Health Care NewsTracker

TennCare Computer System’s Completion Date Still Unknown

Although he won’t speculate as to when the state’s new TennCare computer system will be completed, Darin Gordon, the program’s director, told members of the General Assembly he hopes a planned third-party audit will provide that answer.

Gordon gave testimony Tuesday to the Joint Fiscal Review Committee on the progress, or lack thereof, of the Northrop Grumman Corporation in developing the new “Tennessee Eligibility Determination System” for TennCare.

Tennessee has so far paid Northrop about $4.7 million of the $35.7 million it committed to the cybersecurity contractor in December of 2012, when they signed a three-year contract to develop the new system made necessary by the Affordable Care Act, Gordon said.

TEDS was supposed to go live in October 2013, and Northrop was last paid in January, Gordon added.

There are four “different tools” for the agency to ensure contractors comply with contract stipulations: penalties, liquidated damages, withholds and non-payment, in order of weakest to strongest. “We’re using the biggest tool that we have at this point to make sure that everybody is properly motivated to getting to where we want to be,” Gordon said.

Gordon said that Northrop, one of five firms to bid on the contract, made the lowest bid to produce the system. The next lowest was for $58 million, with the highest bid coming in at $109 million.

Wyoming, one of the other states to use Northrop to produce their system, is also “having challenges,” Gordon said.

Gordon told the committee that he had no idea as to when the system would be completed, because he’s “lost confidence in people’s ability to accurately predict” a timeline for completion.

Northrop is currently 99 percent done with its systems integration testing, the second phase of its five phases of implementation — but that doesn’t mean that phase is nearly done, Gordon said, because when issues with testing arise, developmental changes need to be made and the phase “can be at 99 percent for a longer period of time.”

The company is also about 80 percent complete with its third phase — user integration testing, but can’t start on the last two phases until the others are completed, Gordon explained.

“These are complex systems, there’s a lot of working in a very tight time-frame, and we want to make sure that what we do turn on, works,” Gordon said.

On Aug. 18, TennCare signed a no-bid contract with KPMG, an audit and advisory services firm, to run a 14-week audit of Northrop’s progress at a cost to the state of $1.2 million, Gordon told the committee. That report is expected to be ready sometime in late November or early December.

Following Gordon’s testimony, the committee also approved an extension of a contract with Policy Studies, Inc., the contractor who provides eligibility determination and processes application for the state’s children health insurance program. The contract, which is being extended through Dec. 2015 as a result of the delay in implementing TEDS. The contract extension is eligible for a 75 percent federal match.

The total cost to the state of the delay in getting the computer system on-line is not currently known, Gordon said.

The failure in bringing the new system online is one reason that TennCare is facing a lawsuit from the Southern Poverty Law Center, the National Health Law Program and the Tennessee Justice Center on behalf of several Tennesseans who have allegedly been denied coverage, though they claim eligibility.

“These system failures have serious impact on vulnerable Tennesseans and the health care infrastructure we all reply upon. It’s time for the state to spend less time blaming others and more time managing problems that have devastating consequences for our state,” said Michele Johnson, executive director for the TJC, in an e-mail.  Tennessee’s “lack” of a TennCare enrollment process “makes us unique in the nation,” she added.

The TJC filed the lawsuit because despite having met with TennCare officials since October of last year, “at some point it became clear that their willingness to problem-solve was not there,” and the Tennesseans they represent “couldn’t wait any longer,” Johnson told TNReport Wednesday.

Gordon was questioned by state Rep. Brenda Gilmore, a Nashville Democrat, about whether anything was being done to help hospitals cope with financial problems stemming from the inability to process emergency Medicaid applications because of the delay in TEDS implementation.

Gordon told Gilmore that because of the pending litigation the only information he could give was already included in his response to the federal Centers for Medicare & Medicaid Services, or in the briefs filed in the lawsuit.

However, the Gordon assured Gilmore that TennCare is in contact with the Tennessee Hospital Association “pretty much every week.”

Johnson told TNReport that she “thought it was interesting” the administration continued to say they couldn’t comment on anything related to the lawsuit because government agencies are required to “answer questions that the legislature has for their constituents.”

The next hearing in the federal case is scheduled for Friday.

Gordon noted to the committee that although TennCare has appeared before the legislature in the past, it wasn’t a result of computer system problems.

“Every state in the country all started from different starting points,” Gordon said. “Some had some modern technology already in place, and only had to adapt that technology to the new requirements. Other states, such as ourselves, had to start from scratch because our system was an old legacy system not capable of handling the changes that would be necessary to comply with the ACA.”

Additionally, the changes required by Obamacare have been “some of the most complicated” for the system since it began, Gordon explained.

Several other states — such as California’s backlog of hundreds of thousands of enrollees, or Oregon’s broken website and over-taxed Medicaid rolls — have had their own problems in developing a working system, Gordon said.

“These are complex systems, and are being implemented on a very quick runway, and so I think, if you look across the country, a lot of folks have had challenges with these,” Gordon said.

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Haslam: Medicaid Expansion Talks Didn’t Get Down-and-Dirty with New HHS Top

Tennessee’s Republican governor, Bill Haslam, said he had a “great conversation” with Sylvia Mathews Burwell when she was in Nashville a little over a week ago for the for the National Governors Association summit.

But Gov. Haslam said he and Burwell, the Obama administration’s new U.S. Health and Human Services Secretary, didn’t get into particulars with respect to working out a deal that might enable the state to draw down Affordable Care Act money from Washington earmarked for expanding the number of people in Tennessee eligible for government-finance health insurance.

“It wasn’t that kind of specific conversation in terms of where we are in the issues,” Haslam told TNReport in Winchester Monday. The governor was visiting the Franklin County seat to announce he was handing out half a million dollars in taxpayer-funded grants for city-center revitalization and regional recreation upgrades, like renovations to campsites and trails in Tims Ford State Park, and new lights at a local ball field.

“I do think we continue to make progress,” the governor said of the meeting with Burwell. “We had a good conversation about that, as well as numerous — you know, HHS obviously encompasses a lot of areas for the federal government, so we had a pretty broad range of conversation.”

Haslam said part of his talk with Burwell was a process of  “just getting to know each other.” He added that the two discussed “the history of where we are, and then both the financial and political realities that we’re dealing with in Tennessee.”

“I was very impressed by her,” Haslam said.

About two weeks ago, Haslam told TNReport at another grant announcement in Southeast Tennessee that he was hoping t0 find some middle-ground for facilitating Obamacare’s Medicaid-expansion provision in the Volunteer State when she stopped off in Middle Tennessee for the NGA festivities.

Haslam noted that although he’d met Burwell previously when she was filling a different role in the Obama administration, he was looking forward to talking with her for the first time since she’d taken charge at HHS. Haslam said that he hoped new blood at HHS could mean getting “some of the logs unjammed.”

Haslam told the Chattanooga Times Free Press following the NGA meeting that while his conversation with Burwell was upbeat, there were several “bright lines” that divided the state and the feds policy-wise. Some of those divisions include what’s covered and how to incentivize better health choices — which includes Haslam’s desire to use co-payments for the expansion.

In related news, the federal government has kicked off a new $100 million initiative program — developed with input from the National Governor’s Health Care Sustainability Task Force, and praised by Haslam — intended to help states improve their Medicaid programs.

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Haslam Optimistic New HHS Head Will Work With TN on Medicaid Expansion

Tennessee Gov. Bill Haslam said he expects discussions about Medicaid expansion in the Volunteer State will come up this week at the National Governors Association meeting in Nashville.

Sylvia Burwell, the new U.S. Department of Health and Human Services secretary, is expected to attend the NGA meeting, Haslam told reporters following a grant announcement in Dunlap Tuesday. She was appointed to the post June 9.

Despite the fact that it’s been about a year and a half since Haslam said he wanted to develop a special “Tennessee Plan” for accessing Affordable Care Act money to expand government-financed health insurance for the state’s lower income residents, there’s been little visible movement toward a compromise.

In the meantime, the Legislature has passed a law requiring that the General Assembly sign off on any agreement the Haslam administration reaches with Washington for it to take effect. Republicans dominate in the statehouse, and many have indicated they’re in no way whatsoever interested in facilitating any aspect of Obamacare.

Still, the governor said, new blood at HHS may mean novel approaches will be considered by those administering the ACA at the federal level.

“We’ve always had hope that there’s something to work out, or we would have just quit a long time ago,” Haslam said. “But I think obviously whenever you introduce somebody new into the process, you hope it’ll be somebody who can help get some of the logs unjammed.”

Haslam said he’s met Burwell previously when she was in a different position, but this week’s meeting in Nashville would be the first chance he’s had to speak with her since she was appointed head of the department that oversees the execution of Obamacare policies.

Former HHS Secretary Kathleen Sebelius, Obama’s first appointment to that role, resigned on April 11, in the wake of months of criticism over the problematic roll out of the Affordable Care Act federal health care exchange.

According to the Affordable Care Act, if Tennessee agrees to expand TennCare, the federal government will pick up the tab for the coverage through 2016, and provide part of the cost after that.

Haslam initially held out for a waiver from HHS that would allow him to establish a “third way,” and use federal money to subsidize private insurance to extend coverage to 175,000 uninsured Tennesseans.

An agreement was never reached between Sebelius and Haslam, but Haslam has continued to say that he is still working on finding a way to reach a middle ground between the Obama administration and Tennessee’s Republican super-majority in the General Assembly.

The Tennessee House Democratic Caucus sent out a press release last week referencing a recent report by the White House Council of Economic Advisors that “lays out the fiscal, economic and moral failure caused by the Haslam administration’s refusal to expand Medicaid in Tennessee.”

But there is concern among those opposed to expanding the state’s poverty health care program about whether the federal government can afford to do that, as well as what the state should do in the case that the money for the program is not forthcoming from federal officials.

Back in the mid-2000s, under Democratic Gov. Phil Bredesen, Tennessee had to remove more than 300,000 from TennCare coverage, due to rising costs and lack of funding, a problematic time that is often pointed to by opponents of Medicaid expansion.

Haslam was in Dunlap to award a transportation grant of $591,141 to the city for them to help connect nearby residential areas with the downtown education centers and business district.

The NGA meeting begins Thursday, July 10, in Nashville, and runs through July 13.

Press Releases

TN House Dems: Haslam Hurting TN by Not Expanding Medicaid

Press release from the Tennessee House Democratic Caucus; July 2, 2014:

NASHVILLE, Tenn. (Wednesday, July 2, 2014) – A new report released by the White House Council of Economic Advisers titled “Missed Opportunities: The consequences of state decisions not to expand Medicaid,” lays out the fiscal, economic and moral failure caused by the Haslam administration’s refusal to expand Medicaid in Tennessee.

“How much more proof does the Governor and this Republican majority need to realize they are hurting Tennesseans by playing politics with Medicaid?” said House Democratic Leader Craig Fitzhugh. “You don’t have to be an economist to understand the positive impact expansion would have on our economy and our citizens’ lives.”

Tennessee is one of 24 states listed in the report that has refused to participate in the Medicaid expansion, which would be fully-funded by the federal government until the end of 2016 and would give working men and women up to 138% of the federal poverty level access to health care coverage.

“It is gut-wrenching to think of all the women whose lives could be saved through early detection of breast and cervical cancer,” said Rep. Raumesh Akbari (D-Memphis). “This is an issue that should transcend politics. We have the opportunity to help so many hardworking families in a way that boosts our economy and creates jobs – I just can’t fathom how people of faith and good conscience could refuse to act.”

The report by the Council of Economic Advisers forecasts the benefits of Medicaid expansion for states if they would have joined the 26 other states, along with the District of Columbia, in participating in the Medicaid expansion. The results for Tennessee are as follows:

Health and Well-being of Tennesseans

The number of Tennesseans with insurance coverage would have increased by 234,000 people by the end of 2016 if Governor Haslam and the Republican majority expanded Medicaid.

14,000 women in Tennessee would be receiving cancer detecting Pap smears, along with 9,500 more women who could catch breast cancer early through mammogram screenings.

56,000 more Tennesseans would have a usual source of clinic care, with 27,000 more Tennesseans receiving all the medical care they require due to the 632,000 additional physician visits each year.

As a result of Medicaid expansion, the number of Tennesseans experiencing depression would have decreased by 19,000, with 31,000 more Tennesseans reporting good, very good or excellent health.

Health and Well-being of Tennessee’s Economy

If Governor Haslam would do the right thing, 10,500 fewer Tennesseans would be stuck paying catastrophic out-of-pocket health care costs each year, while 33,300 fewer people would have to take out loans to pay for their medical bills.

Tennessee’s gross domestic product would increase by $3,810,000,000 between 2014-2017 if we expanded Medicaid, thanks to the $5,130,000,000 increase in federal expenditures in Tennessee, resulting in 21,700 jobs creased between 2014 and 2017.

The full “Missed Opportunities” report can be found here:

Press Releases

TNHDC: Haslam Letter to HHS Latest ‘Farce’ in ‘Continued Obstruction’ to TennCare Expansion

Press release from the Tennessee House Democratic Caucus; December 10, 2013:

Haslam Letter to Sebelius a Farce
The time to act is now on the Medicaid expansion.

NASHVILLE, Tenn. – Late yesterday, Governor Haslam released a letter to Health & Human Services Secretary Kathleen Sebelius regarding his continued obstruction of Medicaid expansion in Tennessee.

“The Governor’s letter is simply the latest in a series of farces,” said House Democratic Leader Craig Fitzhugh. “It’s more of the same hand-wringing, ducking and dodging we’ve come to expect from this administration, all in an attempt to absolve themselves of the worst moral and mathematical failure in a generation—denying health care to 330,000 working Tennesseans.”

Governor Haslam’s letter offers no specific proposals, instead laying out a series of complaints and concerns about the overall Affordable Care Act. It offers no details about the so-called “Tennessee Plan,” which the Governor has yet to provide either to the federal government or state legislators.

“Governor Haslam is seeking to offer lower quality care to fewer people and still collect all the money allocated in the Medicaid expansion – that is not something that Secretary Sebelius has the power to authorize, and he knows that,” said House Democratic Caucus Chairman Mike Turner. “If Governor Haslam is going to negotiate seriously with CMS on creating a ‘Tennessee Plan,’ it needs to be done in a way that both conforms to federal law and appreciates the economic, fiscal and moral blunder that would result from a decision not to expand Medicaid.”

A hybrid Medicaid expansion plan has already passed the Arkansas legislature and been approved by the federal government. The Arkansas Plan includes cost-sharing components and addresses questions about defining “medically frail” through a questionnaire developed by the state.

“Expanding Medicaid in Tennessee is not an impossible task, but Governor Haslam is doing everything he can to make it one,” said Leader Fitzhugh. “All of the serious questions about creating a hybrid plan have been addressed in the Arkansas Medicaid waiver. Tennesseans don’t have time for the Governor to wait for political cover. The time to act is now.”

The Tennessee General Assembly returns to session on January 14, 2014. Speakers Harwell and Ramsey have pledged to move the session along as quickly as possible, meaning the Governor may only have a few months left before legislators will be gone for the rest of the year. If we do not act by January 1, 2014, Tennessee will begin to lose $2.5 million per day in federal funding.

Press Releases

TN House Dems Warn of “Fiscal, Moral Disaster” At Years End

Press release from the Tennessee House Democratic Caucus; December 3, 2013:

28 Days until Fiscal and Moral Disaster

NASHVILLE, Tenn. – In 28 days, Tennessee’s Republican leadership is poised to make the greatest fiscal, economic and moral blunder in decades. According to reports in the Tennessean, the Governor’s decision to put politics above policy is already resulting in layoffs and hiring freezes in hospitals across the state – a trend that will only worsen as the full impact of Governor Haslam’s decision goes into effect on January 1, 2014.

“The indifference shown by Governor Haslam and Tennessee’s Republican leaders is truly remarkable given the stakes,” said House Democratic Caucus Chairman Mike Turner. “There has never been an easier way for the state of Tennessee to improve the lives of its citizens without having to spend a single dime in state funds for years to come.”

When the 2010 Affordable Care Act was passed, hospitals struck a bargain with the federal government that they would forgo money in the form of reimbursements in order to get more patients through the Medicaid expansion. When the Supreme Court left the decision to expand Medicaid up to the states, it created a fiscal disaster for hospitals in states with political leadership too focused on partisanship to put the needs of their people first.

“This Christmas, Governor Haslam has the opportunity to give thousands of working men and women in Tennessee the best gift possible – longer and healthier lives,” said Chairman Turner. “I understand it will be difficult to get the expansion passed in the legislature, but the Governor owes it to the people of our state to try. If he stands by and does nothing, the hospital closures, the jobs lost, and the premature and preventable deaths of Tennesseans will rest squarely on his shoulders.”

Governor Haslam has claimed to be working on a “Tennessee Plan” with the federal government, however, a waiver that would start the process of adopting the plan has not been requested by the Haslam administration. Said Chairman Turner, “Has Governor Haslam reached out to Tennessee’s Congressional delegation with his ‘plan’ in order to help get the approval of HHS? Does he even have a plan to present?”

“People across this state need to understand that if we do not expand Medicaid, their health care options and jobs may be at risk, even if they have private or employer based insurance,” said Chairman Turner. “How many people in our state must suffer so that the Republican leadership can please its Tea Party base?”

Press Releases

TN Senate Dems Call Out Haslam for Not Expanding Medicaid With End of CoverTN

Press release from the Tennessee Senate Democratic Caucus; November 27, 2013:

NASHVILLE, Tenn. – Today’s announcement that 15,400 Tennesseans will lose their health insurance follows three missed opportunities by Gov. Bill Haslam to avoid it.

“Governor Haslam has had three opportunities to make the new health law work for the benefit of Tennessee families,” House Democratic Leader Craig Fitzhugh said. “Instead, he neglected his responsibility, and thousands of Tennesseans will lose their health insurance after Christmas.”

Gov. Haslam decided last year that Tennessee would not participate in defining the minimum coverage offered by health insurance policies known as “essential health benefits.” He left it to the federal government. He then opted not to establish a state-run exchange, defaulting to for the purchase of private health insurance policies. More recently, the Governor has declined to accept federal dollars to expand Medicaid for working families, a program which would provide basic health care services to thousands of working people across the state. Instead, millions of dollars will go to other states.

What’s more, the Governor could decide to continue CoverTN for one year under the ruling from the Department of Commerce and Insurance that allows health care plans not meeting essential health benefits to be extended for one year.

“The Governor has been given multiple opportunities to influence a health care program for the benefit of small businesses and families across Tennessee,” said Senate Democratic Caucus Chairman Lowe Finney. “Unfortunately, inaction has only resulted in a loss of coverage, which will only lead to less health care, poorer health and higher premiums for Tennesseans.”

Finney cited a recent study by the RAND Corporation showing that states that did not expand Medicaid were expected to see premiums increase as much as 10 percent for remaining policyholders.

Press Releases

TN House Dems: GOP Policies Causing TN Workers to be ‘Left Behind’ in Economic Recovery

Press release from the Tennessee House Democratic Caucus; November 22, 2013:

NASHVILLE, Tenn. (11/22/13) – Figures released from the Bureau of Labor Statistics show that Tennessee has one of the highest unemployment rates in the nation. At 8.4%, Tennessee is tied for 42nd in unemployment.

“Unfortunately for Tennesseans, the Republicans are winning their war on working people,” said House Democratic Caucus Chairman Mike Turner (D-Nashville). “The GOP promised that if we gutted worker and consumer protections that we would become an oasis of job creation. Instead, our workers are being left behind in an economic recovery that has led to lower unemployment numbers in most other states.”

Tennessee’s seasonally adjusted unemployment rate remained stagnant at 8.4% in October while 28 other states saw decreases in their unemployment. Earlier this month, Tennessee’s Comptroller released a scathing report indicating that the Haslam administration failed to adequately account for billions of dollars in tax dollars that were supposed to go towards job creation.

“In spite of billions of dollars in giveaways to large corporations, too many Tennesseans are struggling to find a good job,” said Rep. Gloria Johnson (D-Knoxville). “In a little over a month it will get even worse when Governor Haslam’s refusal to accept the Medicaid expansion will result in thousands of jobs and billions of dollars lost in Tennessee.”

According to a University of Memphis study, If Governor Haslam does not expand Medicaid, Tennessee’s economy will lose out on $10.5 billion in federal funds and 18,000 jobs over the next five years.

Press Releases

Senate GOP, Lt. Gov. Approve of Haslam Medicaid Decision

Statement from Tennessee Lt. Gov. Ron Ramsey; March 27, 2013:

Lt. Governor Ron Ramsey (R-Blountville) said the following upon the conclusion of Governor Haslam’s address to a joint session of the 108th General Assembly:

“I applaud Governor Haslam’s decision to reject Obama’s medicaid expansion. Without bold reform of the Medicaid program tailored to Tennessee’s unique situation, there can be no compromise on this issue.”

“Four out of every ten dollars the federal government spends comes out of the back pockets of future generations. Tennessee must receive assurances that have not been forthcoming. Governor Haslam has laid out a plan for what true health care reform looks like. I commend him for his continued thoughtful and measured approach to this complex issue.”

Statement from State Sen. Bill Ketron, R-Murfreesboro; March 27, 2013:

NASHVILLE, Tenn. — “Governor Haslam offered a good solution, rather than expanding an unsustainable and broken program. Unlike Washington, Tennessee has been working hard to control health care costs. Hopefully, Washington will see our 20-year record of working through the problems we face with our healthcare system and agree to work with us on a plan that will truly be both beneficial to improving healthcare outcomes in our state and sustainable over the long run.”

Statement from State Sen. Brian Kelsey, R-Germantown; March 27, 2013:

NASHVILLE, Tenn. – “I applaud Governor Haslam’s decision today to reject Medicaid expansion as envisioned by ObamaCare in this year’s budget,” stated Senator Brian Kelsey (R – Germantown) following the governor’s announcement
this morning. “I am happy to receive the governor’s commitment not to expand Medicaid in future years without legislative approval.”

Sen. Kelsey is the sponsor of Senate Bill 804, filed to block Medicaid expansion in Tennessee. Sen. Kelsey originally filed Senate Bill 1 on Nov. 7, 2012 to block expansion. He redrafted the bill and filed SB 804 on January 31, 2013 with 15 of the 33 state Senators as co-sponsors. The bill is scheduled for a vote in the Senate Commerce Committee Tuesday afternoon, March 27. Sen. Kelsey serves as Senate Judiciary Committee Chairman.

Press Releases

VIDEO: Fitzhugh: Haslam ‘Failed to Deliver’ on Medicaid Expansion

Statement from the Tennessee House Democratic Caucus; March 27, 2013:

NASHVILLE, Tenn. – House Minority Leader Craig Fitzhugh has released the following video statement in response to Governor Haslam’s decision to not participate in the Medicaid expansion:

Earlier today, Governor Haslam announced Tennessee would turn down over $10 billion and not participate in Medicaid Expansion. This shocking decision comes after business groups, hospital associations, doctors, nurses, civic and faith leaders joined together to work with the Governor on this critical decision that impacts our citizens and our economy.

I truly believed that the governor was going to use this opportunity to show real leadership. Instead we’ve seen more of the hand-wringing and delayed action that we’ve become accustomed to.

Here are the facts.

300,000 Tennesseans will now be denied access to quality, affordable health care coverage; Coverage that wouldn’t have cost Tennessee taxpayers a dime for the first 3 years.

Estimates show that 90,000 jobs may be lost, and dozens of our rural hospitals are at risk of closing – leaving as many as 21 counties without a hospital altogether!

Tennessee’s economy will suffer as billions in federal dollars leave our state and go to California, New York and other states that have agreed to participate in Medicaid Expansion.

All of that says nothing about the moral obligation that we have as lawmakers to ensure the health and well-being of the least among us.

Governor Haslam says he is working on a “Tennessee Plan” to address these concerns. However, his announcement today came with few details and even fewer certainties for the hundreds of thousands of Tennesseans who have been counting on the governor to do the right thing.

While I hope that the Governor is serious about working with the federal government to create an alternative plan, past experience makes me question the sincerity of these efforts.

All too often with this administration, we have the Governor study, and study, and study an issue, only to come back later and say “no”.

My friends today is an illustration of why it matters who governs and this Governor has failed to deliver for the people of Tennessee. Our hearts go out to the thousands of people across this state who will suffer as a result of this decision. It is my hope and fervent prayer that in the future we can find a way to care for the least among us when they need it the most.