Waiting for More than 45 Days for TennCare?
Since January 2014, countless Tennesseans have found that even though they are eligible for TennCare, they are unable to enroll. A combination of state policy and TennCare management failures has created a uniquely difficult set of barriers to obtaining health coverage. Many Children with chronic health conditions, frail seniors in need of in-home or nursing home care and families are unable to get the coverage they need. Tennessee’s unwillingness to help families enroll in health insurance is hurting the most vulnerable citizens of our state. On July 27, 2014 the Tennessee Justice Center joined with the Southern Poverty Law Center and the National Health Law Program to file suit and hold the Tennessee state government accountable for its actions.
At the end of July 2014, we had a preliminary hearing. On September 2, 2014 Judge Campbell ordered TennCare to provide fair hearings upon request to anyone who applied for TennCare more than 45 days ago (or more than 90 days ago for CHOICES) and who has not received a decision.
For more information, read below.
Information for People Waiting for More Than 45 days
If you applied for TennCare, Emergency Medicaid, or a Medicare Savings Program more than 45 days ago, or if you applied for CHOICES more than 90 days ago, and have not yet heard back from TennCare, you are a Wilson v. Gordon class member.
So, what now? As of September 2nd, TennCare has been ordered to give all class members a fair hearing within 45 days of a request. If you are a class member, you have the right to a fair hearing.
You can get a fair hearing in either one of two ways:
- Fax in this appeal form to Tennessee Health Connections at 1-855-315-0669. Keep the fax receipt as proof of the date you faxed it in. You can also mail this in to Tennessee Health Connections, P.O. Box 305240, Nashville, TN 37230-5240. When you fill out this form, check the first check box in section 5. Send in proof of application with your appeal form if you have it.
- Call the Tennessee Health Connections phone number at 1-855-259-0701 and ask for a delay appeal. Write down the date and time of this phone call, and the name of the person you spoke to.
Once you’ve filed an appeal, TennCare will try to find your application in their system. If they cannot find your application, they may send you a letter asking for you to send them proof of your application date. If you have anything that can prove the date of your application, send it in. If you do not have this because you applied over the phone and did not get anything sent to you in the mail, you can try to create an online account, and then search for your application ID#. If you do not have any proof of the date of your application and TennCare tells you they are closing your appeal, please call us.
Always send TennCare any information that they ask you for, even if you have already sent it in before.
So far, TennCare has fixed these problems before class members have had to go to a hearing, so don’t let the idea of a hearing stop you from appealing!
And as always, please feel free to call the TJC office with any questions or if you run into any problems. Call us at 615-255-0331, or toll-free number at 1-877-608-1009.
Information for Advocates
Despite the difficulties that thousands of Tennesseans have had applying for TennCare, many more have been able to get covered for the first time because of the amazing efforts of Navigators, Certified Application Counselors, hospital staff, social workers, and other advocates like you. We are so grateful for the tremendous efforts you have all put into helping our citizens get the health insurance they need.
But for those who still don’t have coverage, we need all hands on deck. If you are working with someone who has been waiting for more than 45 days for a determination for TennCare, Emergency Medicaid, or a Medicare Savings Program or for more than 90 days for a CHOICES application, please follow the steps below:
- Have the applicant fill out this appeal form, and fax it to Tennessee Health Connections at 1-855-315-0669. Keep the fax receipt as proof of the date you faxed it in. If the applicant has any proof of the date of their application, fax that in as well. TennCare may not need it, but it might speed things up if they can’t find the information in their system. If the applicant does not have this because he/she applied over the phone and did receive any papers in the mail, you can try to create an online account, and then search for the application ID#.
- So far, TennCare has been attempting to fix all the problems before having to go to a fair hearing, so many people will not have to go through with that process. However, if they do have to go to a hearing, you can call TJC or your local Legal Aid Society for help.
- We encourage you to keep track of people who have sent in their appeals, so you can make sure they are getting a response or a hearing within 45 days. If there are any problems or concerns, please call our office at 615-255-0331, or email us at firstname.lastname@example.org.
- We have received many requests from the news media on specific stories of applicants who are in this situation. If you are working with someone who is willing to speak to the media about their experience, please email their information to email@example.com with the subject line “Media”.
We are so thankful that you have all been there for our clients in the past, and that you will continue to fight for their rights. As always, please feel free to give us a call if you run into any problems or have any questions. Our office number is 615-255-0331, and our toll-free number is 1-877-608-1009. You can also email us at firstname.lastname@example.org.
Information for Pro Bono Attorneys
While TennCare is holding few delay hearings, many class members go though Wilson delays only to receive an inaccurate decision. There is a growing need for pro bono attorneys to help Tennesseans with these cases. For Tennesseans who have never had to go to a hearing before, these can be intimidating and overwhelming. Your assistance in helping TennCare applicants go through the hearing can make a world of difference, and can be the factor that wins TennCare for the client. For some, this means having the peace of mind of health insurance, in case anything happens; and for others, this means they can finally get the life-saving care that they’ve been waiting for. Check out our Trainings page and our Pro Bono page to see our CLE and other trainings so that you can be a hero to Tennessee families. Email Marysa at email@example.com with any questions, or if you are willing to take on cases.
Training on How to Appeal
The video below is a training held by TJC on September 22, 2014 that goes over the case and how you can help folks who are stuck in the loop. Please note that this information will change as we learn more from the state, so please stay updated with our website.
The training references the advocate’s guide and the class member (pro se) guide (this guide will be updated once we have more information). Other handy resources include: appeal form, a flyer from the Legal Aid Society of Middle Tennessee offering its services, and a release for CACs and Navigators to gather information.
For information and resources from trainings, go here.
Background on the Case
The suit comes after almost a year of ongoing discussions with the State about enrollment issues. It also comes after a severe rebuke from the federal agency overseeing Tenncare. TJC’s discussions have helped some, with the State instituting workarounds that have addressed enrollment for some vulnerable Tennesseans. Nonetheless, the State has failed to present a workable plan for ensuring that all Tennesseans are afforded the coverage for which they are eligible. State officials have repeatedly delayed or rejected the ACA’s enrollment and eligibility reforms. Further complicating the situation has been Tennessee’s failure to develop a functional computer system capable of determining eligibility or accepting applications from the federal online Marketplace. For more background on the case, read the press articles in the Press tab below.
- September 2nd press release in regards to the court orders
- Court-ordered injunction
- Class certification
- July 23rd Press Release in regards to filing suit
- Letter from the Centers of Medicare and Medicaid Services (CMS) to TennCare
- Tennessee’s response to the CMS letter
Recursos en español:
- Petición de Audiencia
- Guía para defensores
- Volante del Legal Aid Society of Middle Tennessee ofreciendo sus servicios y volante del Legal Aid Society of East Tennessee ofreciendo sus servicios
- Permiso de reunir información para los CACs y Navegadores
- Lista de los hospitales que participan en el programa de Elegibilidad Presunta para Recien Nacidos
- Nov. 15 – “TennCare’s Bottom Line Could Cost Her Everything” – The Jackson Sun
- Nov. 15 – “Murfreesboro Woman Works to Help Families Get TennCare” – Daily News Journal
- Nov. 14 – “Thousands Caught in TennCare Limbo Await Hearings” – The Tennessean
- Nov. 8 – “TennCare Patients on Ventilators Face Cuts in Home Care” – The Tennessean
- Oct. 31 – “State Leaders Shirk Responsibility for TennCare Failures” – The Tennessean
- Oct. 28 – “TennCare Signup Woes Still Being Fixed” – The Daily Herald