Monday, April 13, 2009

TennCare Cuts 150,000

150,000 Tennesseans may lose their TennCare May 1!

The records of 150,000 people on TennCare are currently being reviewed internally by TennCare to determine if they may be eligible for another TennCare eligibility category. About 17,00 people are also in another open Medicaid category. On May 1, the first of 40,000 letters will be mailed out monthly requesting additional information until all 150,000 people get their letters. They will have limited number of days to reply or appeal when they get their letter.

What do I need to do before May 1? (See below)

Who will this impact: SSI/Daniels TennCare enrollees
These enrollees are former SSI recipients who are not currently receiving an SSI check. If you are still receiving a monthly SSI check, you should not get a letter.

Yes! But who are these enrollees? They are thousands of Tennesseans who have children with very serious medical conditions or adults who have a very serious medical condition. Even though these folks may not be eligible for another TennCare category, thousands of these
folks have serious medical conditions and will have no other place to go to get the medical care they need.
What is this all about?
This group of TennCare enrollees have been protected since 1988 by the federal court that determined that these enrollees should stay on Medicaid until Tennessee is able to determine that they are not eligible for another TennCare eligibility category. Since 2007, the governor actively pushed this in federal court and the federal court has now given TennCare permission to make these cuts.

Why is this happening now?
Because the state says that "it is not fair for these folks to keep their coverage while others cannot get it." However, we say: "It is not fair to cut thousands of very sick, vulnerable people off TennCare when there is no place for them to go to get the medical care they need."

Who are these enrollees?
• 14,905 are children under the age of 19
• 90,000 are dual eligible
• 872 are children who are seriously emotionally disturbed
• 15,754 are adults who are seriously persistently mentally ill

What services do the 90,000 dual eligibles receive now that they will not receive when they lose their TennCare?

1. Mental health case management
2. Non-emergency transportation
3. Inpatient hospital services beyond the Medicare limit (150 days)
4. Psychiatric hospital services beyond the Medicare limit (190 days)
5. Home health services for individuals who are not homebound
6. Home health services that serve a "custodial" purpose (Medicare exempts coverage of custodial care.
7. TennCare says that medically necessary home health care cannot be denied because it is "custodial" in nature).
8. Private duty nursing
9. EPSDT services (Early Periodic Services Diagnosis and Treatment - This is for children)
10. 24 hour residential treatment
11. Mental health crisis services
12. Psychiatric rehabilitation services
13. SNF services beyond the Medicare limit (100 days)

Action Step #1: Attend meeting in Nashville, April 23 11am-1pm

United Way in Nashville, 250 Venture Circle, Nashville, TN 37228 (Email me if you can attend the Nashville meeting at


organize a meeting of your area and call the Tennessee Health Care Campaign at (877)431-7083. We will make every effort to make a presentation in your area.

Action Step #2: Call your two state legislators toll-free 1-800-449-8366 or go to:

and ask them to do two things:

1. Immediately open the Medically Needy Program - Not everyone but thousands of Tennesseans who are cut from SSI/Daniels could qualify for the Medically Needy Program.

2. Eliminate the cap on Access Tennessee and provide additional funding for premium assistance. This program has a cap of 6,000 enrollees and has a waiting list of 4,300 people. It has also run out of money for premium assistance.

TennCare has over $500 million in TennCare reserves, over $750 million in its Rainy Day Fund, and receiving over $1.1 Billion in additional federal stimulus money just for TennCare. It is time to take care of Tennesseans and make them the state's priority.

Action Step #3: Call two legislative leaders who can make this happen.
Call Senator Randy McNally, Chair of the Senate Finance Committee
- 1--800-449-8366, extension 16806
Call Representative Craig Fitzhugh, Chair of the House Finance Committee - 1-800-449-8366, extension 12134


1103 Chapel Ave.
Nashville, Tennessee 37206
United States

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Elyssa D. Durant, Ed.M.