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Working for affordable access to high-quality health care for all Tennesseans
Working for affordable access to high-quality health care for all Tennesseans

State Health Care Policy

The following appears in the March 2, 2014 Knoxville News-Sentinel opposite the Editorial page..

“Online-only access to TennCare means many go without aid” 

Walter Davis, Guest Columnist, Knoxville News-Sentinel, Page 3, Section F (editorials, columns, letters.) March 2, 2014

Mary goes to her local Department of Human Services office to apply for TennCare. She used to be on her husband’s insurance before his illness and death. She can’t work and needs coverage until she can start Medicare. A DHS person helped her apply before.

This time, the worker at the counter says, “We can’t help you with TennCare. Use the computer over there to apply.”

A “kiosk” they call it, but it’s a computer she can’t operate. No one is there to help her. Not knowing what to do, Mary leaves. A TennCare official calls this system “a much more convenient process, where you are able to submit your information online.” For Mary, it’s a dead end.

Until this year, TennCare handled eligibility and enrollment through the local DHS offices in each of the state’s 95 counties. Applicants applied in person with a caseworker, who could also see if a person qualified for food stamps or aid to dependent children. There were also DHS workers in many hospitals. TennCare allowed hospitals to determine presumptive eligibility for some patients.

Effective January 2014, TennCare turned off the in-person enrollment in DHS offices. Tennesseans can apply only online for TennCare, and DHS offices now have computers in kiosks. Tennessee is the only state that has done that.

But TennCare’s own multi-million dollar computer system was and is not ready.

So where do you go if you have questions about TennCare? From multiple state information sites, including the new state call center (“Tennessee Health Connections”), TennCare’s own website and even TennCare Deputy Commissioner Darin Gordon’s homepage, TennCare applicants or inquiries are directed to the federal Healthcare.gov website. In other words, if you have a TennCare issue, you can’t get there from here.

In-person, face-to-face assistance is important in areas of the state such as Shelby County, including Memphis, where 25 percent of population (more than 230,000) are enrolled and who must periodically requalify for TennCare. Former TennCare procedures weren’t easy, but people could find out if they were eligible for the program.

TennCare, our Medicaid managed-care program, serves 1.2 million Tennesseans. Many applicants have low incomes, little knowledge of health insurance, difficulty with transportation and education limitations.

Impersonal self-service kiosks providing computers in local DHS offices are a poor substitute for in-person assistance. Applications can take 45 minutes to several hours.

The TennCare Bureau has been concerned about a “woodwork” effect. The pejorative term refers to Tennesseans who are eligible under current TennCare rules but not currently enrolled who might come “out of the woodwork” to sign up as a result of the Patient Protection and Affordable Care Act. TennCare knows that federal government reimbursement under present TennCare rules is 65 percent rather than the 100 percent Washington would have paid for newly eligible enrollees if Gov. Bill Haslam had expanded TennCare.

Were the changes in the TennCare application process designed to increase barriers and slow down new enrollment of those currently eligible? The TennCare Bureau estimates at least 50,000 Tennesseans eligible for TennCare under current rules have not enrolled. Yet TennCare has closed off the ways people previously enrolled and created a logjam through the federal marketplace. The elderly and disabled are sent to a federal marketplace that cannot serve them.

Haslam says TennCare is one of the best-managed Medicaid programs. If so, good management means enrollment procedures appropriate to the types of clients TennCare serves. An online option is great for some, but an online-only system has the effect of denying access to many. That should have been a lesson learned from Healthcare.gov’s startup.

Haslam’s State of the State Address contained words I agree with: “I believe that more Tennesseans having health care is good for our state. For Tennessee to be America at its best, we must get health care right — for those who need health care coverage and for the long-term fiscal health of our state.”

A TennCare that is not providing access to Tennesseans is not America at its best.

Walter Davis is the Executive Director of the Tennessee Health Care Campaign

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