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TJC clients: What safety net?

Every day, there is a new heartbreak – a client has called TJC, terrified and ill, in hopes that we can do something to help them regain their health coverage or simply get the medicines they need to live.

Often, after listening and asking questions and researching every possible avenue for Medicaid, we can do little except refer them to the "Safety Net" – the elusive, complex and constantly changing patchwork of temporary help for the newly-uninsured. It has aptly been described as being more like a basketball net – with a big hole at the top, and a big hole at the bottom.

"Most of our clients have tried calling, tried to find out where these programs are – but in reality, it’s too little too late for most people. The doctors don’t have time to fill out the forms for the free medicines, and the patients don’t have time to wait for medicine that may never come," said TJC Advocate/paralegal Jane Beasley. "It’s almost as if the state doesn’t want anybody to really access these services."

For those who’ve been dropped from TennCare entirely, there is a short list of older, generic drugs that the state is offering through some pharmacies for a co-payment. First, the enrollee has to find out whether they can use any of the drugs on the list, and then must find a pharmacy that actually participates. The state also has paid a company to produce a drug discount card similar to those found for free on the Internet.

Most people, however, need drugs other than those on the state-sponsored list. So they turn to the "free drug" programs offered by the drug manufacturers. These programs rely on long, complex forms required to be filled out and filed by doctors. The forms change frequently, take a long time to complete, and there is no guarantee – even if the patient clearly qualifies in the program – that he or she will actually get the medicines requested. The wait for delivery is anywhere from two weeks to six months, and approval is for no more than a three-month supply.

The state has touted its planned renovation and expansion of a handful of Health Department clinics across the state, but the truth is that most of the service expansion won’t happen until 2006, and the services will be primary care only – not the types of specialist services needed by the chronically ill. Likewise, the state has spread $6.7 million among the state’s charity and federally-funded health clinics, which were already overwhelmed with uninsured patients even before the TennCare disenrollments.

The most tragic story is that of the "safety net" for the Seriously and Persistently Mentally Ill who have been dumped from TennCare. Of those cut from TennCare, there are about 25,500 whom the state recognizes to be in the SPMI category. But the state only counts those who have a recent assessment from a Community Mental Health Center as SPMI, leaving out the severely mentally ill who’ve been cared for through private physicians. Likewise, because TennCare is closed to new enrollees, uninsured people who develop mental illness have no access to coverage.

"The failure of the Safety Net is predictable – you can’t take $1.2 billion worth of federal funding out of the state’s health care system without doing significant damage to people’s health," said Michele Johnson, managing attorney for TJC. "TennCare's strength was that it drew down significant federal dollars to take care of Tennesseans. TennCare needs to be restored for just that reason."