Dental care now available to adult TennCare enrollees

About 600,000 adult TennCare enrollees are now eligible for dental benefits, joining children and pregnant women who were already covered under the expanded Medicaid program.

Here are the details from TennCare:

Nashville, TN — Approximately 600,000 adults on TennCare are now eligible for extensive dental benefits. Last year, Governor Lee proposed and the General Assembly approved a $25 million investment to offer dental care to persons 21 years and older on TennCare. Children on TennCare, as well as pregnant women on TennCare, already receive dental benefits.

Regular dental checkups help dentists identify, prevent, and treat dental related issues promptly. Early detection of tooth decay and gum disease can prevent painful, complicated, and costly treatment down the road and preserve a person’s natural teeth.

TennCare’s dental plan DentaQuest is responsible for administering the dental care of members under the oversight of TennCare. Members can receive regular exams, x-rays, cleanings, fillings, crowns, and more. DentaQuest has been growing the provider network to support the increased population prior to launching the new benefits, and TennCare and DentaQuest are committed to ensuring all adult members have a dental home in their communities. A dental home is the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral healthcare delivery, in a comprehensive, continuously accessible, coordinated, and family centered way. To find a dentist in-network, members can use the “Find a Dentist Tool”, which is also available through TennCare’s website.

“We are excited to offer this new benefit to our adult TennCare members,” said TennCare Director Stephen Smith. “Dental care is critical to overall health and will help us further our mission of improving lives through high-quality, cost-effective care.”

DentaQuest began sending members a welcome letter in December with more information on accessing dental benefits. TennCare members can also go online to the TennCare Dental Services website to get more information. All members should make sure TennCare has their correct address by checking online through Tenncareconnect.tn.gov or by calling 855-259-0701. Members can use their TennCare member IDs or their health plan card when visiting the dentist.

TennCare enrollees will be required to reverify their eligibility

TennCare enrollees will have to reverify their eligibility for the expanded Medicaid program starting in April under a new law passed by Congress.

Here’s the release from TennCare:

Nashville, TN – [. . . ] Congress passed legislation which will end the Medicaid continuous enrollment requirement related to the COVID-19 pandemic on April 1, 2023. At that time TennCare will be required to reverify the eligibility status of everyone receiving TennCare or CoverKids benefits. One of TennCare’s top priorities during this process is to make sure all eligible members do not risk a gap in health care coverage.

Per federal requirements, the ending of the continuous enrollment requirement will represent the first time in three years that Medicaid and CHIP members will go through the renewal process, and it will be one of the most substantial health coverage processes around the country. For Tennessee, the legislation means that more than 1.7 million Tennesseans will be impacted by this process. It is imperative that TennCare and CoverKids members update their contact information with TennCare and respond to all TennCare communication.

Over a twelve-month period, TennCare will review every member’s eligibility and, where approved by state or federal rules, use available data sources, such as Internal Revenue Service (IRS) income data and Supplementation Nutrition Assistance Program (SNAP) information, to automatically renew members. If TennCare cannot auto-renew a person’s coverage using available and approved data sources, the member will receive a pre-populated renewal packet by mail or a notification by email, depending on the selected preference. TennCare and its partner health plans will also use texts, email, and social media when available to enhance outreach efforts. A member will be able to complete the renewal packet through a variety of ways: Online, by phone, by mail, by fax, or at any county Department of Human Services (DHS) office.

For members no longer eligible for TennCare or CoverKids benefits, TennCare will send their information to the federal Health Care Marketplace, as required by CMS, where alternative health insurance options are available. For nearly three years, TennCare has carefully planned for the end of the PHE and the resumption of renewals. The agency worked to improve TennCare Connect, the online portal where members can update their information and renew their coverage, as well as improved the mobile application for easier document submission. TennCare has also worked to increase the number of members who can be approved through the auto-renewal process. TennCare initiated several campaigns to encourage members to update

their contact information and worked closely with health plans, advocates and providers to ensure that members completed this important step. TennCare has created a public toolkit for stakeholders to continue to maximize awareness of the renewal process. The toolkit and other resources can be found here: https://www.tn.gov/tenncare/information-statistics/unwinding-the-phe-for-partners/phase-ii–educate.html.

TennCare has been and is committed to making the renewal process as easy and user-friendly as possible so that those eligible can continue to receive TennCare benefits, but it is a critical requirement for Tennesseans who receive these benefits to participate in the process by updating their contact information and responding to all TennCare communication. To prepare for the renewal process, TennCare members should verify that their address is up-to-date by logging in to TennCareConnect.tn.gov or by calling 855-259-0701. Information for members can be found at: www.tn.gov/tenncare/renewals.

TennCare alerts 1,700 enrollees of privacy breach

TennCare, the state’s expanded Medicaid program, says about 1,700 enrollees may have be subject to a privacy breach.

Here’s the release from TennCare:

Nashville – The Division of TennCare, which provides health care insurance to 1.7 million Tennesseans, announced today that it has notified approximately 1,700 Medicaid members of a privacy issue that may have impacted their personal information.

During a recent review, TennCare learned that a routine update to a computer system may have caused a limited number of individuals from one household to be able to view some information about individuals in another household that included some of the same people. This happened when a new application listed the name of a person who was already in another household.

For a limited time, the name and age of affected individuals and their dependents may have been visible to people who were at one time on the same case file. For fewer than 15 people, additional information, such as social security number, address, and date of birth may have been visible.

TennCare immediately took steps to determine the scope of the breach, address the issue, and notify impacted members, all of whom are being offered 12 months of free identity theft protection services.

Based on TennCare’s analysis, there is no evidence to suggest the information was misused; however, out of an abundance of caution, TennCare is offering free identity theft protection services through Experian to those affected. These services include 12 months of credit monitoring, $1,000,000 identity theft insurance coverage, and identity theft restoration services.

TennCare will incorporate the learnings from this incident to further strengthen its commitment to protecting personal information for TennCare members.

Answers to certain questions related to the incident:

What was the issue?

A routine update to a computer system may have caused certain individuals from one household to be able to view some information about individuals in another household that included some of the same people. This happened when a new application included the name of a person who was already part of
an existing case.

How did TennCare discover the incident?

TennCare received a few privacy communications from affected members, which led to the discovery of the issue.

When did this occur?

On July 12, 2022, TennCare found that members may have been affected by this issue. The issue was fixed on July 22, 2022.

Has TennCare corrected or will TennCare correct the household information potentially impacted by
this issue?

TennCare has addressed the programmatic issue so information is no longer visible to individuals from a different household. TennCare is reviewing the household members’ information in our systems and are making any necessary corrections, if required.

Who qualifies for the credit monitoring and identity theft protection services?

Any member who was affected by the incident. Those affected have been notified and were provided an enrollment code.

How do those affected enroll in the credit monitoring and identity theft protection services?

An individual who has been affected can enroll by following the instructions on the notice they received.

The deadline to enroll is December 5, 2022.

The feds have some issues with Tennessee’s block grant program

Gov. Bill Lee speaks to reporters in Nashville on July 6, 2022. (Erik Schelzig, Tennessee Journal)

The Centers for Medicare & Medicaid Services are looking for some significant changes to Tennessee’s block grant program approved toward the end of Republican President Donald Trump’s time in office.

The biggest questions appear to be over how the state will determine the amount of shared savings achieved through the new approach. One area the CDC has rejected out of hand is an effort to institute a closed formulary for prescription drugs under which the state could opt out of providing certain expensive medications approved by the FDA.

Negotiations are understood to have been going on for some time, so a letter sent to TennCare Director Stephen Smith last week did not come as a huge surprise to officials in Nashville. Here is what it said:

Dear Mr. Smith,

This letter is to advise Tennessee of a decision by The Centers for Medicare & Medicaid Services (CMS) to propose changes to the waiver and expenditure authorities and the Special Terms and Conditions (STCs) for the TennCare III section 1115 demonstration (11-W-00369/4), in response to the federal public comment period which closed on September 9, 2021.

After reviewing the public comments, CMS has significant concerns on the following items and whether they promote the objectives of Medicaid and should be supported under section 1115 authority. CMS is evaluating a range of actions, but is asking the state to make the following changes to address these concerns. Making these adjustments would significantly mitigate CMS concerns. The following list summarizes CMS’ proposed changes to TennCare III.

Closed Formulary

Remove the expenditure authority for pharmacy and associated pharmacy flexibilities from the demonstration.

Financing of the Demonstration and Limitations on Reductions in Benefits or Coverage

Submit a new financing and budget neutrality model, based on a traditional per member per month cap instead of an aggregate cap. Additionally, modify the STCs to more explicitly state that Tennessee cannot cut benefits or coverage in effect December 31, 2021 without an amendment to the demonstration, subject to additional public comment period and CMS approval.

Demonstration Expenditure Authorities

We support the state’s policy goals to expand coverage and benefits and propose that instead of the current framework for savings and investment, CMS will work with the state on necessary expenditure authorities to meet common goals. In place of the structure in the current demonstration, the state should include in the demonstration amendment a request for expenditure authority for state reinvestments for initiatives that the state would like to support with budget neutrality savings (e.g., adult dental services, expanded 12-month postpartum coverage and enhanced home and community-based services; etc.).

We appreciate your state’s commitment to improving the health of the people in Tennessee, and being responsive to the concerns raised during the public comment period. At this time, CMS requests that Tennessee submit an amendment to the demonstration including the changes listed above, subject to the requirements for an amendment as described in the STCs, by August 30, 2022.



Daniel Tsai
Deputy Administrator and Director

Feds rescind effort to lock in Medicaid changes made by Trump administration

Gov. Bill Lee speaks to reporters following his address to a joint convention of the General Assembly on Jan. 19, 2021. (Erik Schelzig, Tennessee Journal)

A little over two weeks before President Donald Trump left office, the Republican administration sent out a letter to states like Tennessee to declare it was locking in any approved changes to Medicaid programs for a period of at least nine months. Democratic President Joe Biden is now rescinding that guidance, meaning that previously approved demonstration projects or waivers could be withdrawn at any time.

The most immediate effect of the move could be a cancellation of work requirements for Medicaid recipients that had been approved in several states. But Tennessee’s first-in-the-nation block grant could also be on the chopping block.

“We’re the first state in America that just got a federal waiver for Medicaid that allows us to share savings with the federal government,” Gov. Bill Lee told the Nashville Area Chamber of Commerce on Tuesday. “There’s a lot of partisan squabbling about that, but that was a business deal that was negotiated over a year-and-a-half that will allow Tennessee to have more money to spend on its Medicaid population than it would have underer a traditional Medicaid agreement.”

Read the full letter from the Centers for Medicare and Medicaid Services to TennCare Director Stephen Smith below.

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Lee says block grant critics are ‘misinformed’

Gov. Bill Lee speaks at the state Capitol on Sept. 16, 2019. (Erik Schelzig, Tennessee Journal)

Gov. Bill Lee says the largely critical response to his Medicaid block grant proposal in public hearings around the state is coming from people who have either been misinformed or haven’t taken the time to understand the proposal, the AP’s Kimberlee Kruesi reports.

From the AP report:

“I do think that a lot of the folks who are concerned about this have been either misinformed or have not taken the time to really understand it. And there’s legitimate concern about that. We want people to understand this,” Lee, a Republican, told reporters.

The public comment period is required under federal rules for seeking Medicaid waivers. Public hearings were scheduled for Nashville, Knoxville, and Jackson this week. Lee has said he will add stops in Chattanooga and Memphis.

Lee’s block grant proposal: What they’re saying

Gov. Bill Lee’s administration on Tuesday unveiled its Medicaid block grant proposal, kicking off a 30-day public comment period. Here’s a sample of how Tennessee news outlets are covering the news.


Currently, the federal government provides about $7.5 billion to $8 billion annually to pay for TennCare. This funding increases or decrease as the need grows or shrinks, and the money is theoretically limitless if the state continues to operate TennCare in accordance with federal guidelines.

As proposed, Gov. Bill Lee’s administration’s plan would convert that funding into a “modified block grant,” giving the state government more authority over how this money is spent. Block grants are generally finite, raising concerns this money might run out, but the governor’s proposal asks the federal government to commit to providing more money if it is needed by the state in the future.

Chattanooga Times Free Press:

Lee’s proposals have already come under fire even before he made full details public.

“I think the issue is that when they say that they’ve created all these ‘savings’ for the federal government, that includes like the 220,000 children that were cut off even though tens of thousands of them were eligible,” said Michele Johnson, executive director of the Tennessee Justice Center, in an early September interview.

“Here’s the bottom line,” Johnson said. “The Trump administration has said they’re going to cut over a trillion dollars out of the [national] Medicaid program through block grants. The Lee administration says we’re going to be able to get all this money, an expansion of health care? The math doesn’t work out.”

_ The Daily Memphian:

Initially, the governor avoided answering how much the state could net through the block grant proposal. But after TennCare Director Gabe Roberts acknowledged the state’s “budget neutrality” figure is $2 billion, the governor conceded Tennessee could land $1 billion if the feds agree to the state’s entire proposal.

Lee couched that comment by noting the amount will depend on whether the feds place new service requirements on TennCare, which typically receives about $8 billion from CMS and about $4 billion from the state.


Primarily, the additional money comes from a plan to split savings TennCare already generates with the federal government. Under its current waiver, Tennessee’s Medicaid program costs the federal government billions of dollars less than if it were just the open-ended federal benefit. Tennessee now wants to share those savings 50/50, which is expected to be a key sticking point in negotiations.

The block grant also envisions saving money by cutting red tape, like the periodic reapprovals of Tennessee’s waiver. Even when very few changes are made, the process takes nearly a year. Tennessee is asking for its new block grant proposal to be considered permanent.

TennCare wants to change a few rules that would ensure it’s the “payer of last resort,” particularly in cases where a patient also qualifies for Medicare.

_ The Associated Press:

The plan’s likelihood of ever being implemented, however, remains largely unknown. To date, no state has been given permission to rely solely on block grants to cover Medicaid expenses. The idea has been floated by Republicans for decades but never implemented, due to possible legal challenges and concerns that doing so would result in large spending cuts to the states’ most vulnerable populations.

Yet Lee remains hopeful, noting that support is growing under President Donald Trump’s administration and asserting that no services to the state’s indigent population will be cut. Tennessee’s GOP U.S. Sens. Lamar Alexander and Marsha Blackburn have also expressed interest in the plan, an endorsement that some say could help push the idea further along.

The Nashville Business Journal:

The 50/50 split Lee is pitching, as well as other aspects of the proposal, are subject to changes and negotiation once Tennessee submits a formal proposal to the federal Centers for Medicare and Medicaid Services.

“We think we have crafted a waiver that is going to really mitigate the risk that Tennesseans have and actually give us an opportunity to benefit from the efficiencies and the way that we run our program,” Lee said. “That benefit will give us an opportunity to provide enhanced services to our TennCare population … and eventually, for the same money, provide additional services to more people.”

While health systems have yet to comment publicly on Lee’s plan, Republicans in Congress had pitched a similar proposal in 2017 as their effort to repeal and replace the federal Affordable Care Act. At the time, more than 20 organizations, including the American Hospital Organization and the American Medical Association, came out against the proposal, which ultimately failed.

_ The Washington Post:

Tennessee is setting up the nation’s first test case of how far the Trump administration is willing to go to allow a state the “flexibility” that has become a watchword of the administration’s health-care policies.

If TennCare, as that state calls its Medicaid program, wins federal approval for its plan, it could embolden other Republican-led states to follow suit. It also almost certainly would ignite litigation over the legality of such a profound change to the country’s largest public insurance program without approval by Congress.

The Wall Street Journal:

If block grants catch on, the Trump administration could be successful in achieving the Medicaid changes congressional Republicans were unable to in their failed 2017 repeal of the ACA, also known as Obamacare. Tennessee’s proposal released Tuesday would be submitted to the Trump administration in November following a public comment period.

Under Tennessee’s draft proposal, the state would get a lump sum based on projected Medicaid costs. The grant would be adjusted each year for inflation. The federal government would increase its funding on a per capita basis when Medicaid enrollment eclipses the number used to calculate the state’s initial grant amount.

TennCare director Wendy Long leaving for Nashville post

TennCare Director Wendy Long is leaving her position with the state to become director of health for the Metropolitan Board of Health of Nashville and Davidson County.

Here’s the full release from Gov. Bill Haslam’s office:

NASHVILLE – Tennessee Gov. Bill Haslam today announced TennCare Director Dr. Wendy Long will leave state service in January. The Metropolitan Board of Health of Nashville and Davidson County has selected Dr. Long as the new director of health, pending contract approval by the Metropolitan Council.  

Haslam appointed Dr. Long in June 2016 as the director of TennCare after she previously served in other executive positions within the agency including deputy director and chief medical officer. Dr. Long has 14 years of service to TennCare and more than 30 years to Tennessee State Government. Dr. Long’s state service includes working as assistant commissioner at the Tennessee Department of Health where she oversaw a wide variety of programs and services including maternal and child health, communicable disease control, and the operation of local and regional health departments throughout the state. 

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Tennessee’s uninsured rate up by 10% over 2017

Tennessee uninsured rate increased by 10% over last year, according to a new study released by the University of Tennessee.

An estimated 452,000 Tennesseans are uninsured in 2018, or 6.7% of the state’s total population. That compares with the 408,000 people, or 6.1%, who were uninsured in 2017. That followed a low of 5.6% in 2016. That state’s uninsured rate hovered near the 10% mark between 2006 and 2013, before the Affordable Care Act went into effect.

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TennCare moves to implement new TN ‘defund Planned Parenthood’ law

In compliance with a law approved earlier this year by the state legislature, TennCare officials last week applied to the federal government for a waiver that could block clinics that provide abortions from being paid for other health care services, reports the Johnson City Press. An ETSU professor says there may be unintended consequences including more abortions; a legislator disagrees.

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