Gov. Bill Lee and Senate Speaker Randy McNally made the assertion about the state's Medicaid program, TennCare, and another insurance initiative, CoverKids, in letters last month in response to criticism from Chattanooga Mayor Andy Berke.
"Under the Trump administration, the economy is growing and more people are coming out of poverty; in turn, less people qualify for the benefits," wrote McNally, who also said the state is getting a more accurate assessment of eligibility through income verification.
Berke and other critics say the GOP leaders' economic argument is a fallacy. They point to a study by the Georgetown University Center for Children and Families that found "scant evidence" that a nationwide enrollment drop among children from Medicaid and Children Health Insurance Program, or CHIP, is primarily the result of a strong economy.
Berke, a Democrat, says the state should make reforms and temporarily halt the disenrollments, some of which include families who lost coverage despite still being qualified.
Berke has featured testimonials on his Facebook page from Tennesseans who were removed from the rolls due to administrative issues, not economic improvement.
"While some claim that fewer Tennesseans qualify because of economic growth in our state, we now know this is untrue," Berke said in a statement. "Our most vulnerable families and children are losing their health coverage because the state officials responsible for re-enrolling them simply haven't done their jobs."
One in every eight children in TennCare were struck from the rolls between December 2016 and this January, according to an analysis of state data by The Tennessean.
State officials attributed the purge to the programs dropping children who no longer qualify or whose families didn't respond to mandatory renewal forms.
The Georgetown report says Tennessee had a 10.1 percent drop in child enrollment in TennCare and Children's Health Insurance Program initiatives, including CoverKids, this January compared to January 2018 — the highest in the country.
TennCare officials say that's due to Tennessee temporarily pausing its annual eligibility evaluations and experiencing one of the highest levels of enrollment growth in TennCare — including adults and children — and CHIP during the study period among states that did not expand Medicaid but did freeze evaluations.
Lee, who took office in January, wrote that the decrease in the last two years was due to an improving economy and the restart of those annual eligibility evaluations, which resulted in fewer disenrollments from 2014 to the first half of 2016. Lee said TennCare serves about 87,000 more children than were enrolled prior to the 2014 evaluation pause.
Tennessee suspended the evaluations, which require beneficiaries to provide updated information, while the state worked to implement new requirements under then-President Barack Obama's health care law, TennCare spokeswoman Sarah Tanksley said.
Additionally, about 60,000 children stopped receiving coverage for reasons other than the evaluations from 2016 to 2018, including 40,000 whose families asked for their children to be removed or who moved out of state, Tanksley said.
Michele Johnson, the Tennessee Justice Center's executive director, argued that if children were losing TennCare coverage because their parents' income was rising, they would be more likely to end up with programs like CoverKids with a higher income threshold.
Instead, many parents don't know their children lost coverage and could learn when they end up needing costly care the most, Johnson said. Lee said there was significant outreach before the evaluations resumed, and beneficiaries can complete the process by phone, online, fax and mail.
"The facts are, if children are $1 over income for Medicaid, then they can roll over into these other categories of Medicaid that enable kids who are middle class who don't have access to employer-sponsored coverage to keep their coverage," Johnson said.
Johnson also said that in counties that didn't make economic leaps, the number of kids who lost coverage still increased. Many of the state's 15 economically distressed counties saw child enrollment drops at levels near or above the state average.