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

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.