TennCare II

TennCare II, implemented July 1, 2002, replaced the original TennCare Demonstration (11-W-0002/04), which ended on July 30, 2002. Like its predecessor, the TennCare II Demonstration uses savings from mandatory Medicaid managed care and reallocation of Disproportionate Share Hospital funds to extend Medicaid eligibility to selected low-income uninsured populations. All Medicaid State Plan eligibles are enrolled in managed care under TennCare II, except those whose only Medicaid benefits consist of Medicare premium payments. Medicaid State plan populations receive the TennCare Medicaid benefit package, while expansion populations receive TennCare Standard, with some State Plan benefits omitted. Individuals with demonstrated need for nursing facility level care can participate in the TennCare CHOICES, which provides integrated coverage for physical health, behavioral health, and long-term care services through a single managed care entity. CHOICES members who are able to remain in the community with assistance can request access to home and community-based services to help them stay in their homes. In 2005, TennCare coverage was discontinued for demonstration eligible uninsured adults, and the State plan non-pregnant medically needy adults group was closed to new enrollment. In November 2006, an amendment was approved to restore coverage to non-pregnant medically needy adults through the Standard Spend Down program, with enrollment capped at 105,000. The current list of expansion populations includes the Standard Spend Down group, children who qualify to receive TennCare Standard coverage after rolling over from Medicaid eligibility, and CHOICES members who qualify because they receive home and community-based services.