CONTEXT The abrupt initiation of capitated Medicaid care in Tennessee (TennCare) in 1994 prompted many questions about changes in quality of care. OBJECTIVE To evaluate the effect on perinatal outcomes of the transition to TennCare in 1994. DESIGN Before and after retrospective cohort analysis. SETTING AND POPULATION Births to women residing in Tennessee between 1990 and 1995 with complet...

Managed care was the intended foundation of Tennessee's Medicaid-replacement program (TennCare) when it was implemented in 1994. By the Summer of 2005, however, when the mandated disenrollment of approximately 200,000 adult TennCare beneficiaries commenced, it was obvious that the promise of managed care had not been realized. The program collapsed under the weight of mismanagement and unrealis...

OBJECTIVE To evaluate trends in childhood immunization coverage after implementation of Medicaid managed care in Tennessee (TennCare) in 1994. DESIGN Before-and-after study using the Tennessee Department of Health annual cross-sectional survey of children aged 24 months. PATIENTS A mean of 1663 children per year who were randomly sampled during 1986-1999. MAIN OUTCOME MEASURE Completion r...

BACKGROUND TennCare, Tennessee's Medicaid managed care program, was introduced in 1994 with the goals of controlling spending and of improving access to health care. OBJECTIVE To assess changes in the continuity of enrollment following the implementation of TennCare for 2 groups: infants in the first year of life (defined as persons aged 0-12 months in this study) and children hospitalized wi...

dents. In 2005, the state’s inability to overcome numerous financial and legal difficulties finally led to painful cutbacks in both enrollment and medical services. The program has undergone many structural and implementation changes, some initiated by the state and some forced on the state by litigation and court rulings (Chang, 2005). This article traces the history of TennCare and describes ...

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BACKGROUND Fluoroquinolones are widely used to treat routine bacterial infections, but they are also potential first-line antituberculosis agents. Empirical fluoroquinolone therapy can delay the diagnosis of tuberculosis and cause resistance in Mycobacterium tuberculosis. Rates of fluoroquinolone exposure before tuberculosis diagnosis and the impact of fluoroquinolones on culture-negative tuber...

OBJECTIVE Twenty-three million people, accounting for >58% of Medicaid enrollees, are enrolled in Medicaid managed care programs. Although the expectation of management in Medicaid managed care programs necessitates restrictions in use of some services sought by patients and families, the circumstances surrounding care denial and related access problems in vulnerable populations of children hav...

BACKGROUND Immunoprophylaxis is the only pharmaceutical intervention for mitigating respiratory syncytial virus (RSV) infection. Patient level data on adherence to American Academy of Pediatrics (AAP) immunoprophylaxis recommendations are limited. This study characterizes adherence to AAP guidelines in privately insured and Medicaid populations. METHODS We performed a retrospective birth coho...

HIV-1 protease inhibitors (PIs) contribute to hyperlipidemia in persons treated for HIV infection. There are potential drug-drug interactions between PIs and some statins, which are drugs frequently used to treat hyperlipidemia. We performed a retrospective cohort study using the TennCare program to determine prescribing rates of contraindicated combinations of PIs and statins in HIV-infected p...