Thread by @BrettKelman

For the past few months, I have been investigating Tennessee’s state Medicaid system, which most people know as TennCare. Today, the @Tennessean published this story, written by myself and @mreicher. It is a whopper. This is a thread. tennessean.com/story/news/inv…

We should start with this: TennCare is IMPORTANT. It insures about 1.4 million people, mostly low-income kids. TennCare is also our states’ most expensive program. It is easy to dismiss TennCare as too complex or too boring (and it is!) but it is our duty to care.

One of TennCare’s priorities is confirming it only insures people who are actually eligible. That is logical. You don’t want a program for the poor to benefit the rich. You don’t want a program for kids to benefit adults. But the devil is in the details.

Confirmation is done in two stages. First, TennCare attempts to verify eligibility by cross-referencing other government programs, like food stamps. This works for about 60 percent of families. That’s pretty good. What comes next? Not so good.

For years, TennCare verified eligibility for the other 40% by mailing renewal forms to families. Coverage hinged entirely on these forms. Some forms were 47 pages long. My investigation focused on this process.

The crux is this: The paperwork system rarely worked. From 2016 to 2018, TennCare mailed hundreds of thousands of renewal forms to families. Most forms never came back. At least 220K kids faced losing insurance because of paperwork problems ... eligible or not.

That’s real bad for kids like 6-year-old Abel Sewell. He lives in Chattanooga. He’s a leukemia survivor. He needs monthly blood tests to make sure his cancer doesn’t come back. TennCare covered those tests until last October. Then his coverage vanished.

Three months later, the same thing happened to Abel’s brother, Jacob. He has ADHD and needs medication. It ain’t cheap. His insurance disappeared too.. The Sewells don't know why either kid lost their coverage.

This was disastrous for the Sewells. Suddenly, they were facing medical bills of $900 a month. To pay, they had to extend their mortgage, adding years of debt to a modest home that was nearly paid off.

“If I had all the money in the world, I’d go out and get them insured proper,” said John Sewell, the boys’ father. “But we don’t have that luxury. And there are lots of people in Tennessee who don’t.”

The Sewells are just one family of many who lost coverage within TennCare's broken paperwork system.

How did we figure this out? It wasn’t easy.

This investigation is based on massive database made by Maximus, a company hired to send and receive TennCare renewal forms.

The data covers 319,000 kids and documents 50+ kinds of notices that were mailed to families. Time to renew coverage? You get a notice. Approved? You get a notice. Denied? Notice. Need more info? Late response? Incomplete paperwork? No response? Notice.

With some fancy analysis, we tracked these notices to figure out what happened to each kid. Of the 319K, the data shows that only 32K got real decisions. They were either approved because they were actually eligible or denied because they weren’t.

What happened to the rest?

Some responded too late. Some submitted incomplete forms. More than 200,000 never responded at all. Most of those kids lost their insurance as a result. Were they still eligible? Nobody knows. Did the families actually get the forms? Nobody knows that either.

It should be said that TennCare disputes the findings of this investigation. They say our math is flawed and the data we used is unreliable (It’s TennCare’s data, BTW.)

How many kids lost coverage because of paperwork? This question, TennCare claims, is unanswerable.

Earlier this year, two Tennessee lawmakers also asked TennCare how many kids lost coverage because of paperwork problems. They didn’t get answers. Both lawmakers told me they think TennCare wants this info buried. @yarbro @VoteThompson96

“They aren’t going to let this out,” said Rep. Dwayne Thompson, who reviewed the findings of our investigation. “They know that several of us at least – and probably all of us – would be appalled by the number of children who have lost coverage.”

Let it be known: If you tell me an important question can’t be answered, I just might review 8 million points of data to prove you are wrong. Sometimes the truth is petty, but it’s always the truth.

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