128,000 Children Purged from TennCare

April 9, 2019

On April 2, 2019, the Tennessean reported that at least 128,000 children over the last two years have been purged from TennCare or CoverKids.[1]  TennCare responded that most families and children were disenrolled because they did not respond to the renewal forms.

 

A day later, the Tennessean reported that Commissioner McWhorter (Commissioner for Finance and Administration) said at least some of the dis-enrollments were the result of an improving economy.  However, national data does not support this conclusion.

The Tennessean reported on April 2, 2019, “Unsurprisingly, in the same years that TennCare and CoverKids cut so many children, the number of uninsured kids in the state sharply increased, according to recent studies from Georgetown University and the University of Tennessee. These two studies measured uninsured children very differently but agreed on the conclusion that the problem is worsening.” So, what happened in 2016-17?

When the Affordable Care Act began enrollment on Nov. 1, 2013, TennCare discontinued its annual renewal process for current enrollees in order to focus on TennCare’s new applications coming through the ACA (healthcare.gov). When a person/family applied for coverage, the ACA would determine if an individual would be eligible for private insurance through the ACA or TennCare or CoverKids through TennCare. This happened because:

  1. In 2013, TennCare was not able to convert its existing eligibility system to comply with the new ACA eligibility requirements;
  2. TennCare began using the federal eligibility system, healthcare.gov, for individuals and families to apply for coverage, and began using paper applications for other eligibility groups such as individuals needing nursing home care, CHOICES, QMB, etc.; and
  3. In 2016, TennCare re-instituted the renewal process after more than a 2-year delay. Over this time span, many families had moved and TennCare had had very little communications with enrolled families, resulting in many families not receiving the renewal packets.
  4. The Renewal process, consisting of is a 47-page renewal form, was very intimidating.
  5. Finally, TennCare never created a way for a family to get assistance to enroll by phone.

These application and redetermination hurdles caused an increase in the un-insured rate of children in Tennessee.  The Georgetown University Policy Institute, Center for Families and Children reported, “The share of children without health insurance nationally increased from 4.7 percent in 2016 to 5 percent in 2017. Nine states experienced statistically significant increases in their rate of uninsured children (SD, UT, TX, GA, SC, FL, OH, TN, MA).[2]

TennCare now has an online application system through which families with children can apply, enroll, renew, and update their information. However, before getting to this point, thousands of children and parents had lost coverage. The current online application still presents a barrier for folks needing to renew or enroll.  In-person assistance and the ability to enroll over the phone are important steps to strengthen TennCare’s application system and prevent further disenrollment.

 

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