TJC Story Blog
May 2021
Anonymous
A couple lives in Farragut, Tennessee with their three children. The family had recently transitioned out of TennCare for being over income, but due to the Covid-19 pandemic, they have been allowed to keep their TennCare for the time being. This has been a help to the family, as the husband is on Medicare and the wife had been on a plan through the Marketplace. They both had to pay premiums, but now that they have TennCare they do not have to pay any premiums. The family also recently applied for SNAP, but they were denied based on their assets.
The family’s 11-year-old daughter has overcrowding teeth, which has caused problems with her biting into skin. It was recommended that she have some teeth removed and get braces to help with the overcrowding, and her doctor said it had to go through TennCare. TennCare denied the braces and said that she did not score enough points to show that she medically needed them. The daughter also has some problems with speech, and her doctor said that might also be caused by the teeth overcrowding.
The family appealed the braces denial, and the appeal went to a hearing with TennCare. The father mentioned his daughter’s speech problems at the hearing, but they did not have any evidence that this was caused by her teeth, so the braces were denied. The daughter has also not been eating well, which again could be tied to her teeth overcrowding. It has been recommended that the daughter begin going to speech and nutritional therapy. The family is working on getting these therapies set up, and they hope that in about a year, once their daughter has been in therapy for awhile, they can get a new dental exam and hopefully apply for braces again.
