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Tennessee: TennCare home health cuts prompt concerns

By: Emily Bregel
(Contact)

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Lori Smith

When Patsy Evitt’s mother suffered a series of strokes in 2005, leaving the 74-year-old retiree paralyzed on her left side, Mrs. Evitt’s world changed.

“When something like that happens you turn into caretaker mode,” the Harrison resident said. “It changes your life.”

Around-the-clock help from a certified nursing assistant, paid for through TennCare’s home health and private-duty nursing benefit, eased the strain on Mrs. Evitt and her brother, who had to help with everything from feeding and bathing their mother to turning her over in bed.

But now, as the state’s managed Medicaid program strives to rein in ballooning costs in that benefit, Mrs. Evitt’s mother is limited to 35 hours a week of paid assistance. The family received a letter last month warning of the impending changes, which took effect a week and a half ago.

“There’s no words to describe how you feel. You’re panicked. ... You’re just seeking and looking and trying to find some way to keep that quality of care for your loved one,” Mrs. Evitt said.

She discussed her concerns at a Monday news conference organized by the Tennessee Health Care Campaign, a Nashville-based advocacy group.

The group held similar events around the state in an effort to call attention to the changes under way in TennCare’s benefits, said Lori Smith, an advocate with the campaign.

“We want to be fiscally responsible as consumers in this state. But we’re talking about a subset of people who are very seriously ill and disabled and required by their doctors to get this care,” she said. “If somebody is getting 24/7 (care) and now they’re being told the maximum is 35 hours (of covered in-home services per week), that’s drastic.”

Cuts to TennCare’s home health and private-duty nursing benefit are going into effect statewide, and letters mailed last month advised enrollees of new program limits.

The policy changes are critical for the program to avoid being bankrupted by out-of-control costs from the formerly unlimited benefit, Gov. Phil Bredesen and TennCare officials have said.

Spending on TennCare’s home health and private-duty nursing benefit skyrocketed by 1,250 percent from 2000 to 2007 — growing from $18 million to $234 million, TennCare figures show. With the coverage changes, the bureau expects to save nearly $88 million in fiscal year 2009, said Marilyn Wilson, TennCare spokeswoman.

“The state’s overarching goal is to make home and community-based support a reality for more people (on TennCare),” she said. “We’re committed to providing in-home care that is safe for our members, that effectively meets their medical needs and is also cost effective so that we can offer more of that in-home care to more people.”

Fewer than 1,000 people statewide will be affected by the cuts, and the state has no plans to expand those cuts to children under 21, which she said would violate federal law, Ms. Wilson said.

Restrictions don’t apply to adults who use a ventilator for more than 12 hours a day or who have a tracheotomy and depend on other nursing services.

Advocates for enrollees want more time before the cuts go into effect to give affected families a chance to figure out home-based alternatives to a nursing home for their loved ones.

Ms. Smith said she sees some hope in legislation to improve access to nonmedical in-home services for elderly and disabled Tennesseans, but she emphasized that right now the infrastructure and volume of providers is not there to achieve the goals of that bill.

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