Contriversy regarding TennCare & disabled people.

**RosesrReder, BSN, MSN, RN** · Aug 10, 2005

Interesting article.

Straydandelion · Aug 16, 2005

This issue may be helpful to the poor, the ones that qualify for Tenncare, but a larger issue is Medicare which is not just the state of Tennessee, but Federal. All medicare is allotted to encouraging elderly and disabled to go to Nursing Homes also. NO private duty/nursing visits for non-skilled is paid for any disability, however Medicare will pay for at least the first 90 days in a Nursing Home (this is usually with Physical Therapy as the skill), then Tenncare would kick in thereafter if the individual can prove they have less then $2000 in assets, otherwise that person would be a paying patient until the money is gone. Tenncare simply replaced the old Medicaid of Tennessee and may be on the outs.

Traveler · Aug 19, 2005

Medicare will pay 100% under part A for home health for homebound indiviuals with a skill. However, with the change to PPS several years ago those requiring extensive aide visits in the home for ADL's went from a max of 3x per day to 3 times per week which meant many had to be served in the nh. Most of my patients in home health in very rual SE Tennessee had Medicare and Tenncare (some were on Tenncare Medicaid and some on basic Tenncare). Now many have either lost their Tenncare coverage totally or have had their meds reduced. I have been dealing with this with my patients for several months now.....sitting down with them and discussing which meds are the most expensive, which are the most important, etc. Some last-minute changes have been made. I went into a local pharmacy to discuss this with the pharmacist to find out the latest. He had no clue as to what was going on either. It's very chaotic and scary.

LydiaNN · Aug 19, 2005

The Medicaid Kill-Off

by Marta Russell

President George W. Bush and Congress slashed $10 billion from the Medicaid

budget for this coming year. Medicaid is the primary public health care

program for impoverished persons that serves over 53 million people.

The cut is clearly an attack on poor people, and it may wind up killing

disabled and chronically ill persons before all is done. It is also a

strike from those segments in our society who wish to dismantle the entire

Medicaid system. Worse, it will force a rollback of disabled people's civil

rights.

Even before this $10 billion slicing goes into effect, governors and state

legislatures in states such as Minnesota, Mississippi, Missouri, and

Tennessee are cutting back on Medicaid to reduce costs. Maneuvers include

restricting eligibility, paring down the rolls by kicking people off the

program entirely; eliminating or reducing "optional" benefits such as

prescription drugs, wheelchairs, diabetic testing supplies, rehabilitation

services, and even oxygen; initiating co-payments for services including

drugs; and reducing payments to doctors and hospitals.

Privatization -- or subcontracting oversight of programs -- is also being

promoted in several states, such as Florida, though there is no reason to

believe this will reduce costs. Rather, it is an ideological shift to the

right -- more "free market" healthcare. Placing private corporations in the

middle between citizens and government mostly adds more overhead. Then, of

course, those corporations' goal is to make profits, taking dollars which

should go straight to patient care.

In the middle of all this are disabled people fighting for their right to

live in the community. As I write, http://www.mcil.org/log/2005/tenncare.asp

significantly disabled protesters in Tennessee have occupied the Republican governor's office at the Capitol for over three weeks to stop cuts to their state Medicaid program

Gashing Medicaid promises to roll back the clock on disabled persons who

nearly always were locked up or warehoused, with no option to live in the

community, before direct (in-home) support services became a part of some

states' Medicaid program. Present rollbacks of Medicaid are undermining

disabled people's civil rights -- the right to be free of institutionalized

"care" see http://www.atlantalegalaid.org/impact.htm (see the Olmstead v. L.C.

and E.W. Supreme Court decision outlining the right for services to be

delivered in the "least restrictive setting" http://straylight.law.cornell.edu/supct/html

Tactics like denying medications and treatments force disabled persons into

nursing homes to get services they must have to survive. Nursing homes have

proved to be costlier than in-home services. Why this fact is not a part of

every state's Medicaid budget discussion is a grave oversight -- but then

we know the nursing home lobby spends tens of thousands to protect its turf.

The governors say their budgets can no longer sustain the growing Medicaid

program. Rising Medicaid costs are often attributed to the economic

downturn. In part this is true because, as people lose their jobs, they

generally lose their healthcare. As more people lose their healthcare

unable to afford they flock to Medicaid

http://www.dol.gov/dol/topic/health-plans/cobra.htm

Private insurers have increased their premiums to unaffordable levels for

middle and low-income people, forcing them to turn to Medicaid when they

can. Yet another reason is that prescription drugs have increased in price

by double digits over the past years, driving up Medicaid costs all across

the nation.

Perhaps a reminder is due here that Bush, while at Harvard Business School, said that he opposed Medicaid, Medicare, and Social Security. It is no fluke that we see this attack on Medicaid now.

It is optional whether or not to cover some disabled persons under Medicaid

rules -- a pure piece of bad welfare state planning if ever there was one.

The only people who are covered unconditionally are children, pregnant

women, and blind people.

Gov. Haley Barbour's effort in Mississippi to reclassify 65,000 Medicaid recipients as ineligible "poverty-level aged and disabled" was stopped in court last year.

http://www.clarionledger.com/apps/pbcs.dll/article?AID=/20050314/NEWS010504/50314006/1205

But new restrictions on medications have been enacted in Mississippi that

will limit the number of prescriptions a person on Medicaid receives to five beginning next year.

http://www.medicalnewstoday.com/medicalnews.php?newsid=26320

Only two name-brand prescriptions are allowed. While saving the state money, the rule change is likely to seriously impact the lives of 80,000 elderly,

mobility-impaired, deaf, blind, "mentally ill," diabetic, and cancer-ridden

recipients.

Under the governorship of Phil Bredesen in Tennessee, people on Medicaid

are in a desperate situation. Gov. Bredesen is executing the cruelest

slashing of public health coverage in the history of the nation. According

to ADAPT, every day, around

two thousand people enrolled in TennCare receive letters of termination or

reduction of benefits.

Hundreds of thousands of disabled and chronically ill Tennesseans are

living in fear because of Gov. Bredesen's decision to strip them of the

only health care they have. Many Medicaid beneficiaries have disabilities,

and virtually none can afford to pay for their health care out of their

disability checks.

The protestors are still in formation in their sit-in at the Gov.'s office.

They are there to try and stop the Governor from making massive cutbacks to

TennCare that would dump over 200,000 people off services.

Among the people who will be deeply harmed by the cuts are 100 individuals

who use ventilators. Up until now, they were getting services in the

community, but the Governor's plan shuttles them into nursing homes. This

is a clear swipe at their civil rights: a violation of the Olmstead Supreme

Court' ruling on "least restrictive environment."

ADAPT confronted Gov. Bredesen.

"So you are saying," asked Randy Alexander of Tennessee ADAPT, "you will

institutionalize people because they have a disability?"

"Yes," replied Bredesen, "I care about them, I'm not cutting their services

I'm going to provide their services in a nursing home."

"We are talking about basic human rights here," said Alexander before the

Governor could leave. "You have admitted today this state is willing to

imprison people simply because they have a disability."

This is only the beginning. Ten billion more to be taken from Medicaid next

year.

A record deficit, coupled with right-wing ideology and over-extended

empire, underlies the demolition of Medicaid upon which these disabled

people's freedom rests.

The current impetus is towards less restriction of pharmaceutical and

insurance corporate profits, a rollback of government programs for the

people, large tax cuts to the rich, and less health care security for the

working class. The endless war Dick Cheney spoke of will feed the "defense"

contractors and the "rebuilding" company Halliburton, Bechtel, and Kellogg,

Brown and Root. It will increase military spending needed to maintain the

US Empire -- all of which will continue to increase the already

over-stretched deficit.

Bush's term will be marked as one that killed tens of thousands of innocent

Iraqis and others in territories the US has invaded, as well as over 1800

troops who should not have been sent overseas in the first place. Now,

given time, his policy will kill off Medicaid and innocent poor people with

it in the US -- if the people do not arise and fight this momentum as

though their life depends on it -- and it does.

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http://www.martarussell.com

LydiaNN · Aug 19, 2005

Family Voices has some good information about Medicaid and children and youth with disabilities and special health care needs:

www.familyvoices.org

http://capwiz.com/familyvoices/home/