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While we appreciate TennCare will only be analyzing compliance on a 6-month process initially prostate 73 flomax 0.4 mg fast delivery, it is unclear how this process will continue once a person is initially removed from Medicaid coverage for non-compliance prostate awareness month generic flomax 0.4mg otc. Additional clarification on this process is needed to determine the exact impact to providers mens health quick adjust resistance band buy 0.4mg flomax with mastercard, however prostate cancer quality indicators order 0.4mg flomax overnight delivery, the current information provides detail to recognize this will add significantly to the overhead operating costs of our rural providers not to mention the uncompensated care costs for individuals that lose coverage and seek care in rural emergency departments. Impact to Rural Medicaid Beneficiaries Rural areas of Tennessee have unique challenges in relation to the implementation of Medicaid work requirements that need to be taken into consideration when rolling out a program change of this type. These include access to employment, internet connectivity, transportation and childcare. Another notable fact, is all of the counties with the highest rates of unemployment are rural. The information presented in January of 2018 is important in that it highlights the portion of the year where seasonal employment opportunities are at their lowest. This is important to note as seasonal employment makes up a large portion of the work opportunities in our rural areas. It also highlights the volatility in access to stable employment in rural Tennessee. Another issue in our rural areas is access to Community Service (volunteering) in approved settings. The draft amendment stops short of providing any information on what would be included in the definition of "approved settings". It is also recommended that a survey be completed of our rural counties on the availability of volunteer sites that would allow an individual to comply with the requirements of the proposed draft. For example, only 2 percent of urban citizens do not have access to 25/3 broadband connectivity in Tennessee compared to 34 percent of rural citizens. Although the draft is largely silent on how the self-reporting will be deployed, it is highly probable that is will be disproportionally burdensome on rural Medicaid enrollees to comply with this provision on a monthly basis. Penalties should be waived for rural areas that are unable to comply with monthly compliance deadlines. Rural areas of our state completely lack any type of public transportation infrastructure. A review of the Tennessee Poverty Rate by County reflects that 42 counties in Tennessee have at least 20% poverty rate if not higher. Without the proper social supports, like access to transportation, individuals will not rise out of poverty, they will simply lose their healthcare coverage for non-compliance with this proposed work requirement, thus sinking them deeper into poverty. A second barrier to satisfying these requirements is access to affordable childcare. Obviously, young children under age 10 should not be left without supervision at any time. In most cases, older teenage children may be left alone for short periods of time. In its first two years, the program has shown promise and has generated strong participation among enrollees, likely because the state has engaged in intensive outreach, offered meaningful services, and provided trainings to service providers and partners in how to meet the needs of low-income Medicaid enrollees. Due to the fact that TennCare cannot forecast the expected impact on enrollment these changes will have, we encourage the Bureau to proceed slowly without penalties until a greater understanding of the potential impact can be assessed. We strongly encourage a period of in-depth education of Medicaid beneficiaries and a grace period where penalties will not be implemented for at least the first-year post rolling out these proposed requirements. Page 4 states there will be "an emphasis on linking individuals to existing community resources. Simply put, the risks to families are not adequately addressed in this draft amendment and far outweigh any hypothetical benefits. The disruption of treatment or loss of access to health care would affect a particular group. Sharon Cox Sent from my iPad 1 Jonathan Reeve From: Sent: To: Subject: Rakhit, Shayan <shayan. Tenncare Feedback on Amendment 38 Dear Tenncare, Does the State of Tennessee and Tenncare have a plan to compensate safety net hospitals for the increase in uninsured Tennesseans seeking care at safety net hospital emergency departments, which is required by the Emergency Medical Treatment and Active Labor Act, the federal law signed by Ronald Reagan in 1986 Safety net hospitals, such as Vanderbilt University Medical Center, operate on razor thin margins and thus are dependent on as many funded patients as possible, of which ensuring as many insured low-income Tennesseans as possible.
March of Dimes is also concerned that the current exemption criteria may not capture all individuals with prostate removal side effects purchase 0.4mg flomax with amex, or at risk of man health institute purchase flomax 0.2 mg online, serious and chronic health conditions that prevent them from working duke prostate oncology discount flomax 0.2mg free shipping. Sincerely prostate seed implant buy flomax cheap, Tamara Currin Director of Maternal Child Health and Government Affairs March of Dimes, Tennessee Arkansas Department of Health and Human Services, Arkansas Works Program, August 2018. Employment Status and Health Characteristics of Adults With Expanded Medicaid Coverage in Michigan. As a medical student, I am opposed to any new requirements which would limit access to care for vulnerable populations. I am concerned that work requirements would place an undue burden on vulnerable patients and cause many to unfairly lose access to crucial care. I have lived in both Montgomery and Davidson Counties while working for the Department of Human Services as an Eligibility Counselor. I worked in that department for five years, evaluating participants for eligibility and their compliance with policy. The program changed drastically while I was a member of the department and we got to see the before and after effects as those changes were implemented. I have had an extended family sit in my cubicle and apply for medical assistance and had to tell them that they had to apply for welfare for the adults to be covered. I remember attempting to get her covered, give her the opportunity to recover before requiring that she show up at the salvation army to sort clothes as her "work activity" shortly after having surgery on her feet. These work requirements more often than not are the barriers thrown up, get in the way of those attempting to work their way out of poverty. Our priorities are terribly mixed up if we feel the need to make the poor prove their worthiness to receive healthcare. Their government should not impose harsh and arbitrary obstacles to the benefits they need just to survive. It will add more bureaucracy to the process of administering TennCare and it will cause people to lose their healthcare insurance. Long, I adamantly oppose the proposal (draft Amendment 38) to deny health care coverage to people who do not work a set number of hours a month. I can speak to this issue personally: Many years ago, my unemployed parents received Medicaid benefits that enabled them to live long enough to finish raising their children. I and my seven siblings have seven college degrees and many advanced degrees among us. The additional qualifying and reporting requirements would impose complex administrative burdens on people and their families who already are stressed. Furthermore, taking health care coverage away from the unemployed, which is the intent of the proposed amendment, undermines the goals of the Medicaid program and also the aim of the proposal itself. Unemployed people who are deprived of health care are less able to look for work and less able to work; if their health issues are left untreated, those people are less attractive to potential employers and thus more likely to remain unemployed. I object to my tax dollars being used to deprive otherwise-eligible people of health care. Tenncare Public Chapter 869 I oppose the proposed Public Chapter 869, which requiresTennCare to submit a waiver proposal for "reasonable" work requirements for non-disabled adults under 65 without children under 6 yrs old. Additionally, "reasonable" is a very subjective and non-specific term which will most likely cause a lot of glitches, clogging up the system with appeal processes, etc. Our legislature is definitely non-supportive of needy families across Tennessee, particularly regarding their health needs. Adequate health coverage, and convenient hospitals in rural areas will in the long run save the state many dollars. Lastly, we are concerned about the Amendment 38 statement that "it is not possible to reliably project the magnitude of this decrease in enrollment at this time. Tenncare New Work Requirement for TennCare Please do not add a new work requirement to people depending on TennCare for the healthcare. Tenncare I unequivocally oppose the proposal to take health coverage away from people who are unemployed Dr. Wendy Long, I am submitting the following comments in response to the public notice inviting public comments on proposed Waiver Amendment 38. The proposed waiver would lead to large coverage losses even though they remain eligible. Disruption of treatment or loss of access to health care would affect cancer patients, people with addiction, and people with diabetes among others.
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