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Tennessee Health Care Campaign

May/June 1999 issue of Poverty & Race

Tennessee Health Care Campaign
1103 Chapel Avenue
Nashville, TN 37206-2446
615/227-7500
Contact: Tony Garr

The Tennessee Health Care Campaign’s PRRAC-funded report (“Limited Access to Maternity Care in Tenn., 1992-1993: Results of the THCC Prenatal Care Survey”) remains an important study, not just for Tennessee but for the rest of the country as it looks to Tennessee to see if access to care can be expanded under a TennCare type of managed care design.

The study documented:
• The extent of barriers to prenatal care for pregnant women under the former Medicaid fee-for-service system; and
• The substantial distortion in the number of Medicaid prenatal care providers because of the methodology (claims processing data) used by the state to measure access to prenatal care.
The study provided Tennessee a base line to measure “true” access to prenatal care providers.
It found that:
• Medicaid, as a form of insurance, was a substantial barrier to access to prenatal care;
• Medicaid claims processing data is not a reliable method to count the adequacy of the number of prenatal care providers;
• Prenatal care providers, in a fee for service system, limit access to Medicaid patients by limiting the number of Medicaid patients they will see at any one time;
• Despite the claims data, there were very few providers who would take a “new” Medicaid patient;
• Lack of providers resulted in a lack of access to prenatal care.

As other states attempt to expand prenatal care access through Medicaid 1115 demonstration waivers, there are lessons to be learned. It appears that TennCare’s design has improved access to prenatal care and that the number of providers has expanded. Managed care only works when there is “true” access to prenatal care. Otherwise, managed care is impossible. Despite these apparent improvements, access to prenatal care for TennCare enrollees remains a major policy concern for the Tennessee Health Care Campaign.

This study provides a baseline for changes in access as a result of managed care. The existence of the PRRAC/THCC study uniquely equips researchers to accurately make those comparisons.

Notes:

Copies of the THCC report are available from Tony Garr for $2 ($5 with attachments).

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