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.
Photo Credit: Jim Hagans