Latest news with #TennCare
Chicago Tribune
19-07-2025
- Health
- Chicago Tribune
Letters: Diaper banks are meeting families' demands and making change possible
Amy Kadens' opinions in her July 7 op-ed 'America's diaper bank model is incapable of meeting families' needs' are misguided, ill-informed and simply wrong. The National Diaper Bank Network (NDBN) and our more than 300-member basic needs banks, including five serving the greater Chicago area, provide vital services to children and families in crisis. Diaper banks are dynamic, trusted members of local communities that equitably distribute hundreds of millions of diapers to children and families each year. They are the model of success. Her caricature of the diaper bank community is not reality. Diaper banks meet families where they are. This means operating mobile units, partnering with pediatric clinics, integrating with home visiting programs, and working through schools, libraries and community centers to get families what they need. Kadens uses NDBN research, data and talking points — all unattributed — to conclude that nonprofit diaper banks are failing babies and communities. Kadens fails to recognize that NDBN and our member diaper banks drive policy solutions. The successful solutions cited — CalWORKs, TennCare — are terrific examples of what works, and they are the direct result of NDBN's nearly 15 years of research, advocacy and lobbying efforts to change public policy and end diaper insecurity in the U.S. However, when considering the grossly underfunded Supplemental Nutrition Assistance Program and Women, Infant, and Children food-based programs, NDBN strongly opposes including diapers. Babies can't eat diapers, and no more money is coming. NDBN and diaper banks are the lynchpin to change. Elected officials as well as state and federal agencies rely on the expertise of the diaper bank community to create legislation and policies that help children. Currently, states supporting and funding diaper distribution efforts include California, Colorado, Connecticut, Indiana, Michigan, Minnesota, New York, Tennessee and Washington. Recently, Missouri Gov. Mike Kehoe signed legislation to end state sales tax on diapers, joining more than 20 U.S. states. Our growing network distributed nearly 250 million diapers last year alone. This isn't a model that has 'reached its limit.' It's a movement that's scaling rapidly to meet demand, and yes, diaper banks need more funding to weave the social fabric that unites our communities and our country. The National Diaper Bank Network will continue building the support necessary for systemic change. We're not holding back progress — we're making it possible. Real change comes from building on what works, not tearing down what serves. And what serves right now, while we fight for better, is a network of dedicated community-based organizations ensuring that babies have clean diapers article regarding the hodgepodge of e-bike laws popping up in the suburbs begs the question as to when Illinois Secretary of State Alexi Giannoulias will address the issue statewide ('In suburbs, a confusing patchwork of e-bike laws,' July 14). These new and more powerful e-bikes are in fact electric motorcycles and should require license plates, licensed drivers and insurance, just like their gasoline-powered counterparts. I witness these bikes breezing down bike paths, sidewalks and through intersections daily, the riders ignoring traffic signals, buzzing horns at pedestrians and dog walkers, and disregarding verily every rule of the road. They present a danger to all and, in the presence of scooters and traditional pedal bikes, a liability due to the lack of financial responsibility the drivers are not required to carry. Electric cars are automobiles in every sense of the word, other than what powers their engines. Electric motorcycles are no different and should not be exempted from state in the 'Big Beautiful Bill' is a school choice program that allows states to participate in scholarship programs for students in low-income families. I agree with the Tribune Editorial Board that Illinois should participate in this program ('A second chance for school choice in Illinois,' June 16). In Illinois, the Invest in Kids Act was allowed to sunset in 2023, leaving children who benefited from this program abandoned and parents wondering how to assure their children get a quality education. So now it will be up to Gov. JB Pritzker to decide whether Illinois will participate in this program. Does he put the kids first or does he continue his battle with President Donald Trump? Does he put the kids first or the special interests of the teachers unions first? Time will one of a rare breed of print newspaper subscribers, I opened my Sunday edition of the Tribune eager to read the full write-up on the Chicago Sky's dominant home win the day before. Chicago's scrappy WNBA team soundly beat the Minnesota Lynx, currently the best team in the league. This win marks a huge turnaround for our ladies, who were all but counted out during the first quarter of the season. It was also nationally televised, the noon slot on ABC, so it was understood by the people who make big money decisions to be an attention-grabbing event. I am glad to report that it lived up to the hype, as I was fortunate enough to attend myself. Considering the rapidly growing popularity of the WNBA, much if it due to Chicago's own globally recognized sports superstar Angel Reese, I couldn't wait to read all about this newsworthy event in my Sunday paper. Instead, coverage of the Sky win was copied and pasted from The Associated Press, hidden in a blurb that was tucked away in the top left corner on the second page of the Chicago Sports section — crowded out by the continuation of a story about the Bulls summer league, no less! The Tribune couldn't even be bothered to send one of its own reporters to cover the game. And I thought WNBA execs took the cake for dropping the ball (pun intended) on one of the most exciting sports stories in recent time. To the Tribune, in case it missed this also, the NCAA women's basketball title game in 2024 had more viewers than the men's. And now, many of those college phemons are WNBA players. Catch up: It ain't 2005 anymore. Reese and the Chicago Sky are front-page news.
Yahoo
29-06-2025
- Business
- Yahoo
Opinion - Congress should look to Tennessee as an example for Medicaid reform
As Congress wrestles with the need to trim spending, attention has turned to Medicaid, and to a lesser extent, Medicare. These are hardly new issues. Within seven years of the 1965 enactment of Medicaid, for those eligible for federal income support (largely those in poverty), and Medicare, primarily for those eligible for Social Security, Congress in 1972 turned its attention to concerns about containing costs in those programs. Tennessee has been a pioneer in managing its Medicaid costs, and Congress might benefit from the Tennessee experience with TennCare, the state's Medicaid program. About 30 years ago, Tennessee faced unsustainable annual increases in its Medicaid program. A popular Democratic governor, Ned McWherter, called the state's Medicaid program the Pac Man of the state's budget. He sought to find a way to pay for the Medicaid increases through a state income tax (Tennessee does not have one) but failed. The TennCare program was designed to address the issue by containing the rate of increase in costs. Tennessee received a waiver so that it could implement a universal and mandatory managed care program. Tennessee had no managed care in Medicaid, and a move to 100 percent managed care was projected to reduce costs by 20-25 percent on a recurring basis. Support from patient advocates was secured by agreeing that cost savings would be used to increase access to Medicaid to previously uncovered persons. The mandatory Medicaid managed care program was deemed such a success that, in 1997, Congress allowed states to implement Medicaid managed care without a waiver. Managed care introduced economic considerations into the process of medical decision-making. While the cost savings projections were pretty much on target; once those savings were fully realized, the projections recognized that the rate of cost escalation would be restored, albeit from a lower cost basis. That projection also turned out to be pretty accurate. A Republican governor, Don Sundquist, succeeded McWherter and unsuccessfully sought to implement an income tax. Another wonderful Democratic governor, Phil Bredesen, was elected to succeed Sundquist under a promise not to seek an income tax. Bredesen was determined to find a way to manage down the rate of increase of Medicaid spending. I served as his outside counsel. A reform team determined that the target for reform should focus on the concept of 'medical necessity.' That insight was informed by work I had done as part of an Institute of Medicine study group, which looked at hospital staffing in a system that had recently merged three hospitals. There were three distinct models, and no consensus about which was the 'right' one. Traditionally, the concept of 'medical necessity' was the term used to define the scope of benefits under health plans, including Medicaid. The concept assumed that there was a single correct way of practicing medicine, and that it had a justification based on scientific consensus. But the existence of clinical uncertainty called into question that traditional view. As it turned out, many alternatives were available at varying costs, and evidence of superiority of one particular approach was often lacking. Those insights led to the policy conclusion that, if a more expensive alternative were proposed, the state should not pay for that more expensive alternative unless there was good scientific evidence that it was superior and worth the additional cost. If an aspirin were adequate, it should be used instead of a more expensive prescription-based alternative. If an adequate outpatient procedure were available at lower cost, TennCare should not pay for a more expensive inpatient option. These insights resulted in a TennCare definition of 'medical necessity' that could serve as a national model at considerable (but hard to measure) cost savings. That definition has been in place for nearly 20 years and has been approved by a federal court. TennCare has kept costs manageable so that the state has been able to live within existing sources of revenue, and the state even proposed to accept financial risk if it could share in the cost savings from TennCare above a projected baseline. The TennCare definition includes the traditional requirement that a medical item or service be recommended by a treating physician (no doctor shopping) and that it be 'safe and effective.' The reasonably anticipated medical benefits must 'outweigh' the reasonably anticipated medical risks 'based on the enrollee's condition and scientifically supported evidence' to be covered under TennCare. That is, a medically based risk-benefit calculation is a requirement as part of medical decision-making. The innovative aspects have three components. First, a medical item or service must be required 'in order to diagnose or treat an enrollee's medical condition.' That circumscribes the type of item or service covered under the program. Second, the medical item or service must be the 'least costly alternative course of diagnosis or treatment.' That expressly incorporates economic factors into medical decision-making. An alternative course of diagnosis or treatment 'may include observation, lifestyle or behavioral changes, or, where appropriate, no treatment at all.' If an item or service can be safely provided in an outpatient setting at lower cost, then that is what TennCare will pay for. More expensive inpatient treatment is not 'medically necessary.' Third, the less costly alternative need only be 'adequate for the medical condition of the enrollee.' The yardstick is not the best possible standard or some comparison with private plans. The standard of 'adequacy' means that sub-standard medicine is not acceptable, but that some differences between benefits for TennCare enrollees and those on private plans are acceptable. These innovations were controversial 20 years ago, when proposed and enacted, but they have become part of the fabric of TennCare and have been in place successfully for two decades. They help shape the medical decision-making culture that costs are to be considered and that the issue is the adequacy of care not what might be available in some private plans. That type of modest stratification, by the way, is expressly endorsed in the Affordable Care Act. Section 1302(b)(5) expressly allows for supplementation by health plans beyond the essential health benefits mandated by the Affordable Care Act. In the discussions that led to these reforms, the estimated range of savings was from 1 percent to 5 percent of total Medicaid spending. In an environment in which a program entails large expenditures, even a 1 percent per year savings could be considerable. James F. Blumstein is University Distinguished Professor at Vanderbilt Law School and the director of Vanderbilt's Health Policy Center. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
The Hill
29-06-2025
- Business
- The Hill
Congress should look to Tennessee as an example for Medicaid reform
As Congress wrestles with the need to trim spending, attention has turned to Medicaid, and to a lesser extent, Medicare. These are hardly new issues. Within seven years of the 1965 enactment of Medicaid, for those eligible for federal income support (largely those in poverty), and Medicare, primarily for those eligible for Social Security, Congress in 1972 turned its attention to concerns about containing costs in those programs. Tennessee has been a pioneer in managing its Medicaid costs, and Congress might benefit from the Tennessee experience with TennCare, the state's Medicaid program. About 30 years ago, Tennessee faced unsustainable annual increases in its Medicaid program. A popular Democratic governor, Ned McWherter, called the state's Medicaid program the Pac Man of the state's budget. He sought to find a way to pay for the Medicaid increases through a state income tax (Tennessee does not have one) but failed. The TennCare program was designed to address the issue by containing the rate of increase in costs. Tennessee received a waiver so that it could implement a universal and mandatory managed care program. Tennessee had no managed care in Medicaid, and a move to 100 percent managed care was projected to reduce costs by 20-25 percent on a recurring basis. Support from patient advocates was secured by agreeing that cost savings would be used to increase access to Medicaid to previously uncovered persons. The mandatory Medicaid managed care program was deemed such a success that, in 1997, Congress allowed states to implement Medicaid managed care without a waiver. Managed care introduced economic considerations into the process of medical decision-making. While the cost savings projections were pretty much on target; once those savings were fully realized, the projections recognized that the rate of cost escalation would be restored, albeit from a lower cost basis. That projection also turned out to be pretty accurate. A Republican governor, Don Sundquist, succeeded McWherter and unsuccessfully sought to implement an income tax. Another wonderful Democratic governor, Phil Bredesen, was elected to succeed Sundquist under a promise not to seek an income tax. Bredesen was determined to find a way to manage down the rate of increase of Medicaid spending. I served as his outside counsel. A reform team determined that the target for reform should focus on the concept of 'medical necessity.' That insight was informed by work I had done as part of an Institute of Medicine study group, which looked at hospital staffing in a system that had recently merged three hospitals. There were three distinct models, and no consensus about which was the 'right' one. Traditionally, the concept of 'medical necessity' was the term used to define the scope of benefits under health plans, including Medicaid. The concept assumed that there was a single correct way of practicing medicine, and that it had a justification based on scientific consensus. But the existence of clinical uncertainty called into question that traditional view. As it turned out, many alternatives were available at varying costs, and evidence of superiority of one particular approach was often lacking. Those insights led to the policy conclusion that, if a more expensive alternative were proposed, the state should not pay for that more expensive alternative unless there was good scientific evidence that it was superior and worth the additional cost. If an aspirin were adequate, it should be used instead of a more expensive prescription-based alternative. If an adequate outpatient procedure were available at lower cost, TennCare should not pay for a more expensive inpatient option. These insights resulted in a TennCare definition of 'medical necessity' that could serve as a national model at considerable (but hard to measure) cost savings. That definition has been in place for nearly 20 years and has been approved by a federal court. TennCare has kept costs manageable so that the state has been able to live within existing sources of revenue, and the state even proposed to accept financial risk if it could share in the cost savings from TennCare above a projected baseline. The TennCare definition includes the traditional requirement that a medical item or service be recommended by a treating physician (no doctor shopping) and that it be 'safe and effective.' The reasonably anticipated medical benefits must 'outweigh' the reasonably anticipated medical risks 'based on the enrollee's condition and scientifically supported evidence' to be covered under TennCare. That is, a medically based risk-benefit calculation is a requirement as part of medical decision-making. The innovative aspects have three components. First, a medical item or service must be required 'in order to diagnose or treat an enrollee's medical condition.' That circumscribes the type of item or service covered under the program. Second, the medical item or service must be the 'least costly alternative course of diagnosis or treatment.' That expressly incorporates economic factors into medical decision-making. An alternative course of diagnosis or treatment 'may include observation, lifestyle or behavioral changes, or, where appropriate, no treatment at all.' If an item or service can be safely provided in an outpatient setting at lower cost, then that is what TennCare will pay for. More expensive inpatient treatment is not 'medically necessary.' Third, the less costly alternative need only be 'adequate for the medical condition of the enrollee.' The yardstick is not the best possible standard or some comparison with private plans. The standard of 'adequacy' means that sub-standard medicine is not acceptable, but that some differences between benefits for TennCare enrollees and those on private plans are acceptable. These innovations were controversial 20 years ago, when proposed and enacted, but they have become part of the fabric of TennCare and have been in place successfully for two decades. They help shape the medical decision-making culture that costs are to be considered and that the issue is the adequacy of care not what might be available in some private plans. That type of modest stratification, by the way, is expressly endorsed in the Affordable Care Act. Section 1302(b)(5) expressly allows for supplementation by health plans beyond the essential health benefits mandated by the Affordable Care Act. In the discussions that led to these reforms, the estimated range of savings was from 1 percent to 5 percent of total Medicaid spending. In an environment in which a program entails large expenditures, even a 1 percent per year savings could be considerable. James F. Blumstein is University Distinguished Professor at Vanderbilt Law School and the director of Vanderbilt's Health Policy Center.
Yahoo
12-06-2025
- Health
- Yahoo
Tennessee has highest maternal mortality rate in country, CDC data says
NASHVILLE, Tenn. (WKRN) — New data from the Centers for Disease Control (CDC) ranks Tennessee number one for its maternal mortality rate from 2018 to 2022. According to the report, there were 166 pregnancy-related deaths in TN during the five year span, making the state's maternal mortality rate 41.1 per 100,000 births. Sen. London Lamar (D-Memphis) told News 2 she sadly isn't surprised by the statistic. 'If we don't invest on the front end and give women access to services they need, we can only expect negative outcomes,' Sen. Lamar said. 📧 Have breaking news come to you: → According to TN's Maternal Mortality Review Board, from 2020 to 2022, the leading causes of pregnancy-related deaths in the state were mental health conditions, including substance use disorders, cardiovascular conditions, and infections. The committee also found in 2022, 76% of pregnancy-related deaths were preventable. Sen. Lamar blames, in part, the state's near-total abortion ban and lack of access to quality care for TN's high maternal mortality rate. 'We need to make great policy decisions and put our money where our mouth is if we're going to be a pro-life state to ensure women have the healthcare services that they need,' Sen. Lamar said. The Democrat believes that includes building more hospitals and healthcare centers, reimbursing doctors, and implementing TennCare coverage for doula services. Although the state currently has a pilot program requiring TennCare to reimburse for doula services, Sen. Lamar told News 2 making it permanent would improve outcomes for mothers and babies. 'Doulas reduce the rate of maternal and infant mortality and morbidity, period, because when someone has the education and support that they need, or someone has the training to identify things that could potentially be going wrong with the pregnancy, we can act faster, we can put you on the path to success, we can create a plan that can help you make it throughout the pregnancy process and afterwards in postpartum,' Sen. Lamar said. Tennessee has taken steps aimed at reducing its maternal mortality rate over the years, including providing grant money for community organizations to increase the number of postpartum and substance use disorder screenings and efforts to improve access to support services. ⏩ However, Sen. Lamar told News 2 she plans to continue to push for more. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
04-06-2025
- Business
- Yahoo
'Big Beautiful Bill' cuts to Medicaid, food aid raise alarm in Tennessee
From left, Ashlie Bell, a survivor of childhood cancer and director of Family Voices of Tennessee, and Dr. Megan Schwaim, executive director of the Tennessee Caregiver Coalition, address how federal cuts to food programs will affect Tennesseans. (Photo: John Partipilo/Tennessee Lookout) Advocates for low-income and disabled Tennesseans sounded the alarm Tuesday over federal legislation that could slash an estimated $1.1 trillion over the next decade from federal safety net programs that provide food and healthcare to millions of Americans. The package includes a $600 billion reduction in federal Medicaid spending over 10 years, impacting TennCare, Tennessee's program, which currently covers healthcare costs of 1.4 million people, including two of every five children in the state. It also includes nearly $300 million in cuts to the Supplemental Nutrition Assistance Program (SNAP), formerly known as 'food stamps,' which helps more than 700,000 Tennesseans buy food. Some savings from SNAP cuts would then be used to increase farm subsidies. Both programs would establish new work requirements for adult recipients. Tennessee counties stand to lose a net $5.3 billion in federal help over 10 years if Congress approves the SNAP cuts even with increases in farm subsidies, one recent analysis found. Jeannine Carpenter, chief communications officer for the Chattanooga Area Food Bank, warned the proposed cuts to SNAP would create a surge in hunger among Tennessee families. The food bank provided 17 million meals last year to families in southeast Tennessee and northwest Georgia, but, Carpenter noted, those efforts pale in comparison to the role SNAP plays in Tennessee. 'For every meal we provide, SNAP provides eight,' she said. 'So, if we take these benefits away, we're talking about a food insecure population that cannot be cared for by our current charitable infrastructure.' Speaking during a downtown Nashville news conference held outside the offices of Tennessee's two Republican senators, Marsha Blackburn and Bill Hagerty, Carpenter urged the pair to reject the cuts and 'protect the very people they were elected to protect,' she said. Medicaid cuts in the so-called 'One Big Beautiful Bill' would largely come from new work requirements for adults and imposing more paperwork requirements that are expected to disqualify recipients unable to complete them. The work requirements could have a narrower impact on Tennessee, which has opted not to expand Medicaid, than other states. They apply primarily to non-elderly adults without disabilities. Most TennCare enrollees are children, their parents, pregnant women, seniors and people with disabilities. TennCare has an uneven history for the existing paperwork process it uses to enroll and then periodically verify people enrolled in the program. One government audit found that of the more than 240,000 children cut from TennCare between 2016 and 2019, only 5% were found to be disqualified from the program. Other children lost insurance because families did not fill out paperwork correctly. Neither Hagerty nor Blackburn responded to requests for comment about the bill left with their offices. The Senate is expected to take up the package already approved by House Republicans later this month. GOP supporters of the bill say it is designed to root out 'waste, fraud and abuse' from the programs. An analysis by the Environmental Working Group, which has tracked farm subsidies for over the past three decades, found that just three of Tennessee's 95 counties would see their net funding increase even with deep cuts to SNAP: Crockett ($32 million increase), Haywood ($32 million increase), and Lake ($1.2 million increase). The rest would see farm subsidy bumps far outweighed by SNAP cuts. The group examined USDA county-level farm subsidy data and federal data for SNAP by county to determine how much funding each county stands to gain or lose should SNAP funding see a $300 billion cut and farm subsidies get a $35 billion boost under the bill. Tennessee's most populous counties would lose the most, with Shelby County expected to see a net $1.2 billion decrease, followed by Davidson ($500 million), Knox ($301 million), Hamilton ($283 million), and Rutherford ($167 million). But more rural counties will also see significant reductions in overall funding. 'We have thousands of SNAP recipients in a single county that receives support to help their families eat on a daily basis, but that will get cut so that a couple hundred (farmers), maybe, will receive a few extra thousand dollars when it comes to harvest time,' said Jared Hayes, senior policy analyst for the Environmental Working Group. These particular farm subsidies have higher payouts for larger commodity harvests, Hayes said, benefiting large-scale farmers over smaller operations. 'No matter what, people are going to be losing out in every single county. It's just who is getting the money,' he said. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
