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TennCare's Chief Says Fraud Threatens To Sink Program

MANAGED CARE June 1999. © MediMedia USA
News and Commentary

TennCare's Chief Says Fraud Threatens To Sink Program

MANAGED CARE June 1999. ©1999 Stezzi Communications

Tennessee Gov. Don Sundquist wants a $400 million tax increase, much of which would keep TennCare, the state's managed Medicaid program, from "imploding" — as put by its director, Brian Lapps. An actuarial study found that TennCare, which covers nearly a fourth of the state's residents, is $289 million underfunded.

Lapps says TennCare needs to pay backlogged provider claims, and to enact changes that include shutting off enrollment to the chronically ill who have been denied commercial coverage. Tennesseeans can ask a denying carrier for a form declaring them "uninsurable" — in essence, a ticket for TennCare eligibility. Lapps, himself a former TennCare recipient, says many people do this fraudulently, and it's driving TennCare to ruin.

Lapps also wants to increase premiums and deductibles for some enrollees whom he blasted as able "to afford cigarettes ... and their alcohol" but who oppose picking up a greater share of their health costs. Lapps took heat for the remark, but his supporters said his point was valid.