Gunnar suffers from a stomach deformity and severe acid reflux which force him to eat a special diet so he can keep enough food down for adequate nutrition. He has trachea problems and asthma as well, which, alongside a lowered immune response, contribute to breathing problems and frequent respiratory infections. When Gunnar was just an infant, Jane began receiving confusing notices from the state Department of Human Services (DHS) office saying that Gunnar’s TennCare was going to be cut off. Not sure what to do, Jane called TJC for help.
TJC wrote to DHS, requesting clarification of the notices. DHS wrote back immediately, apologizing for the confusion, explaining the situation, and affirming that Gunnar’s TennCare coverage would continue without interruption. Now, Gunnar is able to get the medicines, therapies, and other care he needs to be his best.
When Dusty, now in his 20’s, was about three years old, his doctor told his parents that he had severe mental delays. He is also autistic and has 250 to 300 seizures each month, some of which can become life-threatening. Dusty has TennCare and is on the Department of Intellectual and Developmental Disabilities (DIDD) waiver, a program that allows people with developmental delays to get services in their homes rather than moving to an institution. Due to the unpredictability and severity of his seizures, Dusty needs two personal assistants at all times, which is provided to him through the DIDD waiver.
In 2010, DIDD announced that all enrollees’ services would be reduced to one personal assistant whose hours would be limited to 50 per week. Dustin’s physician at Vanderbilt and Nancy asked TJC to help them stop DIDD from reducing these services for Dusty and her other patients. TJC’s intervention with state and federal officials blocked the proposed reduction, but Dusty is now facing more cuts by DIDD. Currently, Dusty is still receiving the care he needs and is still able to live at home. Nancy calls TJC a friend and guardian angel in disguise saying,“I will be forever grateful for having crossed paths with TJC.”
While visiting his aunt in Virginia last year, Brysen had a seizure at Wal-Mart. Fortunately, an employee realized what was happening and a policeman there called an ambulance. On the ambulance, Brysen’s condition was monitored and his temperature was taken. A few days later, he had an allergic reaction to the seizure medication and had to return to the Stafford Hospital Center. A month after Brysen’s seizure, Ms. Rodrigues began receiving bills from Stafford Hospital and from Stafford County Fire and Rescue for the ambulance. Stephanie called the hospital and Amerigroup, Brysen’s managed care organization, attempting to get the hospital bill paid. Amerigroup told her they would pay the bills, but in September reversed their decision, saying they would not pay the bills because the hospital was not cooperating. Ten months later, Stafford Hospital turned the bills over to a collections agency.
Stephanie filed appeals about the illegal bills, but TennCare refused to process them, claiming she had not met the 30 day filing deadline. TJC wrote a letter to TennCare urging them to process the appeal, pointing out that Stephanie had appealed within 30 days of discovering that Amerigroup had failed to resolve the payment issues with either the Stafford Hospital or the Stafford County Fire and Rescue ambulance service. A year and a half after Stephanie received the first bill, following several more letters between TJC, TennCare, Stafford County Hospital, and Stafford County Fire and Rescue Department; Stephanie was finally assured that she would not have to pay the illegal bills.
Linda’s brother, Michael, worked in manufacturing for nearly 30 years until he was laid off in 2009. He also lost his health insurance, could not afford COBRA, and private insurance denied him coverage because of his preexisting condition, Hepatitis C. In 2010, Michael was diagnosed with acute liver disease and received free treatment from Nashville’s public hospital, Meharry. But there was a catch. Michael’s doctors said that the only potentially life changing option for Michael was a liver transplantation but because he did not have insurance benefits that permitted consideration of liver transplantation, they could not initiate the transplant.
Linda called TJC. TJC worked with her to get medical and financial approval for Michael’s transplant. TJC worked with the attorney general’s office and TennCare’s lawyers to ensure that TennCare would pay for the surgery. Michael was placed on the liver transplant list and on November 20, 2010, Michael received his new liver.
Jake has been diagnosed with a rare genetic disorder and autism spectrum disorder, which mean that he has extensive medical needs. Jake was eligible for TennCare as a former SSI recipient, and he got the health care he needed to live an active life. However, in May 2010, Debra received a letter telling her that Jake’s old TennCare category was closing and that Jake would lose his care. In June 2010, Jake became uninsured. Not knowing what to do, Debra called TJC. After TJC reviewed her case, it seemed that the only way Jake would be eligible for TennCare was through the Spend Down program, which helps families that spend large portions of their incomes on medical expenses.
After studying the rules with TJC, Debra didn’t think she had enough bills that would qualify, so she arranged to borrow money to pay old hospital bills to make Jake eligible, even though this would put the family in debt. Working with TJC, she quickly realized that she had spent far more for her family’s medical care than she realized. Between insurance premiums, pharmacy costs, doctor copays, and home health supplies for Jake, she was able to find enough bills to make Jake eligible. It took many nights of digging through her financial documents and lengthy phone calls with TJC, but Debra did not give up until her son qualified for the care he needed. TJC helped her organize her files and sent a copy to DHS, and he was enrolled right away.
Derek, Ethan and Racheal were neglected in their birth home. Because of this, the Tennessee Department of Children’s Services (DCS) approached the children’s grandparents about adopting them. Linda and her husband Alan did not hesitate to take in their grandchildren. They asked that as part of the adoption, the children be guaranteed TennCare health insurance so that the mental health scars left by their previous home could be treated and start healing. DCS agreed at first, but then the agency began to equivocate and reverse its position, threatening one of the children’s access to health care.
Linda contacted TJC. A Client Advocate at TJC accompanied Linda to the Child and Family Team Meeting where the adoption terms were discussed. TJC then followed up with the local DCS office to ensure that TennCare coverage would be included as part of the adoption agreement. Linda said this was monumental, “Knowing that there are people out there, like the folks at TJC, who care enough to go to bat with you and support you and see that you get the care- that’s the key.” Linda’s perseverance, along with TJC’s intervention, won TennCare coverage for the children and made it possible for the adoption to go through. In December, 2010, Derek, Ethan, and Racheal were officially adopted by their grandparents. All three children now receive regular mental health care, vital to their well-being.
2011 Community Mothers
Corey is a survivor of shaken baby syndrome. He was placed in foster care when he was only one month old and ten months later, Carolyn became his legal guardian. Almost a teenager, Corey is now 5’2” and cannot walk, sit without help, or talk. Carolyn says that as demanding as it is to care for someone with Corey’s needs, it is harder to deal with all of the obstacles that lie between Corey and the care he requires. Carolyn has fought courageously with school systems, physicians, pharmacies, mental health agencies, and hospitals to make sure Corey gets what he needs. Corey will never be able to live on his own. But instead of letting Corey’s limitations overwhelm her, Carolyn tries to take her cue from Corey and think positively. “He sets such a wonderful example for everyone who knows him because he finds joy in the simplest things. He is my hero,” says Carolyn.
Kaatje and her husband Brad cook their family’s meals with organic, natural foods, and have their own garden. In the garden, their daughters Kyleigh, Kyndal and Kennedy like to help them plant seeds and harvest the fruits and vegetables. They also like to help out in the kitchen, and to eat their meals together as a family. Kaatje also makes sure her daughters have a lot of exercise. Thanks to Kaatje’s nurturing attention and healthy decisions, her daughters are getting the care they need to reach their full potential.