Friday, August 31, 2012

Medicaid, TennCare, Birth Control and Welfare Babies

So I'm going to bypass posting part two of my TennCare rant for right now, to post something I find a little more.. controversial.

TennCare pharmacy benefits are run by SXC, which the state contracts.(You can read more about this HERE) Not the health insurance company you get through tenncare, SXC manages ALL TennCare prescription benefits for Tennessee.

I have touched before on the limits of TennCare prescription benefits, at 5 a month and how this really affects most disabled people. 
Well, in doing some research to try to get some of my necessary medications covered (which so far hasn't happened, since no one can figure out what I'm talking about) I have uncovered some things.

  1. Per health care reform law, TennCare must cover birth control services and birth control with a 0$ co-pay.
  2. Birth control counts against your 5 monthly prescriptions and according to SXC representatives, Walgreens pharmacists and my OB/GYN is in no way attestable or in layman's terms able to become 'exempt' from counting towards your prescription limit.
  3. That women on TennCare can have ONE pap/std test a year, unless they exhibit symptoms.
  4. That there is no readily published numbers on how many pregnancies happen by a recipent of TennCare.
     5.That there are no readily published numbers (or studies) on how much TennCare pays each quarter       (or yearly for that matter) on maternity services, or pregnancy prevention. 

Well, this irritates me. One of the categories for TennCare eligibility (within income restrictions) is being pregnant.
Ok, well. Of course you have to already BE pregnant in order to get TennCare if you do not fall into another category (like disabled) so of course that already reduces the numbers of pregnant on TennCare people.
So for the sake of numbers, lets count TANF recipients too, (Cash assistance, aka welfare cash)

In Tennessee in 2008 (yes its a slightly outdated fact sheet, I can't find a newer one) there were over 144,000 TANF recipents, which is actually less than in 2007 due to cuts in eligibility.

So, lets say 144,000 TANF recipients (which are all women here in TN) plus the 1,000,000 or so disabled people in Tennessee ALL qualified for TennCare, regardless of pregnancy status.(For the sake of numbers, I will say 200,000 receive disability and are of child bearing age with tenncare, which is a far cry from what is likely true)

So 344,000 people eligible for TennCare. OK, well. The average birth control prescription, is 25$.
So, assuming for the sake of numbers that all females are on and prescribed the pill, at 25$ a month. Well the state won't pay that much, so it will be more like 14$, because they have contracts. OK. So 14$ *344,000 people.equals 4,816,000$. Per month. So times that by twelve, you get $57,790,000 (Now many people go off welfare and lose their eligibility but for numbers sake..)

Its expensive, yes.
For other birth control options, theres the shot (about 30$ for 3 months) or an IUD (about 300$ for FIVE YEARS) but I wont go into that, for the sake of simplicity

The average maternity pay out is $3,500 for basic care (not including NICU, preemie care or high risk) in Tennessee. So again for the sake of numbers lets say 100,000 of those 350,000 people that meet our critera get pregnant. Thats $350,000,000. 

So birth control preventatives - $57.75 million per year vs Maternity care for 1/3 the population that would be taking the birth control if covered by TennCare at $350,000,000.

Well, thats only a difference of $292,210,000. Thats a nice chunk of change.

Well.. what numbers don't show you is that since mom qualified for TANF/Medicaid, now her kid/kids do too.
So.. that's another 100,000 children TENNESSEE needs to cover. (TennCare covers about 1.3 million pregnant women, children and disabled people each year)

So.. for the sake of numbers.. lets say each kid is very healthy and only needs minimal care after birth (assuming newborn care in hospital is under moms maternity spending)

So 100,000 children times about 3000$ in regular yearly health care, including dental, vision, well child check ups, prescriptions and vaccinations, is $300,000,000, assuming the child is not disabled or needs ANYTHING special.

So lets do a quick breakdown of the numbers one last time

Birth Control for 344,000 people of child bearing age (assuming the pill only) =$ 57,790,000 YEARLY.
Maternity Care for 100,000 women who get pregnant while eligible for TennCare (assuming basics and singleton births only) = $350,000,000, yearly.
Basic medical care for children born on TennCare now qualifying for TennCare (assuming 100,000 babies) =$350,000,000 yearly.

So $700,000,000 a year in maternity +infant child costs (for child born through TennCare)
                               = $642,210,000

Well, I think a little more than half a billion dollars is pretty signifigant, don't you?

Then theres the cost to the tax payer (ahem, state) on increased assistance for families of those children. Lets assume only 80% suck up their pride and accept food stamps. Well, thats 1200$ additionally a year for the first four years or so (For numbers, many people do get off assistance entirely).
1200*80,000 people-$96,000,000 yearly.
Then lets assume that 40 percent take housing assistance (which is god awful to live in, much less even apply to the waiting list for, its nearly impossible to get)
So well say average assistance amount for that is 600$ per month per family
$600*12*40,000= $288,000,000 yearly.
Lets assume that 70% of new moms take WIC with baby formula for the first year (based on national breast feeding statistics)
So not including the average food benefit, lets say WIC spends about 200$ a month in formula and baby foods per child for the first year of life.
So, 200*12*70,000=$168,000,000.

So for one year for these 100,000 preventable births, in addition to the $642,210,000, add in $552,000,000 in first year costs, thats $1,194,210,000.

Or in simple terms, 1.2 BILLION dollars per year, on completely preventable births, in the state of Tennessee.

Then there's things like transport costs (Medicaid picks this up I believe) and additional things I can't possibly think of, not including cash assistance, DNA testing, child support orders/enforcement, custody, courts and CHILD CARE. I am NOT counting in child care assistance, as that figure just blows my mind. (Average subsidy per child can be between 300-1000$ A MONTH)

Considering Tennessee has about a 16% below poverty level rate (this is an estimate link) this doesn't really surprise me, but makes Tennessee the third poorest state in the United States.

So my question, dear tax payers, legislators and beaurocrats, why on earth are you supporting the perpetuation of poverty and the burden of the tax payer dime, by denying something as basic as birth control?

Feel free to leave your opinion in comments, or via email.



  1. I live in TN and have had TennCare. I know its jacked up but it definitely came in handy when I had my baby.

  2. Yes, Admin its very handy if you are already pregnant.
    What if you are trying to prevent that?