Children left in TennCare lurch

When Tennessee abdicated responsibility for Medicaid applications to the federal government, foster children got locked out.

Adoption agencies had no way to seek coverage after TennCare made state residents apply through healthcare.gov, a website designed for families to shop for health insurance. The website has no computer equivalent to the state social workers once tasked with making sure children didn't go without medical coverage.

TennCare this year ended an arrangement that allowed staff with the Tennessee Department of Human Services to work directly with adoption agencies and hospitals to sign up newborns and children for the state Medicaid program.

But even babies with parents got left out. That's how Chris Williams and Emily Barron of Columbia wound up with a more than $100,000 hospital bill.

Barron said she and her husband got caught in circles when they contacted either healthcare.gov or the state call center for TennCare. Representatives of one entity would say to call the other. The family got batted back and forth while the medical bills mounted.

"They have turned our backs on us, really," Barron said.

Judy Rister, social services director of Agape Nashville, said she has not been able to file a Medicaid application for any of the children she serves.

"Healthcare.gov is just not flexible enough to address those kind of issues," Rister said. "I don't think we have truly figured out how to do it yet. I think we have been just taking an avoidant role at this point because it is really not clear. There is no one you can go to in the Department of Human Services who can explain how to do that."

For now Agape is not transferring TennCare coverage from parents who have lost custody of their children. But if a child comes into Agape without existing TennCare coverage, the organization has no way to apply, she said.

At the same time that Tennessee sent people to healthcare.gov, it left hospitals without a way to declare presumptive eligibility, a process allowing them to temporarily enroll babies who would likely qualify for coverage

Lee-Ann Higgins, a counselor with Miriam's Promise, said her organization receives babies without coverage and cannot sign them up for Medicaid. Some of these are newborns whose mothers didn't receive prenatal care and just showed up at hospital emergency rooms at delivery time.

"Because the legal process does not allow us to have guardianship immediately, there is no mechanism for us to apply for TennCare for those children," Higgins said. "They basically have no coverage."

Donna Thomas, director of Caring Choices for Catholic Charities of Tennessee, said it also encounters problems as it works with pregnant women who choose adoption.

"The biggest issue that we have is just being sure that the paperwork gets done before the baby is born because they (TennCare) won't back date it any," Thomas said.

That's a scenario that is also happening for young families across Tennessee — even in cases where they applied for TennCare coverage before the child was born.

Barron, who said she submitted her application on June 30, is still waiting for coverage for her baby. Diagnosed with preeclampsia, she went into the hospital on July 10 and gave birth to Cameron Williams on July 16. He weighed only 4 pounds, 1 ounce and stayed in a neonatal intensive care unit for 12 days.

After multiple phone calls and inquiries, she received notification last month from healthcare.gov that she didn't qualify for TennCare. But that determination was based upon their family income in September — not their earnings when the baby was born in July. The state and federal government determine eligibility by different timelines, said Gordon Bonnyman, an attorney with Tennessee Justice Center, a nonprofit organization that advocates for access to health care.

The baby could have also been covered under presumptive eligibility if Tennessee's system had been up and running at the time he was born.

Tennessee did set not up a system for hospitals to do that until Aug. 18. It had offered presumptive eligibility, then halted the service with the full rollout of the Affordable Care Act. The federal law did not require the state to stop offering direct assistance to temporarily enroll pregnant women and babies who probably qualified for Medicaid. In fact the law gave hospitals the right to expand presumptive eligibility to other types of patients.

Babies are still being missed, including one born Aug. 23 with a heart murmur, said Michele Johnson, executive director of the Tennessee Justice Center. That baby has yet to see a cardiologist, Johnson said.

Luckily, Barron's baby has been healthy since leaving NICU, and his weight has about doubled. She said someone representing the state told her Cameron didn't qualify, only to correct himself two days later and say he did.

But the baby is still without coverage.

Reach Tom Wilemon at 615-726-5961 and on Twitter @TomWilemon.

TennCare on Trial

The Tennessee Justice Center, the Southern Poverty Law Center and the National Health Law Program filed a federal lawsuit in July asking U.S. District Judge Todd Campbell to force the state to correct barriers to people applying for Medicaid.

The action came after Cindy Mann, the federal director of Medicaid programs, put Tennessee on notice in June that it was in violation of U.S. laws in regard to processing applications in a timely fashion. She also directed TennCare to set up a presumptive eligibility program for newborns.

In September Campbell issued an injunction ordering TennCare to set up appeals hearings for people who filed for Medicaid and have waited for months for eligibility determinations. Tennessee challenged the order and is asking the U.S. Court of Appeals in Cincinnati to set it aside. However, it is scheduling hearings for people who can prove they applied for coverage.