Children's Defense Fund

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January 11, 2005  
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Ron Eckstein: (202) 662-3609
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Gov. Bredesen's TennCare Proposal Would Erode
Medical Protections for 600,000 Tennessee Children

Tennessee Gov. Phil Bredesen has announced a major plan for overhaul of the TennCare program, which provides health care for more than 600,000 children in low-income families, and contrary to his assertion that it will "preserve full coverage," these children are not likely to continue receiving the same medical benefits they have now. The Bredesen administration is taking significant steps to water down the state's definition of "medical necessity" in a way that would enable state bureaucrats to deny needed health care services. Worst of all, if federal officials approve the change in Tennessee, it will open the floodgates to similar limits on children's services in many states that are seeking flexibility in the way they run their Medicaid programs.

In a document filed yesterday in U.S. District Court in the Middle District of Tennessee, state officials asked a judge to modify an existing consent decree that requires the state to protect children's benefits in the Medicaid program. Tennessee intends to implement a new "medical necessity" standard that would undermine the medical decision making of health care providers. The judge is being asked to grant state bureaucrats authority to deny or dictate treatment by approving only services that are the "least costly alternative . adequate to address the medical condition."

The redefinition would give the state agency unfettered discretion to decide what benefits are covered without considering generally accepted medical standards. This is a blatant circumvention of the federal Medicaid statutory requirement of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services. This imposes on states the obligation to cover "necessary health care, diagnostic services, treatment, and other measures.to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the state plan."

While arguing that Tennessee has unquestioned discretion on the medical necessity standard, the state is simultaneously claiming that no children in TennCare will lose benefits. The truth is that all children in TennCare are being put at risk of losing essential health care, and no public pronouncement to the contrary will change that. If Tennessee wants to reduce health care benefits for children, it should acknowledge that fact and let voters and the families of Tennessee 's children assess the plan accordingly. We urge the federal court in Tennessee to deny the state's attempt to strip children of the EPSDT benefits that Congress mandated, and we urge the Bush administration to reject any governor's request to undercut the EPSDT benefits for children.

 

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The mission of the Children's Defense Fund is to Leave No Child Behind and to ensure every child a Healthy Start, a Head Start, a Fair Start, a Safe Start, and a Moral Start in life and successful passage to adulthood with the help of caring families and communities. CDF provides a strong, effective voice for all the children of America who cannot vote, lobby, or speak for themselves. We pay particular attention to the needs of poor and minority children and those with disabilities. CDF educates the nation about the needs of children and encourages preventive investment before they get sick, into trouble, drop out of school, or suffer family breakdown. CDF began in 1973 and is a private, nonprofit organization supported by foundation and corporate grants and individual donations. We have never taken government funds.

 

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