228082 Effects of TennCare disenrollment on the Davidson County, Tennessee's safety net and strategies to ameliorate

Monday, November 8, 2010

Janice Emerson, MS, PhD candidate , Center For Health Research, Tennessee State University, Nashville, TN
Pamela Hull, PhD , Center for Health Research, Tennessee State University, Nashville, TN
Van Cain, MA , Center for Health Research, Tennessee State University, Nashville, TN
Michelle Reece, MS , Center for Health Research, Tennessee State University, Nashville, TN
Meggan Novotny, M A , Department of Counseling Psychology, Tennessee State University, Nashville, TN
In mid-2005 Tennessee's Medicaid program (TennCare) cut almost 200,000 from its roles with nothing in place to prevent deleterious effects on those disenrolled and on the health care safety net's ability to serve them. The purpose of this study was to examine these effects using the Davidson County Tennessee safety net data (i.e., quantitative clinic surveys and qualitative key informant interviews) and the Tennessee Hospital Discharge Data System. Study found that from one year prior to the TennCare cuts (2004) to before recession effects (2007) there was a significant (p=0.05) difference in numbers of uninsured (self-pay) visits to Davidson County hospital emergency rooms (EDs) from 19.1% (N=30,359) to 25.6% (N=40,090). Additionally, uninsured (self-pay) visits to EDs for ambulatory care sensitive (i.e., avoidable with regular primary care) increased from 5,691 in 2004 to 7,737 in 2007, which was a 35.9% change. Further, safety net data revealed resulting strain with fewer funds to treat more uninsured. Interviews with CEOs and other key informants were analyzed with NVivo software and showed that those clinics and EDs that have successfully adapted have formed partnerships with each other and with other community organizations to offer the most affordable services for the uninsured and to keep viable. Study suggests the use of public administration networking theories to enable safety net services to be distributed in a manner that will be mutually beneficial to safety net partners and patients alike.

Learning Areas:
Administration, management, leadership
Provision of health care to the public
Public health administration or related administration
Public health or related public policy

Learning Objectives:
Discuss strategies used by safety net administrators to survive the increase in service to the uninsured population due to TennCare (Tennessee's Medicaid program) disenrollment.

Keywords: Access to Health Care, Partnerships

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I have been a research associate for seven years during which time I collected and analyzed data for several health-related programs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.