Jennifer

Jennifer and Gary. Photo credit: Jim Hagans

At the age of 3, Gary was diagnosed with autism spectrum disorder, hyperactivity, expressive receptive disorder, and developmental delay. One of the prominent characteristics of these conditions is an inability to communicate properly. To treat Gary’s condition, his pediatrician ordered occupational therapy and speech therapy.

Even though TennCare approved Gary for occupational and speech therapies, Jennifer found that quickly securing a provider for these services was not going to be easy. There were three possible therapy providers available in the area, but two of them had extensive waiting lists and the third would not accept Gary’s TennCare HMO. Jennifer requested to have Gary’s HMO changed so that he could start his therapies right away. Her request was denied by TennCare- twice.

In the meantime, Gary was approved for Supplemental Security Income (SSI) due to his disability and was consequently moved to another TennCare HMO. A call by a TJC client advocate pushed up Gary’s enrollment date, just in time for Gary’s appointment with his doctor. A slot with the initial provider opened more than three months after she initially tried to get services, and Gary was finally able to obtain speech and occupational therapy from a permanent provider.

For the full story, please read here.

Cindy

Furman family. Photo credit: Mark Mosrie

Cindy and her husband Richard adopted their son Jacob at the age of five, along with his two younger siblings. Jacob, who suffered severe abuse and neglect in his birth home, has been diagnosed with a variety of mental and behavioral health disorders, along with global developmental delays.

Jacob was admitted to a mental health residential treatment facility (RTF) in early 2010, after his conditions caused him to behave dangerously toward his younger brother. Later that year, Cindy and Richard learned that TennCare would no longer pay for Jacob’s residential treatment. Jacob’s doctors recommended that he enter therapeutic foster care upon discharge, because they were concerned he might present a danger to himself and his siblings were he to return home. TennCare denied the request for therapeutic foster care.

Cindy filed an appeal requesting TennCare cover the care  his doctors said he needed, but TennCare said that therapeutic foster care was not a service they would cover. The Department of Children’s Services (DCS) told Cindy and Richard that DCS could arrange for Jacob to receive therapeutic foster care without taking him into custody. In spite of this promise, DCS later told them that they would have to give up custody of Jacob in order for him to receive services. In late 2010, DCS took Jacob into state custody against his parents’ wishes. To this day, over a year later, DCS has still not found a therapeutic foster care placement for Jacob. He remained in residential treatment for another 8 months before he was moved to a group home in Memphis, several hours from the Furman’s home.

Cindy and TJC believe no child should ever have to enter state custody in order to get health care services they need.

For the full story, please read here.

Felicia

Burk family. Photo credit: Whitney NewbyFelicia  is the adoptive mom of Heith, Scarlet, and Carr.  Scarlet, Heith, and Carr have all been diagnosed with autism as well as developmental disabilities, ADHD, bipolar disorder, and a sleep disorder. Additionally, Scarlet has impulse control disorder and a feeding disorder, Carr has attachment difficulties, and Heith suffers from post-traumatic stress disorder.

Felicia has encountered innumerable obstacles to getting her children the services they need to grow and function. She has had challenges in accessing speech therapy and behavior treatment services for each of her children, even after a judge ordered TennCare to provide it. She has also had trouble getting much needed in-home assistance services for Carr, faced drastic cuts in personal assistance services for Heith and Scarlet, and has had difficulty getting appropriate dental care for Scarlet and Carr. Felicia has also struggled with getting medications for each of the children.

For the full story, please read here.

Sheila

Spain family. Photo credit: Meropi FalkenburgChelsey, the daughter of Sheila, was born with a malformed heart, suffered four strokes at the age of three, and has seven heart defects.

One of the tools that Chelsey needs to grow and thrive is a specific kind of wheelchair, a “stander,” which would allow Chelsey to stand. The stander would also strengthen Chelsey’s physical condition because standing helps her leg muscles develop and improves her circulation.

In 2006, TennCare denied this type of wheelchair for Chelsey. Sheila appealed the denial and won at her hearing. After five years, Chelsey outgrew her wheelchair and needed a larger one. Despite a doctor’s order, TennCare would only pay for a wheelchair with a basic stander, which would have put pressure on Chelsey’s pacemaker, located in her abdomen because of scar tissue around her heart. This would put Chelsey at risk of damage to her pacemaker, and would likely cause pain and internal pressure sores.

In early 2011, Sheila filed an appeal for the special type of standing wheelchair that Chelsey needed and was granted a hearing. Soon after, she contacted TJC for help. TJC found a pro bono attorney to attend the hearing with Sheila. Before her hearing, TennCare called Sheila’s pro bono attorney and said that if the appeal was dropped, they’d cover the special stander that Chelsey’s doctor had prescribed. Sheila says that, “It was by my efforts and the efforts of the Tennessee Justice Center that we were able to help my daughter get the care she needed.”

For the full story, please read here.

Deborah

Balthrop family. Photo credit: Sally Beba

Early last year, Cheyanne, Deborah’s daughter, became pregnant. Deborah took Cheyanne to the health department to apply for TennCare. The health department approved her for TennCare through presumptive eligibility, a way for uninsured pregnant women to get TennCare right away so that they can access prenatal care.  Deborah and Cheyanne quickly submitted her application to the Department of Human Services (DHS) to get full TennCare benefits.

Cheyanne should have been able to access prenatal care right away, but Deborah had to spend countless hours and make dozens of phone calls trying to get Cheyanne a TennCare card, find a physician who would see Cheyanne, and find out whether Cheyanne was approved for long-term TennCare coverage.

Deborah made four separate requests to Cheyanne’s HMO for her TennCare card, and each time the order was either not made, not processed correctly due to employee error, or not processed at all. In addition, numerous doctors told her they would not accept presumptive eligibility without the TennCare card- even doctors that Cheyanne’s HMO suggested would see her right away. Ultimately, Cheyanne was denied service over 20 times because she was not given her TennCare card in a timely manner.

Deborah contacted TJC to help with the process. TJC helped Deborah file an appeal regarding the delays in getting a doctor’s appointment and getting approved for TennCare. TJC also contacted the state on Cheyanne’s behalf. Cheyanne’s application for TennCare was finally approved, and she was able to go to a doctor. Cheyanne was sixteen weeks pregnant when she was finally able to see an obstetrician and get the prenatal care that she and her child so desperately needed. Cheyanne’s baby, Kayleigh-Anne, was born in October 2011, healthy and beautiful.

For the full story, please read here.

Ida

Robert family. Photo credit: Mark MosrieIda has three daughters, Amber, Sarai, and Elisabeth. Two of Ida’s daughters, Amber and Sarai, were born with severe disabilities, including mental retardation and autism.

Ida has persistently fought TennCare for years to ensure that her children are able to get the medical services that they desperately need. She has fought to get the medicines that their doctor has prescribed, to get the diapers and other equipment that Amber and Sarai need from suppliers, to find appropriate specialists for her children, and to keep their speech, occupational and physical therapies in place, which are imperative for Amber and Sarai’s development and growth.

Ida says that “no child with or without a disability should have to go without needed medical services.” Ida adds that the “the challenge of fighting TennCare to get the medical services my children need and working to change the system are worth it so that another parent won’t have to fight quite as hard.”

For the full story, please read here.

Community Mom of the Year

Barbara

Nathan and Barbara MooreThough Barbara has taken care of and provided for her grandsons– Justin, Andrew, and Nathan– their whole lives, she became their legal guardian in January 2012.  The kids say that without their grandmother, whom they call “Nanna,” they would have been separated and placed in foster homes.

Barbara takes them for regular checkups and gets them ready for school. She also spends time with each of them to ensure that they develop to their fullest potential and so that they know they are special and deeply loved. With the support and love that Barbara provides, along with the physical and mental health care services the boys receive, all three of the boys are progressing and thriving.

Barbara is learning that caring for three boys is not easy, especially when they have special needs and she has disabilities herself. Barbara says, “I am trying to make up for all the bad things they have gone through.” Barbara’s courage and love for her grandchildren is making a positive difference in their lives. She says, “All they need is love and understanding, and they have already responded and are doing better.”

For the full story, please read here.