Since 2014, Tennessee has left thousands of applicants for the state’s Medicaid program (called TennCare) in limbo. We’re suing. splcenter.org/news/2018/10/0…
Tennessee is required to determine Medicaid applicants’ eligibility within 45 days — but since 2015, at least 21,552 people have had to wait longer than that (sometimes months longer) to get treatment or medication bc no decision has been issued.
No Medicaid decision means newborns who can’t get monthly checkups and people with chronic conditions who can’t get medicine. Four years after we first filed suit, Tennessee is still averaging 330+ people/month who can’t get medical care bc they don’t know if they have insurance.
We’re suing Tennessee for leaving thousands of Medicaid applicants' lives in the balance while they wait for a decision. Three witnesses who experienced these life-threatening delays — Don Adams, Amy Foster & Kayla Krauss — testified when the case went to trial this week.
When Don Adams’ wife gave birth, they thought her insurance would cover their son. But as he testified: “When my son was born, the doctor told us once he left [the hospital] he wouldn’t have healthcare. So I called TennCare immediately. I applied the day after he was born.”
Don Adams: “For weeks, nothing. When I finally got hold of someone, they said they didn’t have any record of [my application.] I thought the system was just really slow. No one told me we could appeal.”
Don Adams: “I was mortified. I have a child, can’t take him to the doctor. We ran up so many bills they told us not to come back. My wife used to weep over his baby bed because anything can happen in the first year and we didn’t know if he was okay.”
Don Adams didn’t have insurance either. He testified: “Then I got a fever and sores but I didn’t realize it was MRSA because I didn’t go to the doctor: I didn’t want more bills. I had to get help [when] I was afraid I was gonna die. Never had so much pain.”
Don Adams: “They told me in four more hours, I would have been dead, and that I could be dead anyway because of the amount of antibiotics they had to give me could kill me. The doctor said he hoped I had a strong liver.”
Don Adams: “I only made $18,000 a year. I just wanted insurance for myself and my son. I applied on February 27, 2014, the day after he was born. We didn’t have insurance before July.”
Amy Foster cares for a cousin with severe mental illness. Insurance wouldn’t cover the residential care he needed. It took 6 months to get her cousin into a TennCare group home — months during which he couldn’t consistently take his medication and was sometimes homeless.
Amy Foster: “He has moments of psychosis. Bipolar disorder. Substance abuse problems. Suicide attempts. His mom has spent $100,000+ trying to help him [and] continued to carry him as a disabled adult on her health insurance. But many facilities only accept people on TennCare.”
Amy Foster: “When I talked to the hospital they said he needs residential [care] for a year, but insurance wouldn’t cover it. The doctor said a TennCare group home could swing it. So I applied Dec. 28, 2017. On March 6, 2018, they said they were still working on his application.”
Amy Foster: “On more than one hour-long commute [to work], I’d spend my entire commute on hold. I’d get to my office and have to hang up without talking to anyone.”
Amy Foster: “This process was byzantine and burdensome. It felt like they hoped you wouldn’t apply, and when you were delayed they hoped you wouldn’t appeal. … The whole time he was running off. He had periods of homelessness, we couldn’t get him to consistently take his meds."
Amy Foster: “On June 6th, he went to a TennCare group home. He hasn’t been homeless, on drugs: he’s stable. Not one in-patient psychiatric episode. This has been the best it’s been in a really long time. To us, this is a really big deal.”
Amy Foster: “I’m a lawyer. My mom has a doctorate. I went to the trouble of becoming Lee’s conservator to force people to talk to me. I have a partner who supports me, an understanding boss. Not everyone has those kinds of benefits. And it was still this hard.”
Kayla Krauss applied for TennCare just a few weeks after learning she was pregnant. Her application was delayed. She applied again. The second application was delayed.
It took a third application and a delay appeal to finally get a decision on whether Kayla Krauss was eligible for the state’s Medicaid program — five weeks before she gave birth.
Kayla Krauss: “On Nov. 1 2016 I learned I was pregnant. I applied for TennCare. I didn’t receive anything, including delay info. The OBGYN wanted to run tests at the end of Dec; in Jan, she wanted to do an ultrasound & glucose testing, but I couldn’t afford to pay out of pocket."
Kayla Krauss: “In February 2017, I filed a second application for TennCare. I started to have problems with high blood pressure. I was stressed, worried, scared: high blood pressure can kill the baby and be fatal to the mother.”
Kayla Krauss: “I started calling 2x a week. I got transferred or told it was being processed. … No one told me anything about a delay appeal. I found something about appealing if you were denied, but I hadn’t been denied (or approved) so I didn’t think that applied to me."
Kayla Krauss: “In April an advocate helped me file a 3rd application at the same time as a delay appeal. That was the first time I learned about that option. I finally got insurance 2 months after my 2nd application, 5 months after my 1st one — 5 weeks before I gave birth.”
By failing to give applicants to the state’s Medicaid program a decision about their eligibility within the mandated 45 days, Tennessee is depriving thousands of people of access to essential medical care. The state must fix this broken system. splcenter.org/news/2018/10/0…
