County leads Tenncare cuts to kids over paperwork
More Shelby County kids lost their health insurance through Tenncare than any other Tennessee county during 31⁄2 years that saw more than 177,000 Tennessee kids lose insurance due to paperwork issues, according to an audit from the state comptroller’s office.
While that audit did not provide a county-by-county breakdown of the statewide disenrollments that resulted from paperwork problems, it did acknowledge that Shelby County had the most, from the sample the comptroller examined.
Altogether, more than 27,000 kids in Shelby County have been dropped from two state-run health insurance programs for low-income families, according to online monthly enrollment data compiled and analyzed by The Tennessean. It is not known exactly how many were dropped because of paperwork issues.
Tenncare spokesperson Sarah Tanksley said the comptroller’s report confirmed Tenncare “operated as required by law.”
“Individuals, including children, who lost eligibility through the required eligibility redetermination process did so appropriately with the Comptroller finding no systemic issues that call into question the accuracy or legal sufficiency of Tenncare’s prior redetermination process,” she said in an email.
The audit from the Tennessee Comptroller of the Treasury states that between January 2016 and May
2019 more than 177,000 children were disenrolled from Tenncare or Coverkids because enrollment paperwork was incomplete or not returned to the state. During that same time, about 12,000 kids were cut because they no longer qualified for the programs and 36,000 voluntarily left Tenncare or Coverkids.
Kinika Young, director of children’s health at the Tennessee Justice Center, said the audit raised more questions for her than it answered and didn’t delve into Tenncare’s procedures for keeping addresses or why so many people didn’t get the packets Tenncare said it mailed.
“You have to consider some of the characteristics of Tenncare enrollees being more transient, so they might move more often,” she said. “And even if they’re proactive or update their address with Tenncare that doesn’t mean that Tenncare is going to send the packet to the right address.”
Young pointed out that socioeconomic realities mean that any changes to or issues with Tenncare are likely to make a big impact on Memphians.
“I think the fact that Shelby County had the highest disenrollment is reflective of the fact that they have higher rates of Tenncare enrollment to start with,” she said.
As of December 2019, the most recent month Tenncare has released data for, 248,704 Shelby County residents were on the Tenncare rolls, 18% of all Tenncare enrollees. More than half of those are children.
Memphis and Shelby County have higher poverty rates than the rest of the state and country. About 25% of Memphians and 19% of Shelby County residents lived below the poverty line in 2017, according to a report from the University of Memphis. That same year, 39% of children in Memphis and 30% of children in Shelby County as a whole lived below the poverty line.
Tricia Brooks, a research professor at the Center for Children and Families at Georgetown University, said that after the significant declines for child Tenncare and Coverkids enrollment from 2016 to 2018, there was an uptick in enrollment in the first 10 months of 2019.
“We have not seen other states with high declines in 2018 reversing those trends in 2019,” she said. “What that suggests to me, that bounce back, is that kids who are eligible were disenrolled and they are starting to get enrolled again.”
Jenny Bartlett-prescott, chief operating officer of nonprofit, faith-based healthcare provider Church Health in Memphis, pointed out that even for those enrolled in Tenncare, there are still barriers to accessing quality healthcare. About 12% of Shelby County residents are uninsured, according to the nonprofit philanthropic Robert Wood Johnson Foundation. An even greater proportion are under-insured, Bartlettprescott said, limiting which providers they can visit to ensure their care is covered.
“Frankly, there are not enough primary caregivers who accept Medicaid and uninsured patients to take care of the sheer number of people who are uninsured or underinsured in Memphis,” she said.
According to Bartlett-prescott, a quarter of adults in Shelby County don’t have a primary care physician, regardless of their insurance coverage. Access to specialty care is even more out of reach for many in the area. That is compounded not only by whether people have health insurance but also by transportation issues and the ability to take off work to visit their doctor.
“When we talk about the systematic underlying issues that create cycles of poverty in our community, access to affordable, high-quality healthcare is — there are several categories — but that’s one of the main ones,” she said. “We know these issues impact people of color at greater rates than Caucasians and we’re seeing that live out in Shelby County as well.”
‘It is certainly one of the worst’
While Memphis and Shelby County stand out within Tennessee when it comes to Tenncare disenrollment, Tennessee is one of the states that stands out to national healthcare advocates who monitor the disenrollment of children from Medicaid programs and the increasing number of children without any health insurance.
“In terms of trying to situate Tennessee in a national context, it is not the only state to experience this, but it is certainly one of the worst,” said Eliot Fishman, senior director of health policy at Families USA.
Brooks said that from 2008 to 2016 the number of uninsured children across the country declined and the participation rate for Medicaid — how
Online: Tennesseans can now apply for Tenncare or Coverkids online at tenncareconnect.tn.gov. You can also submit documents to renew coverage with Tenncare Connect.
Mobile app: If you want your state insurance information on your cellphone, download the Tenncare Connect app, available in the Apple Store and on Google Play.
Phone: State insurance applications can be processed by calling a Tenncare call center at 1-855-259-0701.
Appeal: If you think your coverage has been terminated incorrectly, you can appeal by calling the Tenncare call center at 1-855-259-0701 or Tenncare Solutions at 1-800-878-3192.
Help: If you need help or legal representation with your Tenncare application, renewal or appeal, contact the Tennessee Justice Center at 1-844-478KIDS (5437).
many children who are eligible for the program enroll in it — increased.
“In 2017, it was the first time in more than a decade that we saw the uninsured rate for kids go up and correlating, the participating rate in Medicaid and CHIP drop,” she said. “There’s a clear correlation.”
Families USA highlighted Tennessee in a report examining Medicaid disenrollment in 2018. The group called out Tenncare’s high number of disenrollments — both for children and adults — and criticized its enrollment procedures. Tenncare operated for years without a computer system, mailing out 48-page packets to recipients that had to be filled in by hand and mailed back to the agency.
Fishman, a high-level official at the Centers for Medicare and Medicaid Services from 2013 to 2017, said Tennessee “was both a process outlier and a loss of enrollment outlier.”
The Tenncare Connect online system was not available to the public until last year. Young, with the Tennessee Justice Center, said users have experienced various problems, including longing onto their online account to find people who do not belong to their household included in it.
Tanksley said Tenncare ways always looking for ways to improve Tenncare Connect.
“We regularly engage with a number of partners and advocates, and part of that engagement is identifying areas for system improvement,” she said. “If a member believes that their online household is incorrect, and they are listed as the head of household, they have the ability now to either call Tenncare Connect or directly mark the individual as out of the household via their online account.”
Next steps
The future for Tenncare recipients also includes the fact that the state is exploring radically restructuring its funding mechanism. Tennessee and the federal government have dramatically different ideas about what block grant funding for Medicaid would look like, but both parties have expressed sustained interest in the concept, Fishman said.
“You’ve got a federal administration that is dead serious about cutting Medicaid funding using this mechanism and then you’ve got a state administration that kind of likes block grants,” but hasn’t given a lot of clarity on how it would interpret the federal comments, he said. “To me, it just feels like a very dangerous situation for Medicaid beneficiaries.”
On Monday, new federal rules took effect allowing immigration officials to consider whether a person is a Medicaid beneficiary during green card applications. Fishman said he worried it could lead to situations where children who are American citizens are not enrolled in Medicaid because a parent or another relative is not a citizen and doesn’t want their Medicaid status to become a barrier to legal status.
Moving forward, Brooks said states should promote online accounts and find more ways to minimize paperwork, which makes the process easier for the enrollee and more efficient for the state. She added that Medicaid programs also needed to be more proactive in keeping databases of addresses up to date and reaching out to families or individuals multiple times if more information is needed from them.
“We want to help people get in and stay in rather than making it harder to enroll to keep one bad apple from getting into the barrel,” she said.
Tennessean reporter Brett Kelman contributed to this report.
Corinne Kennedy is a reporter for The Commercial Appeal. She can be reached via email at Corinne.kennedy@ Commercialappeal.com or on Twitter @Corinneskennedy.