TennCare is the state of Tennessee’s Medicaid program that provides health care for approximately 1.3 million Tennesseans and operates with an annual budget of approximately $10 billion. TennCare members are primarily low-income pregnant women, children and individuals who are elderly or have a disability. TennCare covers approximately 20 percent of the state’s population, 50 percent of the state’s births, and 50 percent of the state’s children.
TennCare is one of the oldest Medicaid managed care programs in the country, having begun on January 1, 1994. It is the only program in the nation to enroll the entire state’s Medicaid population in managed care. The TennCare program operates under a Section 1115 waiver from the Centers for Medicare and Medicaid Services (CMS) in the United States Department of Health and Human Services. Unlike traditional fee-for-service Medicaid, TennCare is an integrated, full-risk, managed care program.
TennCare services are offered through managed care entities. Medical, behavioral and Long-Term Services and Supports are covered by “at-risk” Managed Care Organizations (MCOs). All of TennCare’s MCOs are ranked among the top 100 Medicaid health plans in the country.
The care provided by TennCare’s MCOs is assessed annually by the National Committee for Quality Assurance (NCQA) as part of the state’s accreditation process. The program continues to see improvements in quality measures - 81 percent of quality measures tracked by NCQA have seen improvements since 2007.
In addition to the MCOs, there is a Pharmacy Benefits Manager for coverage of prescription drugs and a Dental Benefits Manager for coverage of services to children under age 21.
As a leader in managed care Long-Term Services and Supports (LTSS), the state successfully implemented TennCare CHOICES in 2010 bringing LTSS into the managed care model. These services are provided in Nursing Facilities (NFs) and Intermediate Care Facilities for persons with intellectual disabilities (ICF/IID), as well as by Home and Community Based Service providers.
The Bureau of TennCare is within Health Care Finance and Administration (HCFA). The Department of Finance and Administration is the state agency charged with the responsibility of administering HCFA and the TennCare program. In addition to the Bureau of TennCare, HCFA includes the Cover Tennessee programs, the Strategic Planning and Innovation Group – which oversees the Tennessee Health Care Innovation Initiative, and the Office of eHealth Initiatives.