TennCare Disputes Patient’s Ability to Continue Receiving Home Care
Tennessee’s Medicaid managed care program is trying to move a patient who currently receives 20 hours of daily nursing care at home to a nursing home to cut costs, but the patient is fighting the move, raising questions about care costs and the patient’s benefits under home care versus nursing home care.
The state’s plans to put Angela Hibbitt in a hospital’s ventilator unit came as a “complete surprise” to Hibbitt, media report.
Hibbitt had asked the state to keep providing 20 hours of daily nursing care during a hearing in May, but the administrative judge ruled in TennCare’s favor.
A managed care specialist for TennCare told the judge that level of care at Hibbitt’s house costs $22,200 a month compared with $18,000 at a nursing home, according to a recent article in The Tennessean.
Hibbitt launched an online petition drive entitled “I’ll die if I am warehoused in a nursing home” that has garnered more than 54,000 signatures. She has filed for a second hearing and is waiting to learn the date.
The decision to cut her in-home nursing hours was made after a regular review of Hibbitt’s health records, Kelly Gunderson, director of communications for TennCare, tells the Tennessean.
“In this case, the member’s plan determined that few private duty nursing hours or nursing facility care were necessary to continue to safely and effectively meet the member’s medical needs while also meeting the needs in a cost-effective manner,” Gunderson says.
A TennCare rule states that in-home nursing, which is available to adults only when they need a ventilator or other life-sustaining medical technology, must be the least-costly alternative course of treatment.
Tennessee has only six ventilator care facilities, according to the International Ventilator Users Network. None of them are in Jackson, the city closest to where Hibbitt lives.
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Written by Cassandra Dowell