Health Care Story of the Week - 1/13/10

This week, instead of presenting a story of an individual's struggle with health care issues, we present a comparison between the availability of care in Tennessee and Alabama, which has been affected by recent policy decisions.

Last month, Alabama won a $39 million performance bonus for making it easier for low income children to get health insurance. Meanwhile, just across the border in Tennessee, legislation was passed that locked many of the state’s 150,000 uninsured children out of TennCare indefinitely.

So, a low income uninsured child on the Alabama side of Ardmore, a town that spans the Alabama-Tennessee border, can now access Medicaid coverage more easily than ever before. But the same low income uninsured child on the Tennessee side of town may now be forced to go without needed medical care.

On December 16, the federal government awarded the $39 million performance bonus to Alabama for doing such a good job enrolling low income children through the Children’s Health Insurance Program (CHIP). Two weeks earlier, Tennessee stopped accepting applications to their version of CHIP, known as CoverKids. Now, all low income, uninsured children in Tennessee who hadn’t applied for CoverKids by December 1st are out of luck.

The performance bonus was one of the programs created by the Children’s Health Insurance Program Reauthorization Act (CHIPRA). Ten states earned a bonus by meeting enrollment increase targets and implementing at least five enrollment and retention strategies.

In Alabama, these strategies included eliminating the in-person interview, providing 12 months of continuous eligibility, using a joint application for both Medicaid and CHIP, using the same form for renewal and application, and by implementing automatic renewal. But Tennessee failed to eliminate in-person interviews, use the same form for renewal and application, or implement automatic renewal. What’s more, Tennessee was one of the only states that failed to implement the use of joint renewal forms.

On December 1, Tennessee became the only state in the country to indefinitely close its CHIP program. The state did so despite the federal government contributing 75% of CHIP costs in Tennessee (a higher share than in most states), and despite the $350 million in unspent TennCare reserves.

Tennessee is clearly in need of a more accessible rather than more restrictive children’s Medicaid program: the state ranks 47th in the country for children’s health care, and infant mortality in Tennessee is worse than in many developing countries. In fact, the rate of infant deaths in Memphis is the worst of any city in America.

Alabama’s leaders know that, if times are hard for the state government, they are even harder for uninsured children and their families. Now more than ever, Tennessee should be following its neighbor to the south’s example by increasing TennCare enrollment instead of slamming the door on uninsured children.