United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1995-09-01 monographic deposited born digital 60 p. GA 1.13:HEHS-95-186 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-95-186 P0b002ee180374afb f:he95186 DGPO 2010-08-12 2011-03-24 GAOREPORTS-HEHS-95-186 machine generated eng fdlp REPORT GAOREPORTS-HEHS-95-186 HEHS-95-186 Medicaid programs State-administered programs Financial management Waivers Health care cost control Health maintenance organizations Medical services rates Disadvantaged persons Federal/state relations Health resources utilization Tennessee TennCare Tennessee Children's Plan Medicaid Disproportionate Share Program Tennessee Primary Care Provider Fund Tennessee Comprehensive Health Insurance Program Letter Report HEHS Pursuant to a congressional request, GAO reviewed Tennessee's Medicaid capitated managed care program (TennCare), focusing on: (1) TennCare's basic design and objectives; (2) the degree to which the program is meeting these objectives; and (3) the experiences of TennCare insurers and medical providers and their implications for TennCare's future.<p/>GAO found that: (1) TennCare's objectives are to expand health care coverage to the state's uninsured and to control program costs by mandating that Medicaid participants enroll in managed care organizations (MCO) and covering certain uninsured, Medicaid-ineligible persons; (2) Tennessee has cut costs by setting its capitation rates below historical Medicaid costs, applying an additional discount based on the assumption that extensive insurance coverage would reduce charity care costs, and discontinuing certain supplemental payments; (3) in granting the Medicaid waiver, the Health Care Financing Administration has required Tennessee to implement measures to monitor and ensure access to quality care and has limited federal payments over the program's 5 years to ensure that federal costs do not exceed what they would have been without the waiver; (4) despite the increased number of participants, federal and state TennCare expenditures have increased much less than the national average for Medicaid programs and program costs have actually declined when uncapitated administrative and long-term care costs are excluded; (5) access to and quality of care could not be measured because Tennessee and MCO have not yet set up their monitoring systems, but a survey of beneficiaries revealed significant dissatisfaction with the new program because of the limited choice of doctors and difficulty in finding providers; (6) many MCO and providers lost money in 1994 despite receiving supplemental payments from TennCare; and (7) although TennCare has met its initial objectives, its long-term success is uncertain. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-95-186/html/GAOREPORTS-HEHS-95-186.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-95-186/pdf/GAOREPORTS-HEHS-95-186.pdf GAO/HEHS-95-186 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-95-186 Letter Report GAO/HEHS-95-186; Medicaid: Tennessee's Program Broadens Coverage But Faces Uncertain Future; Medicaid programs State-administered programs Financial management Waivers Health care cost control Health maintenance organizations Medical services rates Disadvantaged persons Federal/state relations Health resources utilization Tennessee TennCare Tennessee Children's Plan Medicaid Disproportionate Share Program Tennessee Primary Care Provider Fund Tennessee Comprehensive Health Insurance Program