Keep TennCare from Incorrectly Cancelling Your Coverage
Disclaimer: The views and opinions expressed in Bob’s Blog are solely that of the author and do not purport to reflect the views and opinions of the CAC Office on Aging or its staff. Posted 03-24-2023
In prior posts, I have mentioned a little over 13% of people over 65 have incomes at or below the Federal poverty level. Most of these are eligible for TennCare. It supplements the Medicare insurance they have.
That is great because most of the medical bills they have are covered by Medicare and TennCare. They owe very little on any medical expenses they have. They do not have to worry about getting treatment for any medical conditions because they have to pay nothing at all or very little.
In 2023, there is a potential problem facing some of these people.
Through No Fault of Their own, They May Lose Their TennCare Coverage.
How can that happen?
Every year, a person has to show they are still eligible for the TennCare coverage. Wherever possible, the people at TennCare will try to do this for those on TennCare from the information they already have. When they can’t, the person has to complete a renewal packet and submit it to TennCare.
Not all renewals occur at the same time of the year. They start on April 1st and continue during the next 12 months.
You may be saying you don’t see where the problem is. You, a relative or friend has been on TennCare for years. There never has been a problem in the past.
During the Covid Pandemic, from 2020 through 2022, people on TennCare were not required to renew their coverage. It was done automatically.
During those three years, the number of people covered by TennCare increased dramatically. In 2019, 1.4 million low income people in Tennessee were covered by TennCare. By the end of 2022, the number has increased to between 1.7 and 1.75 million.
The state feels the enrollment should be closer to 1.4 million and between 300,000 and 350,000 are being covered who are not eligible. They are going to try to terminate coverage for many or all of those above 1.4 million.
Under normal circumstances, some might say the state is probably correct in its belief that many of the 300,000 to 350,000 are not eligible for TennCare. However, the last 3 years have been far from normal.
• First, Tennessee is a desirable state for many, including retirees, to move to. In 2019, Tennessee’s population was 474,292. In 2023, it is 492,993. That is an increase of 4%,
• Second, the cost of living has increased dramatically from 2019 to 2023. The income of many more people, including those over 65, has dropped to the poverty level or lower.
TennCare has indicated the coverage of at least half of the people covered now will be renewed automatically. They have sufficient information in their file on these people. Renewal packets will have to be sent out to up to the other 850,000.
The people who receive the packets will have to fill out the requested information and either email it, drop it off at one of TennCare’s offices or send it in.
There Have Been Renewals Like This in the Past.
They Have Been Far from Smooth
In 2014, the renewal process stopped. By the time it resumed, the number of people on TennCare also grew by about 350,000.
• After it resumed, 242,000 children lost TennCare coverage.
• After further review, only 5% were found to be ineligible for coverage.
• 159,000 of the 242,000 (66%) lost their coverage because TennCare said their parents failed to respond to their request or did not furnish the information needed. Other children lost coverage due to clerical errors in receiving and returning hard copies of renewal paperwork, even though many were still eligible.
TennCare’s Error Leads to $100,000 in Medical Debt and Ruined Credit For One Family
In 2019, a 3 year-old boy fell and broke his wrist. When his mom took him to the local hospital, she found out they no longer had TennCare coverage. The hospital and medical charges for treating the boy were not covered.
His mom was 9 months pregnant at the time. She also had no coverage. She checked and found out the family’s coverage was canceled. They hadn’t furnished the information requested in a packet TennCare had sent them.
What actually happened was the family never got that packet nor the termination letter TennCare sent to them. It turns out TennCare incorrectly sent the packet and the termination letter to a pasture.
The husband and wife appealed the denial and were rejected. They then reapplied for TennCare and were denied. The paperwork TennCare sent again went to the wrong address.
This family had no coverage for over three years. During that time, the wife had a caesarian section. The Covid-19 pandemic hit and they and their children had other health problems. They incurred over $100,000 in medical bills they couldn’t pay.
This ruined their credit. They also had hoped to buy a home, but couldn’t.
TennCare eventually reinstated their coverage. They also have gone back and covered most of the medical bills the family incurred.
TennCare Still Defended Its Initial Decision to Terminate the Family’s Coverage
The U S Postal Service was at fault. They said the family’s problem was caused by the U S Postal Service not delivering mail to their home. TennCare also blamed the postal service for giving TennCare an erroneous forwarding address.
What Steps Do You Need to Take Now To Make Sure Your TennCare Coverage or That of Someone You Know Isn’t Cancelled?
It’s best to be proactive here for yourself or for someone you know that has TennCare.
If you have TennCare, please check with TennCare to make sure your coverage is still in effect. If TennCare does not have enough information in your file and isn’t automatically going to continue your coverage, make sure they have your correct address.
If a relative or friend has TennCare, help them out. Contact TennCare with them. Make sure TennCare has their correct address. Find out if the packet requesting additional information has already been sent. If not, find out when it will be.
The reason to double check the address is if you or they have moved, you or they may have forgotten to notify TennCare of the new address.
If your relative or friend has Alzheimer’s or has moved in with a relative or to a nursing home, the nursing home or relative may not know they are covered by TennCare.
Make sure you furnish all of the information TennCare requests. If you email or send it back to TennCare, follow-up with them. Make sure they have received it.
Also make sure TennCare has not terminated coverage. If coverage is terminated, it may take quite awhile to get it reinstated. During that time, any medical expenses you or they have won’t be covered. These can add up very quickly.
If you, a relative or friend need help need help dealing with TennCare or getting everything they ask for, you can contact the people working in the Affordable Medicine Options for Seniors (AMOS) program at the CAC Office on Aging. The people there will be glad to assist you.
AMOS’ Phone Number is 865-524-2786
As mentioned earlier, TennCare believes between 300,000 and 350,000 have coverage but shouldn’t. They will be trying to terminate coverage on as many as they can.
They have taken action like this in the past. While they have terminated coverage, the coverage for many was terminated incorrectly. Normally only a small percentage of those covered are not eligible for TennCare.
It is sad when anyone’s TennCare coverage is wrongly cancelled. It’s worse when this happens to an older person. As they age, older people have more serious medical problems. They don’t want to avoid getting the necessary treatment they need because their TennCare coverage was cancelled incorrectly and they have no money to pay the bills for the treatment they need.
If you have any comments on what you have read in this post, I would love to know them. Please email them to me. Also – if you have any ideas about subjects you would like to see discussed in future posts, please send me an email and let me know. My email address is firstname.lastname@example.org.