Changes in TennCare Rules Cause ‘Trouble’ for Tennessee HIV/AIDS Treatment Center, Patients
One of the largest HIV/AIDS treatment centers in the nation is "facing a troubling future" because of eligibility changes to TennCare, Tennessee's Medicaid managed care program, the Nashville Tennessean reports. Approximately 60% of the patients at Nashville's Comprehensive Care Center were covered by TennCare before July 1, but the "drastically tighten[ed]" rules will now exclude some HIV-positive patients from care coverage (Hurst, Nashville Tennessean, 8/4). TennCare was "one of the best-kept secrets for HIV/AIDS patients in Tennessee," Dr. Stephen Raffanti, the center's executive director, said in a phone interview yesterday, adding that between 1994 and July 1, 2002, TennCare covered anyone with HIV because they were considered "uninsurable." The state's HIV/AIDS programs had worked together with the TennCare managed care organizations to develop treatment protocols and a state formulary that included HIV/AIDS medications.
At the start of the new fiscal year, TennCare restructured eligibility and benefits and stopped enrolling HIV-positive patients in TennCare unless their annual income was below 100% of the federal poverty level ($8,860 for a single person). In addition, those patients who also qualify for Medicare -- approximately 11% of the center's patients -- or for work-sponsored health insurance are not allowed to enroll in TennCare. As a result, many of the center's patients who previously qualified for TennCare no longer do, Raffanti said, adding that the state-administered AIDS Drug Assistance Program will be able to help some patients with HIV/AIDS-related medications. However, ADAP funds can only be used for those who have an income of up to 300% the federal poverty level ($26,580 annually for one person) and can only be used for medications directly related to HIV/AIDS. Those patients with comorbidity, such as those who also have a mental health diagnosis, would not receive assistance with any other medications or services. Raffanti said he intends to continue seeing all of his patients, regardless of insurance status, but cannot provide drugs or do labwork for patients without insurance (Susannah Hunter, Kaiser Daily HIV/AIDS Report, 8/7).