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Aimee Luna: How to work with TennCare to restore health benefits

Aimee Luna • Sep 24, 2018 at 9:13 PM

For thousands of low-income Tennesseans, TennCare is a godsend. This state-run Medicaid program, established in 1994, is the only means by which some residents can access needed medical services.

 Although TennCare serves a vital need in our state, getting and keeping eligibility for TennCare can be difficult for people who are eligible.

People who receive TennCare must again be determined eligible for coverage each year, and the redetermination packets – with 12 pages of questions – can be overwhelming, particularly for seniors with failing eyesight or people with poor reading comprehension skills. In addition, TennCare’s communications with applicants can be difficult to understand, which leave many in limbo on the status of their coverage. It’s not uncommon for TennCare recipients to find themselves cut off, even though they still meet the eligibility requirements, or to encounter unexpected roadblocks to access the care they need through the program.

In my work with the Legal Aid Society of Middle Tennessee and the Cumberlands, I assist Tennesseans to get their TennCare benefits restored. We provide our services free of charge to low-income or elderly Tennesseans and have been successful in resolving their situations, often more quickly than they can by themselves.

One recent client of mine is Joshua Hughes, a 19-year-old Murfreesboro resident who previously had cancer. When he went in for a regular checkup, his doctor told him his cancer might be coming back, necessitating further tests. When he tried to use his TennCare coverage to pay the doctor, he was told he was no longer covered.

The reason, according to TennCare, was that Joshua hadn’t responded to a TennCare request for additional information after he completed the redetermination packet. Joshua said he never received the request for additional information, and he didn’t receive a subsequent letter telling him that his benefits had been cut off.

Typically, when people are cut off from TennCare, they have 40 days to appeal the decision. The next step in the appeals process is a hearing, which can have a wait time of as long as 90 days.

In Joshua’s case, it simply wasn’t an option to wait for the appeals process to play out at its normal pace. He contacted Legal Aid Society, and we were able to reach out to TennCare directly. He received approval to get his coverage back just 20 days after we took on his case.

If you’re a TennCare recipient and are unsure about your current status – and especially if you haven’t received a re-application packet in the past 12 months – I suggest calling Tennessee Health Connection at 855-259-0701. Packets aren’t sent out on a regular schedule, and they’re not usually processed quickly, either. I’ve had clients who sent in their packets more than a year ago who still haven’t received confirmation notices of their coverage.

To its credit, TennCare is in the process of implementing a new system, Tennessee Eligibility Determination System, which aims to make the eligibility determination process more reliable and efficient. TEDS is scheduled to roll out by spring 2019.

In the meantime, I suggest a few strategies for people trying to work with TennCare:

• If you send your application packet or any other materials to TennCare, fax them in and keep your fax confirmation sheet on file so that you can prove the date of receipt if necessary. Don’t send your packet by regular mail.

• The most frequent error that applicants make is failing to include additional requested documents, such as bank statements or proof of a life insurance policy. If you’re confused about how to fill out your application correctly, call Tennessee Health Connection to get your questions answered.

• If you’ve been informed that your benefits have been discontinued, appeal immediately so that you don’t miss out on the 40-day window for appeals. The best way to appeal is by faxing your appeal to 855-315-0669. TennCare has an online form for this that you can get if you search “TennCare How to File an Eligibility Appeal.” Be sure to save the fax receipt so you have proof of your appeal. If you cannot fax your appeal, you can call the Tennessee Health Connection at 855-259-0701 to appeal.

• If you have moved or changed your address in the last four years, you should let TennCare know your new address, unless you are sure they have it already. The best way to do this is to fax your new address to Tennessee Health Connection at 855-315-0669. TennCare has an online form called “TennCare Change of Address Reporting Form” that you can use. You should be sure to save the receipt that shows that you sent TennCare your new address. If you can’t fax, you can call Tennessee Health Connection at 855-259-0701 to report a change in address.

If you’ve reached a dead end and aren’t getting helpful information from TennCare, or you’ve had your coverage terminated unexpectedly and don’t know what to do, call Legal Aid Society at 800-238-1443. Our services include clearing up misunderstandings, getting the necessary information to the right people and fighting for you to get the coverage you’re entitled to.

Amelia Miller Luna is the family law practice lead attorney at Legal Aid Society’s Murfreesboro office. She is a graduate of Middle Tennessee State University and a 2003 graduate of the University of Memphis, Cecil C. Humphreys School of Law. She joined the Legal Aid Society upon graduation. While at law school, she worked with the Elder Law Clinic. She was also an editorial board member of the Tennessee Journal of Practice and Procedure and a member of the Moot Court Board, Phi Delta Phi and the Christian Legal Society. She was the District 7 representative for the Tennessee Bar Association’s Young Lawyers Division. In 2015, she was inducted into the TBA fellows division. Legal Aid Society of Middle Tennessee and the Cumberlands advocates for fairness and justice under the law. The nonprofit law firm offers free civil legal representation and educational programs to help people in its region receive justice, protect their wellbeing and support opportunities to overcome poverty. It serves 48 counties, including Wilson County, from offices in Clarksville, Columbia, Cookeville, Gallatin, Murfreesboro, Nashville, Oak Ridge and Tullahoma. Legal Aid Society is funded in part by United Way. Learn more at las.org or by following the firm on Facebook.


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