Tennessee's Medicaid program swelled to 1.5 million people after the Affordable Care Act took effect — matching an all-time high set around the year 2000 and meaning nearly a quarter of the state was on TennCare. Numbers have fallen slightly from that peak as the economy has boomed. But TennCare officials say they're finding a new normal.
For many years, the number of people on TennCare hovered around 1.2 million. Roughly 19,000 would qualify for the subsidized health care each month, and the same number would come off the program for whatever reason.
The ACA meant a flood of people looking for coverage, and some of them already qualified for TennCare. This was dubbed "the woodwork effect" as the individual mandate for everyone to get health insurance or risk a tax penalty drove people out of the woodwork.
TennCare's rolls have generally swelled when the economy is struggling and people lose their jobs. But unemployment is the now the lowest it has ever been in Tennessee. And TennCare director Wendy Long says her agency expects to see elevated numbers remain at 1.4 million, with just a 1.5 percent decrease projected next year.
"We do believe that we've already experienced the biggest decrease that we're going to see and we're going to begin to see a leveling, but probably a bit more of a decrease before we completely level off," she told Governor Bill Haslam at a recent budget hearing.
Rather than the improving economy, Long says the one thing that could drive down enrollment is if congress repeals the individual mandate. But it's also unclear whether just the reduced publicity about getting coverage could have an effect.
"I think probably more so than at any point in our past, enrollment is a little more difficult to predict right now because there's just a lot of unknowns," Long said.