Tennessee Medicaid, SCHIP, & Federal Authority

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Section 1115 Waiver – In 1994, Tennessee received approval from the Centers for Medicare and Medicaid Services (CMS) for a Section 1115 demonstration program, TennCare, to provide Medicaid benefits to an expanded population of uninsured residents with low incomes or with medical conditions which make them uninsurable. After several extensions, Tennessee began a new 1115 waiver program entitled TennCare II in 2002. TennCare II utilizes a managed care delivery model to provide most state plan benefits to enrollees. Due to budget deficits in 2005, the waiver was amended to reduce services for certain populations and close enrollment for medically needy adults and all expansion population adults and children.  Ultimately, 170,000 people were cut from the program.  The waiver was amended again in 2006 to transition individuals dually eligible for Medicare and Medicaid into the demonstration from the existing 1915(b) waiver program and to add a new demonstration population of medically needy adults.

CoverKids Tennessee established a separate, stand-alone State Children’s Health Insurance Program (SCHIP) in 2006 for uninsured children under the age of 19.  The program, entitled CoverKids, combines state and Title XXI funds from the federal government to cover children and pregnant women with family incomes up to 250 percent of the federal poverty level (FPL). Eligibility is layered over current TennCare levels.  CoverKids also offers a buy-in program for children who do not qualify for the subsidized product. Enrollment reached 22,570 children in May 2008.