The Coverage Gap: How Not Expanding Medicaid Allows Medically Complex Individuals to Fall Through the Cracks

Faith Pratt is her son’s biggest fan. A lover of all music—preferably Lil Wayne—Sam is another Tennessean that is falling into the coverage gap. At thirteen years old, Sam survived a hemorrhagic stroke—a blood vessel ruptured in his brain, causing a large bleed and leaving Sam with a traumatic brain injury. Since then, Sam has dealt with memory issues and seizures regularly. In 2024, Sam had a seizure while driving and totaled his vehicle.

The Pratt family moved to Tennessee in December of 2025. After Sam’s health episode, Faith hasn't been able to work for over a year. Without healthcare coverage to help cover nursing hours and doctors’ appointments, Faith had to quit her job to take care of Sam.

After Sam aged out of his parents’ insurance, Faith reached out to TJC. They tried for months to get him TennCare Medicaid coverage, but in the end, Sam didn’t fit into a category for eligibility despite his medical complexities. They were denied private insurance, the ACA marketplace, and TennCare Medicaid because of his conditions. Since Tennessee hasn’t expanded Medicaid, people like Sam are stuck without reliable health insurance.

According to his mom, Sam is just like you and me. “I’ve always told him he’s my hero,” Faith said. "He has the biggest heart and the best personality you could imagine. Even when facing challenges, like having to go without insurance, Sam manages to stay positive and tries to bring positivity with him everywhere he goes. “There’s too much negativity in the world to be negative,” Sam shared. “You have to be happy.”