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Sammy

Sammy, age 15, of Cleveland, TN is blind, deaf and developmentally disabled. From his birth, his parents worked tirelessly to care for him at home, rather than place him in an institution. Before his mother died of cancer five years ago, she succeeded in enrolling him in a special Medicaid program which provides home nursing services to severely disabled children who would otherwise be institutionalized. These services made it possible for Sammy’s father to continue to work to support the family and still manage to keep Sammy at home 

In August, Sammy’s father was stricken with a rare, untreatable pulmonary disease and died. Juvenile Court promptly awarded guardianship of Sammy and his younger sister, Mary, to their grandparents. However, when they took the children home to Bradley County, Sammy’s grandparents learned that the Medicaid home services he had been receiving would no longer be available. Without these services it would be physically impossible for the aging couple to care for Sammy, and they would have to give up custody – very much against their will -- to the state. Numerous phone calls elicited conflicting explanations for Sammy’s loss of services, without any clear path to resolve the crisis. Within 24 hours of the grandparents’ call to TJC, the Center had faxed letters to the General Counsel of three different state agencies, the agencies had convened an emergency conference, and Sammy’s care was reinstated. TJC continues to advocate for expanded and improved home and community based alternatives to institutionalization for children and adults with severe disabilities and chronic disease. [1998]

Shelby

Shelby is 2 years old. She lives in Campbell County and is enrolled in TennCare. Shelby has cerebral palsy, is very medically fragile, and requires ongoing care by a team comprised of a pediatrician, a neurologist, a pulmonologist, a surgeon and an allergist. In July, the state switched her from BlueCross to a state-administered managed care plan called TennCare Select. None of her doctors would accept TennCare Select, and the new plan could not provide her alternative access to the care she needed. Shelby’s mother made repeated calls for months to the state and to TennCare Select, as Shelby went untreated and became progressively worse. In November, she was referred to TJC, and we arranged for Shelby’s transfer back to BlueCross. TJC is pursuing the state’s failure to comply with Grier consent decree safeguards that required the state to timely process the mother’s appeal. TJC is also addressing the broader problem of the inadequacy of network of providers of TennCare Select. [2001]

Vincent A.

Vincent A. is a 41-year old TennCare patient from Nashville. In December 2002, TJC received an urgent call from his physician asking for help. At that time, Mr. A. was dying in the intensive care unit of a Nashville hospital. He had been referred to a hospital in Memphis for a liver transplant earlier in the year. Everything had been lined up and he was waiting for a compatible organ to become available. But a contract dispute arose in December between BlueCross, which administered the TennCare MCO to which Mr. A. was assigned, and the hospitals where the transplant would take place. The physician’s strenuous efforts, aided by sympathetic physicians and administrators in Memphis, were unable to break the impasse, and Mr. A. was about to die. TJC made phone calls to TennCare on his behalf. On January 13, 2003, the physician called to report that TJC’s intervention had cleared away the barriers. Mr. A. had undergone successful transplant surgery, and his prognosis is good. The physician thanked TJC for saving his patient’s life. [2003]

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