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.
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