Client Spotlight:

Client Spotlight

In March of this year, TJC was contacted by the single mother of two autistic children. She describes the situation best in her own words:

“My story should be an example that insured middle class working families that are supposed to have enough income to cover all medical expenses for their special children are also in need of assistance; my children deserve it.

I am lucky to be employed and able to provide the basic necessities for my family, but it is quite discouraging when even though you have private insurance, this one doesn’t cover specific tests/ therapies and doesn’t provide services to children with Autism after they turn 12 (like they by a miracle get cured) and the state insurance does. And you are told you are not eligible because of guidelines.”

TJC staff put their expertise to use, and realized that the kids qualified for TennCare under the complicated Medically Needy Spend Down category. After tracking bills which the mother had to pay on her own, we had her reapply at the end of June. Those bills numbered in the thousands of dollars, and the mother was rapidly eating into her savings to provide the best care available to her children.

The children were once again denied due to TennCare’s utilization of the Federally Facilitated Marketplace (FFM). The FFM was never designed to handle state Medicaid applications, and is unable to screen for the Medically Needy Spend Down category. TJC filed an eligibility appeal on the kids’ behalf.

In the end, a TJC Client Advocate and a TennCare attorney resolved the case three days before going to a hearing. The mother had this to say about her experience and the result:

“From the very beginning every single person that handled my case at TJC was wonderful and caring.  I have no words to thank them for all the hard work they put into getting my case approved.  Through this journey I have not receive nothing but continuous encouragement and support from them.  I really appreciate you determination in assisting me Marysa and Andy  J.”

Volunteer Spotlight: Kyla Wonder

Volunteer Spotlight: Kyla Wonder

TJC has the great fortune of hosting Kyla Wonder as a legal fellow from Vanderbilt Law School. Kyla graduated in the spring and is spending her time with TJC working on a variety of issues, including ECF CHOICES, which is TennCare’s program for individuals with intellectual and/or developmental disabilities. Kyla jumped right in during her first week at TJC and took advantage of an opportunity to use her knowledge of administrative law to benefit TJC’s clients. Kyla was an integral part of the TJC team that drafted and submitted comments on TennCare’s proposed ECF CHOICES rules. Kyla also attended the rulemaking hearing as a representative of TJC. We are excited to see how Kyla will continue to use her legal knowledge and skills to increase fairness to our clients!

Client Spotlight

Client Spotlight

In late May, a mother called TJC seeking Medicaid coverage for her teenage daughter. The whole family was eligible. They had applied three times. We started to dig, but were only able to track down remnants of one out of three applications. For two months, the mother and one of TJC’s client advocates made phone calls and sent letters to both TennCare and the Federal Marketplace. The family had outstanding medical bills incurred after their first two applications, and only getting coverage backdated would help with those debts.

Toward the end of July, the parents’ worst nightmare came true: their daughter was hospitalized for a serious, ongoing health problem. As the hospital put pressure on the parents to either pay or immediately find coverage for their daughter’s stay, priorities shifted. Getting coverage backdated to the earliest possible date was no longer at the top of the list. Instead, the daughter needed the fastest route to coverage.

With the permission of the parents, TJC staff attorneys and the client advocate reached out to the TennCare Office of the General Council. They presented strong evidence of the most recently completed application, and shared a bit of the daughter’s story. Within three days of changing strategies the entire family had coverage, and it was backdated to right before they had contacted TJC. Now, the daughter is able to regularly receive the services she desperately needs, and the course of her life has likely been improved forever.

Donor Spotlight: Christina Cain-Swope

Did you know you can be a TJC donor without ever giving a dollar? There are many ways to support TJC other than giving money – we are always looking for in-kind donations to support our work! Last month we were honored to be the recipients of the proceeds from NALS 4th Annual Silent Auction. Many generous TJC supporters donated items for the auction.

Volunteer Spotlight: Magnus Campos

Magnus is a native of Nashville and currently a Senior at Montgomery Bell Academy. He volunteered with TJC over the summer, helping our Development Coordinator with projects and always bringing a smile to the office with his kind demeanor.