TENNESSEE: Disabled Wrongfully Segregated, Suit Charges

      Lawyers representing six disabled Tennesseans filed suit against the state Department of Health yesterday, alleging that "Tennessee illegally forces disabled people into nursing homes by systematically denying them in-home long-term care options through TennCare," the state's Medicaid managed care program. The Memphis Commercial Appeal reports that the suit, filed by the nonprofit Tennessee Justice Center on behalf of all TennCare members, alleges that the state's actions violate both the Americans with Disabilities Act and federal Medicaid requirements (Wade, 12/8). The suit charges that the state "wrongfully segregate[s]" disabled TennCare enrollees in nursing homes by ignoring Medicaid mandates that require it "to provide home health services to individuals for whom such care is medically necessary." Further, the suit alleges, the state violates the ADA, which requires that public funding for the disabled provide services "in the most integrated setting appropriate." TennCare contracts with managed care organizations according to a capitated fee system, but "nursing home services are excluded from this arrangement and are reimbursed directly by the state." As a result, the suit contends, the disabled are shuttled into nursing homes and the TennCare contractors save money (Cheek 1, Tennessean, 12/8). TJC Executive Director Gordon Bonnyman explained that the suit was prompted in part because TennCare programs "are continuing to withdraw home health care ... because state policymakers are trapped between two politically powerful interest groups, nursing homes" and managed care plans. He said, "It's taken a few years for the [managed care plans] to target the folks who are really costly, and they're saying, 'We don't want to pay for that, let 'em go to the nursing home.'" However, Tennessee Health Commissioner Nancy Menke, who was named as a defendant in the suit, counters that "TennCare was never intended to provide the many long-term care services needed by the disabled." The Commercial Appeal reports that the lawsuit "could accelerate and broaden the state's fledgling efforts to create and fund a viable long-term care network for the elderly and disabled" (12/8).

Consolidating Care
      In other Tennessee news, the Tennessean reports that Gov. Don Sundquist (R) "will not pursue efforts to merge the state Department of Mental Health and Mental Retardation with the state Department of Health when the Legislature returns next month." The proposed consolidation "created a furor earlier this year," with advocates for mentally ill and the disabled saying it would create a gargantuan bureaucracy unable to provide services "to fragile Tennesseans" (Cheek 2, 12/8). Instead, the Tennessean reports that the Tennessee Disability Coalition recommended yesterday that the state create a new department to consolidate services for the disabled. The proposed agency, the Department of Services and Support for Mental Health, Aging, Mental Retardation and Disability, would create a single department to coordinate services for "people [who] have similar needs." The coalition aims to garner bipartisan support from the legislature and receive Sundquist's approval. A spokesperson for Sundquist said, "I think the governor would keep an open mind, but he does have his own ideas and thoughts about how the government should be restructured" (Cheek 3, 12/8).