president of the Tennessee Chapter of ACEP and an emergency physician in Nashville. The state’s traditional Medicaid program was replaced in 1994 by a network of 12 managed care organizations called TennCare. TennCare was supposed to be more efficient and less costly, but it was on its way to consuming half of the state’s budget by the late 2000s, Dr. Herman said.
In 2005, then-Governor Phil Bredesen (D) began slashing TennCare’s funding. In 2010, about $525 million was cut and some 200,000-300,000 enrollees were dropped, said Dr. Herman.
The state proposed limiting ED visits to eight per year and eliminating pay for certain nonemergent conditions. Any other proposal – such as changing benefits or increasing cost-sharing – would have required approval from the U.S. Centers for Medicare and Medicaid Services.
The Tennessee Chapter began meeting with state officials to head off the policy. In April 2011, when the 2012 budget was being formulated, the Chapter learned that visits for nonemergent services would be reimbursed at the rate of a level 1 office visit, or $17. The list of such services was more than 200 pages long, Dr. Herman said.
Lobbying efforts resulted in the $17 becoming $50, at least for the next year. The Tennessee Chapter is working with the current governor and TennCare to come up with a larger solution to help stop the bleeding from the state’s coffers, he said.
Meanwhile, representatives of the Tennessee Chapter go to the State Capitol building every Tuesday and Wednesday to continue the campaign, Dr. Herman said.
Dr. Herman, Dr. Schneider, and Dr. Schlicher urged emergency physicians to get involved in the state Medicaid battles. "Keep your ears and eyes open," said Dr. Schneider, who also recommended that doctors alert the national ACEP organization when a potentially onerous policy is being discussed or proposed "because these people have your back," she said.