Tennessee Justice Center

We've moved!

2011-01-20T09:44:00.001-08:00

TJC's blog is now hosted on our website. We will no longer add new posts to blogger.

To make sure you stay on top of the latest TJC news and happenings, please head on over to www.tnjustice.org/blog!

Update on the Appellate Court's ruling

2010-12-03T08:56:00.000-08:00

You may have heard about a recent ruling over TJC’s lawsuit to improve TennCare services for children. The story has been featured in the Tennessean and in other local media. In case you hadn’t heard, the State had appealed to the 6th Circuit Court of Appeals, asking them to set aside the Consent Decree that TJC negotiated to ensure that TennCare complies with federal law and provides low-income and medically fragile children with the health care they need. A consent decree is an agreement made by both sides of the case to take steps that the court will oversee. The State also asked that the case be reassigned to a new lower court judge for future proceedings.

TJC argued against both setting aside the Consent Decree and reassigning the case. Ultimately, the court did rule that a new judge should be assigned to the case. In 2006, the federal court had asked the State what its plan was for complying with the law that promises children the health care they need. The State said there was no need for a plan because it was already in compliance. Since then, TJC has been monitoring the State’s compliance to its obligations to Tennessee’s children under the Consent Decree. The monitoring and discovery process has been very contentious, delaying a trial on the merits of the case. The Appeals Court noted the “strategy of contention” that the State has pursued has dragged the case out, but it ultimately ruled to reassign the case to a new judge.

The Appeals Court did not, however, relieve the State from its obligations under the Consent Decree. It refused to lift the State’s obligation to provide services to low-income and medically-fragile children in Tennessee. TJC remains committed to holding the State accountable to its most vulnerable citizens. Though the immediate future of this case remains unclear, what is certain is that TJC will continue to stand with Tennessee children when their HMOs deny them the services their doctors say they need.

We are hoping that these new developments will give the State a chance to reconsider its tactics and shift its focus to fulfilling its obligations to children. Legal wars of attrition are not in the interest of taxpayers who have to pay out-of-state lawyers’ huge legal fees. More importantly, focusing on these fights instead of children’s health is costly to the state for generations to come. Our case has never been about TJC’s lawyers scoring points in the courtroom – it is about ensuring that TennCare enrollees get the services they are promised by the law. These are services that taxpayers have already paid HMOs to provide, but the State must hold its contactors more accountable. As long as the State and its HMOs continue to deny children medically necessary services, we will continue to challenge the State’s failures and work to make things right.

Health Care Story - 11/10/10

2010-11-10T09:54:00.000-08:00

Mary and Joe’s foster son, Timmy, is severely autistic and intellectually disabled. Timmy is almost completely nonverbal and can use very limited sign language. Nevertheless, he loves music, watching Barney, and playing on the swing in his yard. Timmy also has dysphasia, esophageal problems, and reflux problems that require regular suctioning. Timmy’s doctor prescribed speech therapy to help him communicate better, but many speech therapists would not treat Timmy because he was too difficult.

Then Timmy’s parents found Susan Hock, a speech therapist at the Parent-Child Services Group in Knoxville, TN. Therapist Hock stuck with Timmy, and he started showing signs of improvement – sitting still, paying attention, correctly using some sign language, and playing simple computer games. And Timmy likes working with Susan. Now that she has worked with Timmy for several years, they have an established relationship, which is vital for Timmy because he has trouble meeting and working with new people. Due to Susan’s hard work with Timmy, he was able to have his feeding tube removed, reducing his risk of feeding-tube related infections.

Despite all of Timmy’s progress, TennCare said that Timmy would have to switch to a new therapist. TJC worked with the family to keep getting Timmy the care he needed. After TJC filed an appeal and sent TennCare letters of support from Timmy’s medical providers, TennCare decided the appeal in favor of Timmy and his parents – he could keep getting therapy from therapist Hock.

Mary said afterward, “I was very pleased with the results of the appeal…I also appreciate the concern and care that Susanne showed us.”

The Tennessee Justice Center works to help children get the care they need. We accept calls from providers as well as parents. If you know a child who is waiting for care, call us.

Health Care Story - 9/8/2010

2010-09-08T11:59:00.001-07:00

Shondrea is a vibrant, determined 28-year-old woman who wants to make her mark on the world. While she was a full-time college student, Shondrea worked as a hotel night auditor while balancing a full load of classes in social work. She knows what it means to work hard, and she wants to have a career that will help to improve the lives of others.

At the moment, however, Shondrea is fighting for her own life. Almost eight years ago, at age 21, she was diagnosed with lupus, a chronic, autoimmune disorder that causes inflammation in the body’s organs. Although she was able to control her symptoms for several years through expensive treatments and medications while on private insurance, her situation changed significantly under the stress of college combined with long, late-night shifts at the hotel. Her body exhausted, Shondrea’s organs began to break down.

Beginning in late 2008, Shondrea began having difficulties breathing, and fluid started accumulating around her heart. After going to the hospital more than once to have the fluid drained, she underwent surgery to implant a device around her heart to reduce the accumulation of fluid. Since her surgery, she has been regularly seeing several specialists who monitor her condition and are treating her with lifesaving medications. Lupus has also attacked Shondrea’s lungs and kidneys, and the weakening of her lungs makes her unable to walk or exercise.

Due to her current medical condition, Shondrea cannot return to school or work. She was deemed disabled in 2009 and lives on just over $1,000 per month in SSDI. Because Shondrea no longer receives SSI payments, she is losing her TennCare. She has a hearing next month, but the state’s rules make it very hard for a childless adult, like Shondrea, to be on TennCare.

If Shondrea loses TennCare, she has few health insurance options. Shondrea must wait two years from when she was determined disabled – until mid-2011 – to qualify for Medicare. This two year gap leaves people with severe disabilities out in the cold when they need health insurance most. In the meanwhile, Shondrea requires regular visits to her specialists and medications. If she stops treatment, her doctor has given her a life expectancy of fewer than ten years.

Private health insurance will not cover Shondrea because she is uninsurable. Her only other option is a high risk pool – either AccessTN, the state’s health insurance for residents who are uninsurable due to pre-existing medical conditions, or a new federal high risk pool. AccessTN is less expensive, and yet Shondrea would still have to pay a monthly premium plus a deductible, a financial stretch on her fixed income.

Not only is Shondrea in the middle of a two year gap, waiting for Medicare coverage to kick in, she’s one of millions of low-income adults who are waiting for 2014, when they will qualify for Medicaid. One provision of the Affordable Care Act mandates that all persons – including those, like Shondrea, without children – who earn less than 133% of the Federal Poverty Level are eligible for their state’s Medicaid program, such as TennCare. If that law were already in effect, Shondrea would not be facing the possibility of being disenrolled from TennCare. For Shondrea, and many others like her, health care reform cannot come soon enough.

TJC Commentary - TJC's Jennifer Tlumak Shares Her Thoughts on Healthcare Changes

2010-08-12T14:15:00.000-07:00

Our nation’s health insurance and delivery system is changing, and TJC is keeping pace, ensuring our clients have access to current information on locating, obtaining, and keeping meaningful health care coverage for their families. The Affordable Care Act, or “health reform” as it’s popularly known, is the law of the land. The law has lots of benefits for our clients, and although key provisions have yet to go into effect, we’re already seeing the real world impact of this historic legislation.

A breast cancer survivor who’s losing TennCare may be able to get immediate coverage, without being screened for pre-existing conditions, in the federal high risk pool that began on July 1, 2010. An elderly uninsured woman with extensive prescription drug needs may also benefit. This new high risk pool created by Affordable Care Act has some benefits over the state version, AccessTN. For example, the federal program has no waiting period for coverage of major medical conditions, and that’s a huge benefit to some of our clients.

A small child with seizures who relies on his father’s employee insurance plan will not be subject to pre-existing exclusions starting in early 2011, when their plan year begins. Health reform is the reason this child and his family will be protected from high out-of-pocket medical costs for his rare disease. The child will be covered, and the private insurance company will be responsible for covering this sick child – including his pre-existing condition – as well as his healthy siblings.

We still don’t have a perfect solution to our nation’s health care problems. But the changes are encouraging: ending rescissions and discrimination on the basis of pre-existing conditions, extending coverage to very low-income adults, providing subsidies so that more people can afford better insurance, and regulating the insurance companies by mandating that they put patient care ahead of profits. In my daily work with clients, I’m beginning to see the positive impact of some of these changes. I look forward to seeing more benefits as the Affordable Care Act is implemented more fully.

Health Care Story - 7/22/10

2010-07-22T09:30:00.000-07:00

Diane adopted Jimmy as a special needs infant when he was only six weeks old. Diane knew that he was born with a cleft palate and some other minor birth defects, but since she has private insurance and (as a special needs adoption) Jimmy also has TennCare, Diane thought all Jimmy’s needs would be covered by insurance.

It turned out that Jimmy’s minor problems at birth became significant impairments as he grew. By age 8, he had been diagnosed with autism, mental retardation, and cerebral palsy. His autism has proven difficult to manage, with behaviors ranging from running into the street and grabbing women’s breasts in public to obsessively chewing warts on his hands and a fascination with the sight of his own blood. Nevertheless, Diane knew that Jimmy had great potential and that all he needed to reach it were the right therapies and treatments. As she told TJC, “Despite his challenges, he is a sweet kid who tries very hard and who inspires most who meet him.”

Diane began searching for therapy to manage Jimmy’s autism soon after he was diagnosed. She even took him to a specialist out of state and paid out of pocket for ABA therapy when her insurance policy said it would not cover the treatment. As he got older and his behaviors worsened, Diane hired specially trained caregivers, once again paying out of pocket, to help care for Jimmy. Over the years, she has spent more than $100,000 of her own money to try to keep Jimmy safe. Unfortunately, all this money and effort has not allowed Jimmy to reach his full potential.

Diane contacted TJC for help getting Jimmy therapy to reduce his harmful behaviors. Jimmy’s PCP and psychiatrist prescribed applied behavioral therapy (ABA), but TennCare denied it as not medically necessary and Diane’s private insurance would not cover the expensive treatment. TJC helped Diane navigate the appeals process and discovered a TennCare procedural error, which allowed Jimmy to receive intensive in home ABA therapy for more than one year. His obsessive biting and other dangerous behaviors have been drastically reduced. In preparation for the family’s TennCare hearing, TJC located a pro bono attorney to assist Diane in court. Based on Jimmy’s severe needs and the successes the ABA treatment had produced, the Judge ordered TennCare to continue providing intensive ABA.

Because he has gotten the health care he needs, Jimmy is adjusting better in school and other public settings. His problem behaviors have gone down. His overall physical and mental health have improved, and he is a happier child. Through the tireless advocacy of dedicated mothers like Diane, Tennessee’s children have a brighter future ahead.

Health Reform Update: New regulations in place to protect consumers

2010-06-23T09:37:00.000-07:00

Yesterday, the U.S. Department of Health and Human Services issued regulations that create a new Patients' Bill of Rights under the Affordable Care Act. These regulations, which apply to nearly all health insurance plans, will help children (and eventually all Americans) with pre-existing conditions gain coverage and keep it, protect all Americans’ choice of doctors and end lifetime limits on the care consumers may receive.

How will the rules help you? They will:

Stop insurance companies from limiting the care you need. These rules stop insurance companies from imposing pre-existing condition exclusions on your children; prohibit insurers from taking away your coverage based on an unintentional mistake on an application; ban insurers from setting lifetime dollar limits on your coverage; and restrict their use of annual limits on coverage.
Remove insurance company barriers between you and your doctor. These rules ensure that you can choose the primary care doctor or pediatrician you want from your plan’s provider network, and that you can see an OB-GYN without needing a referral. Insurance companies will not be able to require you to get prior approval before seeking emergency care at a hospital outside your plan’s network.

There are also several other new provisions. More info on all of these new changes can be found at http://healthreform.gov/newsroom/new_patients_bill_of_rights.html.

Families USA Report: Health Reform's impact on Tennesseans with pre-existing conditions

2010-06-10T08:31:00.000-07:00

Recently, a Families USA report came out exploring what Health Reform will mean for Tennesseans with pre-existing conditions. The full report can be found here: http://www.familiesusa.org/assets/pdfs/health-reform/pre-existing-conditions/tennessee.pdf.

Here are some of the most important facts we saw in the article:

• There are currently 1,275,000 Tennesseans under 65 years old with pre-existing conditions that could potentially exclude them from insurance coverage. That is ¼ of the non-elderly population.
• There are 115,000 children under 18, and 97,700 young adults aged 18-24, that have pre-existing conditions that could be used to deny coverage.
• These groups transcend all socioeconomic indicators. While individuals below the poverty line are the most likely to have a condition, 23.9% of the individuals making over 400% of the poverty level could be excluded.

Keep in mind that this study is only based on individuals who already have a diagnosis. As primary care becomes more readily available, more individuals will likely discover that they have chronic conditions that require treatments that would otherwise be excluded under traditional health insurance practices.

Health Care Story - 5/21/10

2010-05-21T08:19:00.000-07:00

This week, we welcome a guest post from Sheryl Hurst, a 3rd year student at The University of Memphis Cecil C. Humphreys School of Law. This post is about her experience in working on TennCare appeals.

“Andrew” is a seventeen year-old boy diagnosed with numerous mental health issues, including Autism Spectrum Disorder (atypical autism), Mental Retardation, and Pervasive Developmental Disabilities. Andrew was involuntarily civilly committed by the Juvenile Court of Memphis and Shelby County and placed in the custody of the Tennessee Department of Mental Health and Developmental Disabilities (“DMHDD”). DMHDD placed him at the Middle Tennessee Mental Health Institute’s adolescent center (“MTMHI”). Because MTMHI is an acute care facility designed for short term stays, MTMHI searched for a residential treatment program that was willing to accept Andrew and provide the most appropriate treatment possible for his diagnoses. MTMHI eventually was able to secure a spot for Andrew at the National Deaf Academy (NDA) in Florida.

However, upon acceptance to this residential program, TennCare refused to pay for the services. TennCare deemed such treatment to be “not medically necessary.” In so finding, TennCare asserted that residential treatment was not “safe and effective” because Andrew possessed “active severe suicidal, homicidal, mood or thought disorder problems” that required intensive levels of care. TennCare further stated that Andrew was in “need of more care than residential treatment can safely and effectively provide.” In December of 2009, Andrew appealed TennCare’s decision to deny payment for residential treatment at NDA. On January 29, 2010, The University of Memphis Child and Family Litigation Clinic was appointed as Guardian ad Litem for Andrew.

Andrew’s case was handled by a team of Student Attorneys who in the course of several weeks assembled an extensive list of expert witnesses along with evidence in order to present their case. The Student Attorneys assembled two binders of evidence including medical records and school records, a DVD, and various other materials. They prepared three expert affidavits and a pre-hearing brief and delivered their entire product to the TennCare attorney in Nashville. They assembled and prepared four in-person witnesses and two telephone witnesses and prepared for trial. The hearing was scheduled for April 13, 2010, but an hour before it was set to begin the attorney for TennCare called to settle the case. TennCare authorized payment for residential treatment services.

This case turned out to be a huge victory for the team of Student Attorneys working on the case, as well as for Andrew. It was a great feeling of accomplishment when I learned of the result, and the rush I got is unexplainable. It was great working to get Andrew the appropriate medical treatment he was entitled to. Providing Andrew with access to the medical treatment he deserves will greatly expand his capability to progress into the adult which he is capable of becoming. Working on the case was a very enjoyable experience and I was extremely pleased with the outcome.

Housed in the University of Memphis, Cecil C. Humphreys School of Law, the Child and Family Litigation Clinic fulfills a critical community service by providing free legal services to under-represented clients, specifically children. Student Attorneys work under close clinical faculty supervision and develop firsthand knowledge about the various ways they can promote social justice and use their law degree in service to society.

TJC 2010 Mother of the Year - Linda Winford

2010-05-06T10:39:00.000-07:00

Linda Winford of Clarksville is being honored as a 2010 Mother of the Year by the Tennessee Justice Center (TJC). The award is in recognition of her persistence in battling to obtain medical services for her daughter and for her extraordinary commitment to the healthcare of all children and families. Ms. Winford is one of six parents from all over the state who are receiving the 2010 TJC Mother of the Year award.

Just after Christmas 2006, four siblings were adopted by retired phone company employee Linda Winford. While living with their biological parents, the children had endured physical and verbal abuse. When they first came to their foster mom, it was with broken bones, shaved heads (due to lice), malnutrition, and a host of behavioral problems due to Post-Traumatic Stress Disorder (PTSD). The children’s healing began with love and care from their new mom, Linda, supported by her partner, Kathy Lyons, formerly with the Army as a Captain in the Chemical Corps. A near drowning accident resulted in the youngest child, Rebecca, becoming quadriplegic at age three. She cannot walk, breathes with the help of a tracheotomy, and is fed by a tube. Through Linda and Kathy’s consistent care, she is getting stronger every day, and can now communicate through smiles and blinks.

Because she has difficulty coughing and swallowing, Rebecca needs help clearing her throat and lungs. Without proper help, many children in this condition are continually hospitalized for pneumonia. For more than a year and a half, Rebecca has been hospital-free because she uses “the Vest,” a machine that clears her lungs and prevents choking and infections. But last fall TennCare notified the family that the Vest would be taken away because it was “experimental.” The family called TJC, and we helped them get ready for the hearing. They proved to the judge that it would be cheaper for TennCare and better for Rebecca to keep the Vest, so the judge ordered it. Ms. Winford said, “With the Tennessee Justice Center’s help, we were able to keep Rebecca’s Vest, and her respiratory health is excellent. Her pulmonologist just gave her a clean bill of health.”

As the family faces more battles to get Rebecca what she needs, TJC is by their side. Rebecca is benefitting tangibly from hyperbaric oxygen therapy to restore her cognitive function, and needs nurses to accompany her to those treatments. But TennCare denied the nursing care. TJC wrote a letter to the state explaining why she should get the care, and found an attorney to represent the family in court. Unfortunately, they lost at the hearing, but Ms. Winford is not through fighting. Ms. Winford said, “We’ll keep working to help Rebecca and other young people keep their health care and reach their potential.”

One way the family’s fighting to raise awareness of children like Rebecca is their annual RebeccaRoo festival coming up in September 2010. RebeccaRoo 2009 was a big success, with live music, food, and activities for the community to enjoy. The festival benefits Rebecca and other disabled children by raising awareness and funds for their ongoing care needs.

TJC 2010 Mother (and Father!) of the Year - Dr. Bill and Mrs. Karen Shannon

2010-05-04T08:04:00.000-07:00

Dr. Bill and Mrs. Karen Shannon have been caring for their son Jim since he became disabled 38 years ago. Jim was born healthy, but had become nonverbal and quadriplegic by the time he was eight months old. Doctors were never able to explain what went wrong. Over the years, with the help of nurses, Dr. and Ms. Shannon have helped him learn to use a computer with the one part of his body that he can control – the left side of his chin. Jim lives a full life despite his severe disabilities. He has a Master’s degree from Middle Tennessee State University, a job working with computers, is the president of an organization concerned with technology for people with disabilities, and attends church every Sunday.

When TennCare wanted to reduce Jim’s nursing hours in 2008, Dr. and Mrs. Shannon did everything they could to fight it. The Shannons wanted to make sure their son got the care he needed to allow him to reach his full potential. TJC helped them file an appeal and find an attorney to represent Jim at his hearing. We also campaigned to get the rules changed that allowed TennCare to reduce the home health care of enrollees like Jim, and Dr. and Mrs. Shannon led the fight by speaking to legislators at the committee hearing, speaking out against the limits on a local radio show, and getting over fifty members of their community to sign a petition against the home health cuts.

Then, in 2009, TennCare eligibility changed, putting Jim at risk of losing his health insurance altogether. Without TennCare coverage, Jim would lose the nursing care he needs to stay safe. His employer’s insurance wouldn’t help, since their plan does not cover home health care. Dr. Shannon called TJC again, and we determined that Jim was still eligible for TennCare. In their fight to reinstate Jim’s care, Dr. and Mrs. Shannon also spoke for many other parents struggling to obtain care for their children. Currently, more than 500,000 children rely on TennCare for their health care.

Through TJC’s advocacy, and with Sumner County attorney Jim Hawkin’s representation, Dr. and Mrs. Shannon were able to prove to TennCare that Jim was eligible. He continues to receive the care he needs to stay safe and remain a productive member of society. Dr. Shannon said about TJC, “They’re almost like the proverbial David and Goliath story – they’re David, trying to fight a huge machine to protect the rights of individuals.” He continued, “Common folks like us, we don’t know what our rights really are and what w should expect, so these people at TJC, they’re the light at the end of the tunnel for us.” Listen to Dr. Shannon speaking about TJC.

We’re proud to honor Dr. and Mrs. Shannon of Hendersonville as 2010 Mother and Father of the Year.

TJC 2010 Mother of the Year - Trina Parker

2010-05-03T11:34:00.000-07:00

Eleven-year-old Darius “never meets a stranger,” says his mom, Trina, of her outgoing 5th grader. But last fall, chronic headaches and severe weight loss began forcing him to miss school and football practice. Darius was diagnosed with brain cancer. Trina had to cut her work hours in half to care for him, leaving both her and her son ineligible for her employer’s health insurance.

Darius and Ms. Parker didn’t think things could get much worse. Then, TennCare told Darius he would lose coverage the day before he was to have his brain tumor removed. Without insurance, the hospital would not do the operation. Ms. Parker asked the Department of Human Services (DHS) for help, but nothing happened. Then, a social worker told her about the Tennessee Justice Center.

Trina called TJC, and we determined that TennCare had miscalculated the family’s income and that Darius should stay on TennCare. We helped Ms. Parker file an appeal, allowing Darius to keep TennCare during the appeal. The surgery went smoothly, and Darius went home with his Mom about a week later.

But her fight wasn’t over yet. Darius’s cancer was worse than doctors had thought. A few days before Darius was scheduled to return to the hospital for chemotherapy, DHS told Ms. Parker they were going to close Darius’s TennCare case. Ms. Parker called TJC again. We wrote the Case Manager a letter reminding him that DHS rules required him to keep Darius’s case open.

DHS kept the case open, and later approved Darius’s TennCare application. He is currently undergoing chemotherapy and his prognosis is good. Ms. Parker said that despite everything, “Darius is in good spirits. The doctor explained everything and he understands that the treatment is to get rid of the tumor,” said Ms. Parker. “He has a really good family-based support and church.”

Ms. Parker is adamant that other families should not have to go through what hers did to get health care. She said, “I pray that we can work together to fix our country’s health care.”

TJC 2010 Mother of the Year - Evelyn Human

2010-04-30T08:17:00.000-07:00

When TennCare decided to sharply limit home health care for all adults on the program in the fall of 2008, Evelyn Human decided that she was not going to let her son’s care be cut without a fight. Her son, John, is mentally retarded. At 25 years old, he has the mental capacity of a small child. He requires constant care, almost continuous suctioning to keep his airways clear, and assistance with all aspects of his life. He had been receiving enough in-home nursing care from TennCare for his mother to work and provide for the family. TennCare’s new rules, however, said that his in-home nursing hours would be capped at 35 hours per week. With only 35 hours, John would be left unattended for long stretches, and could aspirate from lack of suctioning.

Instead of providing the care John’s needs to stay safe, the MR Waiver, a supplementary program John is enrolled in along with TennCare, only agreed to provide just 4 hours of care per day. Waiver representatives told Ms. Human that this care would be delivered in 15 minute intervals throughout the day – for a total of 16 separate visits each day! Not surprisingly, no nursing agencies agreed to provide care on this schedule. On the day John’s care was set to be reduced, he received no care at all through the Waiver. Ms. Human was unable to work due to the constant care she had to provide.

Ms. Human immediately contacted TJC, and we contacted Waiver personnel to discuss the problem. When that did not fix the problem, TJC contacted attorneys for the State to alert them to the violation of John’s rights. The attorneys agreed, and John began receiving his supplementary care. But there were still long gaps throughout the day when John would be alone. Ms. Human appealed and asked for more nursing hours. TJC located a pro bono attorney, Leslie Muse, to represent the family. TJC helped train Ms. Muse in techniques for winning TennCare appeals. After a hearing lasting several hours, the judge agreed with Ms. Human and John’s doctors that his needs make constant care medically necessary.

Because of Ms. Human’s advocacy, John is now receiving the skilled care he needs to safely live at home. We honor her persistence and dedication as a 2010 Mother of the Year.

TJC 2010 Mother of the Year - Patricia Womac

2010-04-29T13:57:00.000-07:00

Ms. Womac’s daughter, seven-year-old Hannah, suffers from Rett Syndrome, a rare and devastating disorder of the nervous system that renders her incontinent and unable to speak or walk on her own. Rett Syndrome occurs mostly in girls and is occurs in one in every 10,000 - 23,000 female births. Due to these conditions, plus difficulty breathing and frequent seizures, Hannah receives nursing care through TennCare. Even with nurses, Hannah’s mother cares for her full-time – lifting, bathing, and feeding Hannah and fighting to make sure she gets what she needs.

Hannah’s caregivers take joy in her small pleasures and accomplishments. She loves to watch cartoons including “Miss Spider’s Sunny Patch Kids” – a show about a family of bugs who live in the Hollow Tree. Hannah’s mom thinks that Hannah is drawn to the way the characters speak and their voices. She also enjoys listening and moving to country music.

Last fall, Ms. Womac received a notice from the TennCare HMO saying that it would no longer cover the nursing care Hannah needs to be safe. The HMO called Hannah’s doctor and pressured him into reducing his order for nursing. Then they cut Hannah’s care. When Ms. Womac learned about the reduction, she immediately filed a TennCare appeal to keep her daughter’s home health hours. Ms. Womac called TJC, exasperated, and asked for help. She explained that every few months, Hannah’s HMO tries to reduce her nursing. Each time, Ms. Womac must go to court and each time, the judge orders that Hannah’s needed home health care be provided. To stop this exhausting cycle, TJC wrote a letter to the state. The state’s lawyers wrote back, agreeing, and Hannah’s nursing services have continued.

Ms. Womac’s struggles to provide care for her medically fragile daughter are ongoing, as is TJC’s advocacy. In January 2010, Ms. Womac called TJC because she needed help getting Hannah’s wheelchair fixed. The repair company picked up the broken chair, but provided the family with no temporary replacement. Hannah was left for a week and a half without a wheelchair, causing her to miss a doctor’s appointment since Ms. Womac had no way to get her there. When the chair did come back, it was missing head and arm supports. TJC wrote two letters to the state’s TennCare attorneys and got Hannah the safe wheelchair she needs.

Ms. Womac’s tenacious dedication to her daughter is helping Hannah live the best life she can. We honor Ms. Womac as a Mother of the Year!

TJC 2010 Mother of the Year - Maria Vasquez

2010-04-28T10:28:00.000-07:00

Eleven-year-old Henry Vasquez has severe Asperger’s Syndrome, a development disorder on the Autism spectrum. His anxiety and self-harming behaviors prompted Henry’s doctor to order Applied Behavioral Analysis (ABA) therapy, a treatment for children with Asperger’s which involves family members. Asperger’s affects Henry’s emotions and his speech – he stutters and can't get words out.

Henry’s mother, Maria, speaks only Spanish, and requires an interpreter to participate in her son’s hands-on ABA treatment. But a TennCare HMO told the family that it would only cover interpretation services over the phone, not hands-on. TennCare’s offer was not only ineffective for the Vasquezes, but a violation of their rights. Ms. Vasquez contacted the Tennessee Justice Center and we filed a TennCare appeal and a Title VI complaint with Office of Non-discrimination Compliance/Health Care Disparities in late December 2009. Shortly thereafter, on January 14, 2010, Henry received an assessment to determine how many hours of ABA therapy were recommended. A Spanish-speaking interpreter was present.

Through Maria’s persistence and TJC’s advocacy, both Henry and his mom could participate fully in getting the care he so desperately needs. Ms. Vasquez’s experience highlights the irrationality of a system in which TennCare funnels public money to contractors to manage care, but then allows them to operate without oversight. The contractors then create arbitrary rules which result in children like Henry waiting months for needed care. No medical professional would approve a partial heart surgery or a partial tooth filling – ABA therapy without interpretation is equally illogical.

Ms. Vasquez said, “Thanks to all the hard work of the people at the Tennessee Justice Center it seems like everything is easier and going faster.”

Health Care Story of the Week - 4/21/10

2010-04-21T13:09:00.000-07:00

Mother's Day stories will be coming up in the next few weeks... Here's one of our Community Mothers of the Year from 2009. Destiney wrote to us nominating her grandmother, Earnestine, for the award.

Destiney’s grandmother, Earnestine, is her health care hero. Earnestine is devoted to doing everything she can to make sure her granddaughter is as healthy and happy as possible. Destiney said Earnestine taught her that, “when your body is healthy, your mind will be happy and it will help you to focus and do your work.” She and her grandmother work out together in their exercise room at home every day. Destiney enjoys jump roping, riding her bike, skating, and hula hooping. “I love to work out because it makes my muscles look big,” said seven-year-old Destiney.

When Destiney needs a checkup or an immunization shot, Earnestine always takes her to her appointments. Earnestine makes sure that Destiney eats three healthy meals a day, with plenty of fruits and vegetables. Her favorite foods are peas and mandarin oranges.

Earnestine also makes sure that Destiney gets plenty of sleep every night, brushes her teeth 3 times a day, stays hydrated and clean. Destiney said her grandma takes her “to different fun places to have fun… (She) loves me and she takes time out with me every day.” Earnestine knows that keeping kids healthy allows them to get the best start in life and reach their full potential.

Health Care Story of the Week - 4/1/10

2010-04-01T13:14:00.000-07:00

Jacob, age 7, has a rare genetic disorder that requires him to use a machine to keep his lungs clear so he can breathe. He uses another machine to eat and braces and a walker to get around. While Jacob’s condition means that he has many medical needs, he can talk and his friendliness and growing intellect shine through in his speech.

When his doctor said Jacob was ready to attend school, he prescribed a one-on-one nurse to ensure his safety. However, Amy was unable to find a nursing agency that would provide a nurse for Jacob. She appealed to the insurance company for help, but was told that there was nothing the company could do. Wanting her child to learn and be part of a community of other students, Amy contacted the Tennessee Justice Center for help. Since Jacob is on TennCare, TennCare is ultimately responsible for providing needed care. After TJC contacted TennCare, a case manager was assigned to coordinate Jacob’s care. Soon a nursing agency arranged staffing for Jacob. He is now attending school, learning and socializing in a stimulating environment, all thanks to Amy's dedication.

Amy's best friend, Linda, puts it this way, "I have never seen a more protective, providing, loving mother. Amy has ALWAYS put her family first, being at home and trying to find work from home so she would be able to care for her sick child. I am very proud of her love and her strength and determination to get things done where any one of us would have given up a long time ago. She endures."

Health Reform Update - 3/24/10

2010-03-24T13:55:00.000-07:00

There’s been plenty of talk recently about what the health reform bill will mean for Americans. Today, we want to focus on the 10 best immediate benefits that health care reform will have for everyone. These are just a few of the changes that are incorporated into the house bill, and they include the provisions that the Senate is currently voting on.

1) Small business tax credits.
• Tax credits of up to 35% of premiums are immediately available to small businesses that offer coverage. In 2014, these credits will increase to offset 50% of the cost.
2) Closing the Medicare Part D Donut Hole
• All Medicare enrollees that hit the donut hole this year will receive a $250 rebate. Beginning next year, brand-name drugs will be discounted by 50% in the donut hole. By 2020, the donut hole will be completely closed.
3) Free preventative care
• Beginning January 1, 2011, there will be no copays or deductibles for any preventive services paid for by Medicare.
• Starting in 6 months, all new private plans will be required to offer preventive services without charging copays or deductibles.
4) Ending recissions
• Starting in 6 months, health insurance companies will no longer be allowed to drop people when they get sick.
5) No lifetime or annual limits on coverage
• Starting in 6 months, insurance companies will not be allowed to place lifetime limits on benefits.
• Beginning in 6 months, new regulations would restrict the use of annual benefit limits to deny services to patients. In 2014, annual limits would be banned from all new plans.
6) No discrimination against children with pre-existing conditions
• In 6 months, insurance companies will be banned from denying coverage to children based on pre-existing conditions. In 2014, this rule will be applied to people of all ages.
7) New appeals process
• Creates a new and effective internal and external appellate process to allow a patient the opportunity to challenge decisions made by his or her insurer.
8) Premiums must go towards paying for care
• Starting January 1, 2011, all large-group market insurers must spend at least 85% of the cost of premiums on providing actual care. Insurers that cover individuals or small groups must use at least 80% of premiums to pay for care. Companies that don’t do this will have to refund their policyholders.
9) Immediate creation of a high-risk pool
• In 90 days, a temporary subsidized “high-risk pool” will open for people who cannot get insurance due to pre-existing conditions. This pool will close once the exchange opens and insurance companies are banned from denying coverage to adults (in 2014).
10) Health insurance consumer information
• Provides immediate funding to state governments to create programs that will help patients learn their rights and file complaints and appeals when care is denied.

Health Care Story of the Week - 3/17/10

2010-03-17T13:43:00.000-07:00

Laurenda is the adoptive Mom of six girls, including 12 year old Karla and her sister. In 2003, she and her husband, Danny, took Karla in as a foster child. Karla needed to have open heart surgery, and after negotiating with Karla’s birth mother, Laurenda received permission to get heart surgery for Karla.

Laurenda made sure that Karla made it to all of her appointments with the cardiologist and the surgeon, as well as all her other doctors. When Karla went to Vanderbilt for surgery, Laurenda stayed there with her for a week. “She played games with me and even pulled me up and down the halls in a red wagon,” said Karla. “My new Mom even made a scrapbook for me of my time in the hospital so I would always know why I have scars on my chest.”

Thanks to Laurenda’s dedication, Karla’s surgery was a success. Now, “You can’t tell Karla that she can’t do anything,” said Ms. Whisenhunt. “She loves to work with my husband building things. She doesn’t have the fear of overdoing something, she has confidence.”

All of Laurenda and Danny’s adopted daughters have special needs, “but she always manages to take care of us,” said Karla. “I can’t really think of the words to tell you how special she is… All of my friends think she is the bomb.” As this family's story demonstrates, a parent's persistence and dedication to ensure that her children get the care they need can make all the difference.

Health Care Story of the Week - 3/11/10

2010-03-11T13:52:00.000-08:00

This week, instead of telling the story of one family, we'd like to share information about the state of health care in Tennessee as a whole. The following information comes from Families USA. More info on all states can be found at http://www.familiesusa.org/health-reform-2010/cost-of-doing-nothing.html.

1. If we don’t pass health reform now, 158,000 Tennesseans will lose health insurance by 2019.

If we do nothing, 1,065,000 Tennesseans will lack health insurance by 2019, leaving 1,065,000 people with few options when they get sick.
If Congress does the right thing and passes health reform, 611,000 Tennesseans will gain coverage.

2. If we don’t pass health reform now, the average Tennessean’s family insurance premium will increase by $7,737 by 2019.

These increases in family premiums happen at a time of record-breaking profits for health insurance companies. The five biggest for-profit health insurers saw a combined $12.2 billion in profits in 2009.
Passing health reform will provide subsidies to millions of Americans in order to make health insurance affordable. Health reform will also hold insurance companies accountable to their policyholders and not just their stockholders by requiring insurers to spend 85 cents of every dollar on actual health care.

3. If we don’t pass health reform now, more Tennesseans—our parents, our friends, our neighbors—will die because they lack health insurance.

Nearly 13 working-age Tennesseans die each week because they lack health insurance.
Health reform will expand life-saving coverage to thousands of Tennessee families.

4. If we don’t pass health reform now, Tennessee’s small businesses will pay $2.8 billion more for health care premiums by 2018, stifling innovation and job growth.

While Tennessee’s small businesses spent $2.1 billion on health care premiums in 2008, that number will rise precipitously to $4.9 billion by 2018 without health reform.
By passing health reform, Congress will provide tax credits and a new marketplace for small businesses to provide quality, affordable coverage to their employees.

5. If we don’t pass health reform now, 177,000 Medicare beneficiaries in Tennessee will continue to hit the “doughnut hole,” or gap in Medicare Part D drug coverage.

The doughnut hole costs seniors an average of $4,080 per year.
Health reform will reduce the doughnut hole, ensuring that Tennessee’s Medicare enrollees will not have to choose between food or medicine.

Health Care Story of the Week - 3/4/10

2010-03-04T06:14:00.000-08:00

John and Sue have spent the last 20 years helping their son Jonathan reach his maximum potential. Jonathan suffers from Asperger’s Syndrome. This means that when medicated Jonathan has a nearly normal IQ but suffers from many of the debilitating characteristics of Autism. His disability prevents him from being able to socialize with other people and make sound decisions. At the age of 24, he has the functional IQ and emotional maturity of a young boy.

Sue, a BS Home Economist and certified teacher, gave up her career and dedicated herself to taking care of Jonathan. When Jonathan completed secondary school at age 20, John and Sue began searching for a long-term solution for Jonathan. They had heard about a special Medicaid waiver for the mentally retarded, but were then told that Jonathan did not qualify because of his normal IQ.

John and Sue then heard about a vocational rehabilitation program for people with neurological problems. They were then told that Jonathan did not qualify for that program because his functional level was too low.

John and Sue were determined that Jonathan was not going to fall through the cracks created by the bureaucracy of narrowly defined government programs. They did not give up.

The family eventually learned of a residential treatment facility that could treat Jonathan’s behavioral problems and improve his social functioning. They asked TennCare to pay for this treatment in the hopes that Jonathan would be able to go from the treatment facility to a group living environment. Without it, he would never make it in that type of living arrangement.

TennCare refused to pay for the treatment. The family appealed. They found a pro bono attorney to help them with the appeal. That attorney contacted TJC for advice on how to handle the appeal. TJC helped the attorney, and the John and Sue were able to get Jonathan the treatment that he needed.

The story does not end there, however. Despite the fact that Jonathan’s doctors do not think that he is ready to leave residential treatment, TennCare has repeatedly tried to stop paying for Jonathan’s care at the residential treatment facility. John and Sue are persistent and keep appealing to make sure that Jonathan receives treatment for as long as he needs it.

John and Sue are also still tirelessly searching for a long-term placement that will meet Jonathan’s needs, but will keep him in the community once he is ready to leave the residential treatment facility. Jonathan cannot be left unsupervised for his own safety and the safety of others. Finding a place for him to go after he finishes residential treatment when there seems to be no place for him to go is the next mountain that John and Sue are climbing to help their son.

Health Care Story of the Week - 2/24/10

2010-02-24T14:13:00.001-08:00

Tamorra Clark is a 10 year old girl born with multiple medical problems, including cerebral palsy and developmental disabilities. As a result of these conditions, she requires private duty nursing at home to meet her medical needs. Tamorra’s parents both work in the army and are stationed in Tennessee. The army’s medical insurance covers half of Tamorra’s private duty nursing while TennCare covers the other half. In January, Tamorra’s mom received a notice from TennCare telling her that Tamorra was no longer eligible for TennCare services. She was told that Tamara’s eligibility category was closing and she did not fit in any others. This meant TennCare would no longer supplement her private duty nursing hours, and she would go without care for large portions of the day.

Tamorra’s parents were particularly upset about the impending loss of their daughter’s TennCare and home health care given their line of work. They are two people who have promised to give their lives for the protection of our country yet their daughter may have to go without her much-needed nursing care.

Tamorra’s mom, Ms. Quinn-Clark contacted TJC, worried that her daughter would not be taken care of; Ms. Quinn-Clark was scheduled to be deployed to Afghanistan at the end of January, and her husband, who works, would not be able to stay home to take care of Tamorra. TJC explained to her what her options were and told her about the MR waiver. The MR waiver is a statewide program to help individuals with mental disabilities. Enrollment on the waiver also entails coverage by TennCare. Ms. Quinn-Clark applied for the waiver services for her daughter and is waiting a decision.

Ms. Quinn-Clark has already deployed to Afghanistan, where she will remain for one year. In the meantime, her husband must balance his full time military obligations with caring for his daughter, all while worrying about what may happen if Tamorra is not able to enroll.

Health Care Story of the Week - 2/10/10

2010-02-10T11:29:00.000-08:00

Judy’s adopted son, Ladontay, age 6, loves skateboarding, coloring, watching wrestling on TV, reading, and going to school. However, Ladontay has cysts on his nose that make wearing regular glasses painful. Judy knew that if Ladontay’s glasses were more comfortable, he would leave them on at school and be able to learn more easily. His doctor ordered special glasses; however, his TennCare vision plan would only cover non-flexible glasses. The law says that children should have what they need to meet their potential. The plan would not even explain to Ladontay’s grandmother why it was denying the glasses.

Frustrated, Judy called the Tennessee Justice Center for help. TJC called the vision plan, Judy called TennCare, and the two worked together to write a letter to the state’s attorneys. Within three days, Ladontay’s doctor was able to fill the prescription for his new, flexible glasses. With his new glasses, Ladontay’s reading and schoolwork will improve and he will be able to participate more fully in sports.

In her fight to obtain the medical care that Ladontay needed, Judy also spoke for many other parents struggling to obtain care for their children. She said, “When I contacted the Tennessee Justice Center, you steered me in the right direction. Your help was a lifesaver. I am so thankful.” She continued, “Without the Tennessee Justice Center, I would have just taken “no” for an answer. Now, I know my rights.”

Health Care Story of the Week - 2/4/10

2010-02-04T12:57:00.000-08:00

Eleven-year-old Chance enjoys being outdoors. He loves to play basketball and go swimming. Chance was born with hearing and vision impairments as well as serious psychological and neurological problems.

After a recent hospitalization, Chance was discharged but desperately needed follow-up care. Chance’s doctors had ordered residential treatment for him. This intensive level of care and therapy is Chance’s opportunity to develop to his fullest potential. To avoid social isolation due to his deafness, Chance’s doctors recommended placement at a facility where both the staff and the residents could speak to him in sign language. Integrating Chance in a social setting during his treatment increases the likelihood that Chance’s therapy will succeed, and that upon discharge he will be able to function well at home and in school. Originally, TennCare indicated that it would not cover this specialized treatment for Chance.

Chance’s behavior was out of control due to his disorders and he posed a serious risk to himself, his family, and his peers. He could not return to school. He could not be around other people. In order to keep their son, their family and their neighbors safe, his mother, Kim, stayed with Chance at a State Park. Knowing she could not remain awake around-the-clock to watch over Chance, Kim called TJC for help.

With the help of the Tennessee Justice Center, Chance received the care his doctors recommended. TJC’s advocacy ensured that TennCare will cover the treatment for Chance at a facility that works specifically with deaf children who have multiple special health needs.

Chance’s mother wrote to TJC on behalf of the family: “Thank you so much from all of us, especially Chance. We finally have so much more hope for him.”

Health Care Story of the Week - 1/27/10

2010-01-27T07:27:00.000-08:00

Austin is an 8 year-old who is charming, bright, and full of life. He is diagnosed with a severe language disorder that makes his limited speech unintelligible. After three years of attempting to use a communications device, Austin was only able to combine two symbols and was completely unable to navigate between pages of the device without heavy prompting and cueing. This was a source of great frustration for Austin. For three years he and his parents stressed over the loneliness caused by Austin’s inability to communicate.

A different device which enabled him to communicate much better, was denied by his TennCare HMO. They told him they would only cover the one he had been using, the one that did not work.

The HMO denied the medical equipment as “not medically necessary,” even though Austin’s speech therapist and pediatrician found that the device was medically necessary to enable Austin to communicate basic survival skills, make requests, and to express the need for medical assistance and medical care.

When Austin’s parents appealed, TennCare sided with the HMO.

Desperate to end the isolation Austin was forced to live in for three years with his unsuccessful speech generating device, Austin’s parents contacted the Tennessee Justice Center. TJC used the protections of the John B. class action law suit to get Austin the medical equipment his doctor and speech therapist recommended.

Austin was thrilled to learn that that he would be getting the medical equipment he needed. The smile on his face when it arrived, just in time for Christmas, was priceless.

Austin had trouble again shortly after, when he and his 5-year-old sister, Megan, were denied occupational and physical therapy because TennCare had allegedly not paid the bills for these services. Once again, TJC advocated on behalf of the family to address this issue and ensure that their providers continued treatment.

Health Care Story of the Week - 1/21/10

2010-01-21T10:17:00.000-08:00

Twenty-one-year-old Geanine was in a car accident in October 2004. She suffered a traumatic brain injury. Immediately after the accident, Geanine could not walk or talk. Her mother, Gerece, was living in Milwaukee and moved with her son, Geanine’s younger brother, to Tennessee to take care of her daughter.

After four months of rehabilitation, Geanine was discharged. She immediately began experiencing severe behavioral problems as a result of her brain injury. Geanine tried several times to hurt her mother. Geanine would often say, “I wish you would just disappear” or “I wish you were dead.” On one occasion, Geanine held a bottle of bleach over her mother’s head and was going to pour it on her.

Gerece never gave up on Geanine. She fought diligently to get Geanine the care that she so desperately needed. Geanine’s doctor recommended she be placed in a residential facility that specialized in treating brain injured patients. TennCare refused to cover the care. Gerece contacted TJC, and we filed an appeal for Geanine to receive residential treatment at a facility specializing in brain injury. After several months of battling, Geanine finally won approval.

Every step of the way, Gerece constantly supported and advocated for her daughter.

Since Geanine’s admission to residential treatment, Gerece continues to be a tireless advocate for her daughter. Some may have expected her to breathe a sigh of relief and take a break from the turmoil of behavioral problems caused by brain injury. Not Gerece. Gerece continues her active involvement in her daughter’s treatment and therapy and strives to ensure that her daughter receives the care her daughter’s future depends upon. Even though it took a legal battle, Geanine's treatment will open up many possibilities in her future.

Health Care Story of the Week - 1/13/10

2010-01-13T09:33:00.000-08:00

This week, instead of presenting a story of an individual's struggle with health care issues, we present a comparison between the availability of care in Tennessee and Alabama, which has been affected by recent policy decisions.

Last month, Alabama won a $39 million performance bonus for making it easier for low income children to get health insurance. Meanwhile, just across the border in Tennessee, legislation was passed that locked many of the state’s 150,000 uninsured children out of TennCare indefinitely.

So, a low income uninsured child on the Alabama side of Ardmore, a town that spans the Alabama-Tennessee border, can now access Medicaid coverage more easily than ever before. But the same low income uninsured child on the Tennessee side of town may now be forced to go without needed medical care.

On December 16, the federal government awarded the $39 million performance bonus to Alabama for doing such a good job enrolling low income children through the Children’s Health Insurance Program (CHIP). Two weeks earlier, Tennessee stopped accepting applications to their version of CHIP, known as CoverKids. Now, all low income, uninsured children in Tennessee who hadn’t applied for CoverKids by December 1st are out of luck.

The performance bonus was one of the programs created by the Children’s Health Insurance Program Reauthorization Act (CHIPRA). Ten states earned a bonus by meeting enrollment increase targets and implementing at least five enrollment and retention strategies.

In Alabama, these strategies included eliminating the in-person interview, providing 12 months of continuous eligibility, using a joint application for both Medicaid and CHIP, using the same form for renewal and application, and by implementing automatic renewal. But Tennessee failed to eliminate in-person interviews, use the same form for renewal and application, or implement automatic renewal. What’s more, Tennessee was one of the only states that failed to implement the use of joint renewal forms.

On December 1, Tennessee became the only state in the country to indefinitely close its CHIP program. The state did so despite the federal government contributing 75% of CHIP costs in Tennessee (a higher share than in most states), and despite the $350 million in unspent TennCare reserves.

Tennessee is clearly in need of a more accessible rather than more restrictive children’s Medicaid program: the state ranks 47th in the country for children’s health care, and infant mortality in Tennessee is worse than in many developing countries. In fact, the rate of infant deaths in Memphis is the worst of any city in America.

Alabama’s leaders know that, if times are hard for the state government, they are even harder for uninsured children and their families. Now more than ever, Tennessee should be following its neighbor to the south’s example by increasing TennCare enrollment instead of slamming the door on uninsured children.

Health Care Story of the Week - 1/6/10

2010-01-06T12:55:00.000-08:00

Keith and Dianne Warren always thought they would be parents of two or three children. But when their daughter Alissa was born in 2005 with a rare genetic condition called sacral agenesis (aka caudal regression syndrome), they decided not to have any more children. Instead, Keith and Dianne have poured all of their love into making sure Alissa has the best life possible despite her physical disabilities.

Because of her genetic condition, four-year-old Alissa lacks several bones in her lower back and bottom, her legs are permanently crossed, and she has clubbed feet. She has kidney reflux and chronic bowel issues. She only weighs 20 pounds and cannot walk. Despite her physical limitations, Alissa gets around in her own special way just as well other children her age. She attends school, and she is a very smart child who loves life. She’s a happy and active little girl who loves to sing and dance. You can see a video of Alissa singing and dancing.

The Warren’s both maintain a full time job, and Alissa is on her dad’s insurance plan. But it doesn’t cover everything that’s needed. TennCare has been Alissa’s secondary payor, kicking in when the private plan would not cover specialty care needed to treat her rare condition. The Warren’s monthly income has always been sufficient, but now, they worry about crushing medical bills, since Alissa is being dropped from TennCare. Along with thousands of other children with disabilities, Alissa will be cut from the program in the next few weeks. After talking with the state human services office, the Warren’s believe that the only way Alissa can qualify for TennCare again is if the family incurs more than $3,500 in medical bills. Forcing families to run up thousands in medical debt in order to keep their health care means that more families will face financial ruin. Medical debt already is the leading cause of bankruptcy in the nation. For other families, it may mean that children simply go without needed care.

The Warren’s have called state legislators, shared Alissa’s story with friends, and worked with a client advocate at the Tennessee Justice Center. They are determined to make sure their only child gets the health care she needs. The Warren’s story is typical – private insurance plans don’t cover everything that’s needed. While more than 45 million Americans are uninsured, tens of millions more, including Alissa Warren, are underinsured.

Health Care Story of the Week - 12/30/09

2009-12-30T12:50:00.000-08:00

This fall began like any other for ten year-old Darius Richardson. In September, he started practicing with his football team for the season’s opening game. But then, Darius found out that he had brain cancer and would have to have an operation. Darius has been serious about sports since age five. Football, basketball, and baseball are among his favorites.

Darius lives with his single Mom, Trina Parker, who worked full-time until Darius got sick. The cancer began forcing Darius to miss football practice and school due to chronic headaches and severe weight loss. She had to cut her work hours in half so that she could care for him, leaving both her and her son ineligible for her employer’s health insurance.

Darius and Ms. Parker didn’t think things could get much worse. Then, TennCare told him he was going to lose coverage the day before he was to have the tumor removed. Without insurance, Vanderbilt would not do the operation. Ms. Parker asked the Department of Human Services (DHS) for help, but nothing happened. “I didn’t know who else to turn to,” she said. Then, a social worker told her about the Tennessee Justice Center.

When Ms. Parker called TJC, we realized immediately that TennCare had made a mistake in calculating Darius’s family’s income, and that he should stay on TennCare. We helped Ms. Parker file an appeal, allowing Darius to keep TennCare during the appeal. The surgery went smoothly, and Darius went home with his Mom about a week later.

Despite everything, “Darius is in good spirits. The doctor explained everything and he understands that the treatment is to get rid of the tumor,” said Ms. Parker. “He has a really good family-based support and church.”

But her fight wasn’t over yet. Darius’s cancer was worse than doctors had thought. A few days before Darius was scheduled to return to the hospital for chemotherapy, DHS told Ms. Parker they were going to close Darius’s TennCare case. Ms. Parker called TJC again. We wrote the Case Manager a letter reminding him that DHS rules required him to keep Darius’s case open.

DHS kept the case open, and later approved Darius’s TennCare application. He is currently at the hospital, receiving his first round of chemotherapy treatment.

Without a law firm's help, Darius would not have been able to get the surgery he needed to live, even though he still had a right to TennCare coverage. “I don’t know what else I would have done,” said Ms. Parker.

When Darius and Ms. Parker needed it most, our healthcare system was not there for them. “It’s clear to me that the system is broken,” said Ms. Parker. “I pray that we can work together to fix our country’s healthcare, so other families don’t have to go through the same struggle we did just to get basic care.”

Health Care Story of the Week - 12/16/09

2009-12-16T13:07:00.000-08:00

Ms. Benson adopted her son, Zachary when he was 16. Zachary loves skateboarding and outdoor activities like caving, rock climbing, and paintball; he excels in school. Like any parent, Ms. Benson makes sure that Zachary gets appropriate preventive care and treatment. Zachary was adopted from the custody of the Department of Children’s Services, and he was guaranteed enrollment in Medicaid with his adoption. Ms. Benson was eager to adopt but simply could not afford health insurance for an additional family member.

For as long as Ms. Benson has been caring for Zachary, including when he lived with her as a foster child, Zachary’s doctors have reported that they were not being paid. In September, one of Zachary’s providers informed Ms. Benson that if TennCare continued to not pay for services for Zachary, Zachary may be turned away or Ms. Benson might be required to pay for services up front.

Since TennCare is required by law to pay all medical expenses for enrolled children, Ms. Benson decided to investigate the problem. She soon learned that Zachary was somehow still listed as enrolled in the insurance policy his stepfather had through his employer, even though parental rights had been terminated and Zachary had become a full ward of the state some years previously. Consequently, when providers billed TennCare, TennCare would kick the bill back, stating that they were not the primary insurer for Zachary. The bills got bounced around from insurer to insurer without any payments being made.

Since Zachary first came to Ms. Benson’s home, she has struggled with trying to get TennCare to pay for Zachary’s health care needs. Repeated phone calls to DCS, insurance companies and health care providers proved fruitless. In addition to this clerical error, Ms. Benson faced two other challenges related to Zachary’s health care: she had submitted paperwork to have Zachary’s name changed several months ago, and she had not received a new TennCare card reflecting Zachary’s new name, despite her request.

TJC regularly gives presentations to foster parents throughout the state, to inform them of their foster children’s rights under TennCare. TJC specifically targets these groups because most foster children are on TennCare. Ms. Benson met TJC advocate Susanne Bennett at one such event in Cookeville. Ms. Benson informed Susanne about the problems she was having getting care for Zachary due to the administrative glitch she had been unable to resolve for years. Ms. Benson told Susanne, “I am just concerned that the providers get paid so that my son is able to get the medical care he needs.”

On November 2, 2009 TJC wrote a letter to TennCare’s lawyer’s invoking TennCare’s pay and chase policy. This means that TennCare had to make sure Zachary’s providers got paid, and, if a different health insurance policy was responsible for Zachary’s bills, TennCare would have to “chase” it for reimbursement. In late November, Ms. Benson learned that Zachary’s provider had been paid by TennCare, and the charges were paid under Zachary’s new name.

The state’s lawyers responded, stating that these problems would be resolved. When Ms. Benson heard that Zachary’s case was finally being handled appropriately, she said, “I am thrilled that I can take him to the doctor now that I know they won’t have trouble getting paid by TennCare. I was at my wit's end. It was like running on a treadmill. Everyone I called passed the buck and no one tried to fix this problem.” Thanks to Ms. Benson’s tireless advocacy for her son, they no longer have to worry about whether his doctors will continue to see him.

Health Care Story of the Week - 12/10/09

2009-12-10T07:34:00.000-08:00

It was only through Judy's diligence that her 12 year old son, Chase, received the care needed to correct a serious vision problem that limited his activities and ability to read. Chase’s optometrist prescribed vision therapy. After two months of therapy, his eyesight had improved significantly. However, at that point, less than halfway through his program, Judy received notice from TennCare that it would not pay for the treatment. She decided to pursue the care which was bringing her son’s world into focus.

After she received the TennCare denial letter, Judy contacted the Tennessee Justice Center, asking for assistance in presenting her case to TennCare for her son’s vision therapy. Between working at the YMCA and caring for Chase and his sister, she needed help in navigating the TennCare system. TJC explained what Chase’s rights are, and helped her file an appeal as well as supplementing Judy's appeal with a letter to the state about Chase’s situation.

In response to TJC’s letter, TennCare said that the vision therapy was experimental and denied it. The only alternative that TennCare offered was bifocals, which wouldn’t actually correct Chase’s eyes. Judy was determined to find a way to continue the therapy that was helping her son. Since Chase could not continue seeing his doctor, with the doctor’s guidance, his mother performed the vision therapy at home consistently. Through prayer, tenacity, hard work, friends’ support, and with two months of doctor-guided therapy, Chase’s vision is now normal.

“I wish TennCare would cover the treatment that benefited my son and other alternative treatments that could benefit other children,” said Judy. “Instead of facing a lifetime of vision problems, Chase’s vision is normal because of the therapy. A few months of vision treatment seems more medically and financially wise in the long run, instead of the bifocals offered by TennCare. Over the years, bifocals would cost more.”

Judy added, “At first I felt like I was all by myself, thinking ‘am I going crazy?’ not having anyone’s support legally. Because of TJC, I did not feel alone in navigating through the legal system. Thanks to all at TJC!”

Health Care Story of the Week - 12/2/09

2009-12-02T12:45:00.000-08:00

Vicie loves children, and has adopted three special needs children, including her son Trevor. Trevor is extremely medically fragile, but he loves sitting in laps and being snuggled. He is non-ambulatory and non-verbal, but he loves listening to music. Trevor uses an overhead lift system to move and a percussion vest to help him breathe. Still, Vicie takes Trevor and his siblings out to the carnival and car races to enjoy their favorite activities. Trevor had been receiving full-time nursing care for three years. However, in July 2008, his TennCare home nursing care was unexpectedly and suddenly reduced by more than half. Taxpayers have already paid HMOs to provide Trevor the care he needs.

Frustrated but unwilling to take “no” for an answer, Vicie called TJC for help. TJC wrote a letter asking TennCare to provide Trevor the nursing care that his doctor had prescribed. Days later, Trevor’s care was reinstated and Vicie could breathe a sigh of relief. In her fight for Trevor’s care, Vicie also spoke for many other parents struggling to obtain care for their children.

Vicie also asked for TJC’s help with a TennCare policy that appeared to prevent her from leaving the house on short errands while the children were at home with their nurses. Vicie was faced with having to transport her three children, all of whom are wheelchair-bound, with her on the simplest trips to purchase groceries or to stop by the library – or not go at all. TJC wrote to TennCare about this apparent violation of the Americans with Disabilities Act. The state immediately clarified this rule so that Vicie and other parents like her are not forced to be homebound.

Vicie’s greatest hope for all children is that they can “enjoy life, live to their fullest potential, and not be held back because of disabilities.” She said it was a huge relief to have Trevor’s nursing care back, and to have the freedom to leave her home. “TJC is a lifesaver,” she said. “The folks I worked with at TJC really care about our family and will do what it takes to make sure my kids get the care they need.”

Health Care Story of the Week - 11/19/09

2009-11-19T06:53:00.000-08:00

Even though it seems that families are far too often fighting losing battles, there is always hope. This week we are proud to bring a success story, achieved because of parents’ relentless dedication to ensuring their children receive the best care possible.

Four-year-old Rebecca Lyons-Winford and her three siblings escaped from a severely abusive home when they were adopted by moms Linda Winford and Kathy Lyons in 2005. Kathy is a retired Army chemical officer who now owns and operates a pet store, grooming and boarding facility. Linda is medically retired from the phone company and now cares for their four children full time. The children came to the Lyons-Winford home with broken bones, shaved heads, and behavioral problems. Each of the children has special needs. But with the love and care of their new family, the children have begun to heal, improving in school and gaining physical and emotional strength.

Last fall, Rebecca suffered an accident, nearly drowning in the family pool. After being rushed to the hospital and stabilized, the family began the long, slow process of recovery. Rebecca is on TennCare, which is required by law to provide the medical care children need. When the family called the Tennessee Justice Center, we began working to ensure TennCare complied with the law. Only three years old at the time of her accident, Rebecca’s life holds so much promise, and getting appropriate treatment is key to realizing her full potential.

One piece of medical equipment essential to Rebecca’s well-being is her Vest airway clearance system. This machine helps clear her lungs and prevent choking and respiratory infections. She has been successfully using the Vest for hundreds of hours, over the course of more than a year. Because of this, Rebecca has not been hospitalized for any type of pulmonary problems. This is a great feat, as many children in Rebecca's condition are continually hospitalized for pneumonia and other bronchial problems. In September 2009, TennCare wrote the family a letter saying it won’t pay for the Vest because it’s not needed to treat her medical problems and it is experimental.

Ms. Lyons and Ms. Winford talked with Rebecca’s doctor and got a letter explaining Rebecca’s needs and recommending the Vest. Then, in a hearing with TennCare attorneys and a judge, Ms. Lyons argued convincingly that it would be cheaper for TennCare and better for Rebecca to continue using the Vest. TennCare’s arguments that the care was experimental did not hold water. The judge ruled favorably, and now Rebecca continues to make improvements, both physically and mentally.

These mothers’ persistence and dedication to their children, even under adverse conditions, is remarkable. Because of their love, four Tennessee children have a real shot at living full, successful lives.

2009 Year-End Letter

2009-11-17T13:40:00.000-08:00

The following is TJC's 2009 year-end letter, composed by Executive Director Gordon Bonnyman. If you believe that TJC's work is necessary, please consider making a donation. As we are constantly reminded through our service to our clients, even the smallest contribution can have a far-reaching impact.

Dear Friend of the Tennessee Justice Center:

Thank you for standing up for the rights of all through your support of the Tennessee Justice Center. As we reach the end of a most challenging year, I urge you to stand with us once again. We value your support and need your help. And so do the many vulnerable Tennesseans who look to TJC to make America’s promise of Equal Justice for All a reality in their lives.

On my desk is a postcard picture of Nelson Mandela, bearing his reminder that achieving justice “always seems impossible until it’s done.” Down the hall are historical images depicting inspiring Tennesseans of past generations, many of whom are nameless today. They worked tirelessly – fighting slavery, standing up for better working conditions and votes for women, marching for Civil Rights – to hold our nation true to its ideals. They remind us daily that nothing ever happens without the effort of lots of people who persevere even when justice seems unattainable. Their stories keep us going.

Most of all, it is our clients’ stories that keep us going. They remind us why TJC’s work for justice matters, even at times when justice seems all too distant.

Their cases involve the brutal necessities of life: subsistence for the states’ poorest families, health care, foster care, mental health services. Typical is the experience of Trina, who just learned that her 10 year old son, Darius, had brain cancer. Days later, she learned that his health coverage had been cancelled. The doctors said it was imperative for Darius to undergo surgery at once, but the hospital refused the surgery until Trina could produce proof of coverage. TennCare insisted Darius was not eligible, and his distraught mother could not get either TennCare or the hospital to budge. She contacted TJC, we got his TennCare reinstated immediately, and Darius underwent a successful operation. Relieved from the terror that her child would go untreated, Trina is now able to devote herself to mothering Darius through chemotherapy, and his doctors are optimistic.

Through your help TJC is the source of such life-giving support to hundreds of individual families yearly who have no place else to turn. And TJC’s class action and policy advocacy extend the impact of our work on behalf of individual clients like Darius to many thousands more. This year, for example, our TennCare advocacy preserved $300 million of medical and mental health services for some 45,000 adults and children with disabilities. And TJC identified unused federal economic recovery funds that enabled the legislature to restore another $25 million in services for foster children and people with severe mental illness.

TJC’s experience serving individual clients has also enabled us to identify structural weaknesses in the existing Medicaid program. Several reforms proposed by TJC have made their way into the pending health reform legislation. These include provisions that would:
• strengthen Medicaid patients’ access to physician services;
• tighten accountability by states and managed care contractors for their expenditure of federal Medicaid funds; and
• enable low income seniors to obtain affordable Medicare Supplement insurance when they lose Medicaid coverage

These technical fixes are “inside baseball,” devoid of the political and ideological overtones that have roiled the debate around health reform. But, if enacted, they have the potential to help hundreds of thousands of vulnerable Americans nationwide.
And yet, for all of TJC’s remarkable record of success, we don’t always succeed. No account of the past year would be accurate without acknowledging our failures. Because so much is at stake, the consequences of failure are often tragic, and cruelly unjust.

This year has been very difficult for hundreds of thousands of Tennessee families. The combined impact of the recession and of misguided state policies has cost Tennesseans hundreds of millions of dollars of much needed medical and mental health care. TJC lost several clients this year whose life-saving care was interrupted when they lost their health coverage. Many other clients had to watch their children suffer needlessly because the family lacked insurance.

As we have done for years, TJC has helped these families tell their stories to the media, at public forums and in legislative hearings. These courageous clients have reminded us that bearing witness against injustice is most essential at those very moments when justice seems most distant. We have been determined to stand with them in educating the public about how the current system betrays our national commitment to justice and equality.

But now, with health reform at the fore, we see glimmers that even work done without hope of tangible return may sometimes touch others in ways that matter. One of several clients who died needlessly in 2005, in the wake of TennCare purges that TJC slowed but could not stop, was a beautiful, vivacious young woman from Bristol named Nikki White. Her life-threatening lupus went untreated after she was cut from TennCare. Her doctor wrote sadly that, “Nikki died of complications of the failing American health care system.” It is too painful to imagine what her parents have suffered. Can injustice ever be crueler than when it costs your child’s life? Can justice ever feel more remote?

After Nikki died, I spoke to a reporter who interviewed Nikki’s parents and wrote a gripping account of Nikki’s death for the Wall Street Journal. Her story made an impression on T.R. Reid, who included it in his influential book, The Healing of America. In recent months, the story has been repeated in columns and editorials, cutting through the acrimony and political posturing to remind us all of what matters.

We don’t know at this point if there will be real health reform or, if there is, how to measure the impact of Nikki’s story. But surely her courageous parents have moved hearts and minds by their selfless desire to save others the pain they have suffered, and by their unflagging faith that America can be more just.

It is a privilege for TJC to serve such clients, and to work for the ideals we all hold dear. Please continue to be an indispensible partner in our work for justice. Thank you.

Sincerely yours,

Gordon Bonnyman
Executive Director

Health Care Story of the Week - 11/11/09

2009-11-11T12:35:00.000-08:00

Terrell, age 3, has pulmonary hypertension, congestive heart failure, and is ventilator dependent. Though Terrell’s weak immune system confines him mostly to his home, he loves sitting in his backyard. His heart and lung problems prevent him from running around, but he still enjoys the sunshine. He is a bright boy, already learning to write his name and count.

At age 18 months, as Terrell was becoming more independent, his doctor ordered a special wheelchair for him. However, Irene, his grandmother, had to fight for seven months to obtain the wheelchair, although by federal law, children on TennCare like Terrell should receive all the medical care they need. In her fight to obtain the medical services that Terrell needed, Irene also spoke for many other parents struggling to receive care for their children.

Seven months after the doctor’s prescription for a wheelchair was submitted, Terrell still had not received his new chair. Terrell’s mobility was limited without the medical device the doctor ordered. It was impossible for Irene to lift Terrell, along with his oxygen tank and ventilator, suction machine, battery, and medicines – the equipment alone weighed more than 100 pounds – without the special wheelchair. Lacking the wheelchair, Terrell had been late to doctor’s appointments, and the family was increasingly desperate.

At this point, Irene called the Tennessee Justice Center. The TJC worked with her to write a letter of appeal to the state’s attorney. A few days later, Terrell was measured for his wheelchair, and soon it arrived. Irene said, “When all this started, I didn’t know where to go or who to turn to. With TJC on my side, I was able to stand up for Terrell and get him the care that his future depends upon. Having TJC helping me get things done really relieved a lot of stress.”

Health Care Story of the Week - 11/5/09

2009-11-05T07:16:00.000-08:00

Bradley is dependent on a ventilator and a feeding tube. He cannot talk or move; he sits in a wheelchair during the day. Bradley relies on eye gazes to communicate.

Suzette, his mother, explains: "Bradley has not spoken any verbal words in his thirteen years, but his life has spoken volumes of his zeal to live. Despite his physical disabilities, Bradley loves to play basketball, attends school with his friends, and enjoys walking the dog and watching cop videos with his Dad. His perseverance, strength and courage, gives us the motivation to provide him with the best care that we can."

Bradley's father, Barry, works full time and his company provides health insurance for the family. However, in June 2006, the insurance company told the family that Bradley had exhausted his lifetime limits.

With Bradley’s continuing intensive medical needs, and no private insurance, the family was fortunate to have TennCare to rely on as a safety net for Bradley. However, after becoming exclusively reliant on TennCare, bills began to arrive. Children receiving TennCare benefits are not supposed to receive bills from providers. More and more of the illegal bills continued to arrive. The family talked with the hospital and with doctors, trying to assert their rights, however, they were tangled in billing bureaucracy. Worried about the mounting bills and the impact they might have on her son’s medical care and her family’s future, Suzette contacted the Tennessee Justice Center for help. After receiving letters from the Tennessee Justice Center, TennCare acted and notified the family that they were not liable for the bills.

However, Bradley and his family, as well as thousands of other Tennessee families face new hurdles. Pending changes to TennCare mean that Bradley could lose his TennCare coverage. Without TennCare, his family could be in very serious trouble, facing tremendous medical care challenges for Bradley and overwhelming financial problems.

Suzette said, "The work that the Justice Center does on behalf of the medically fragile children of Tennessee is greatly appreciated by our family and other families across the State...they have stepped in and become our advocate in the billing process for Bradley. This has removed the worry of billing and given us the time to focus on what is important - Bradley’s care."

TennCare stories in the media

2009-11-02T17:55:00.000-08:00

Rebekah Hearn’s October 31st article, “TennCut: Why the state Medicaid program is slashing services to thousands of disabled people” tells the stories of 3 severely disabled Tennesseans whose lives depend on a program that is doing everything it can to exclude them. The article includes several beautifully shot, intimate photos by Lance Murphey. According to Ms. Hearn, about 84,000 Tennesseans have lost their TennCare coverage since cuts began earlier this year. Below is a brief summary of the article. The full article can be found at by clicking this link, and it truly is well worth the read.

“Thyroid disease, congestive heart failure, blood clots, anemia, and rheumatoid arthritis are just some of the health problems Memphian Ann B. wakes up to every day,” writes Ms. Hearn. Since Ms. B. lost her TennCare coverage, TJC and her primary care physician have helped her apply for assistance. Even with help from the Partnership for Prescription Assistance, Ms. B. is unable to pay for all the medicines she needs. Losing TennCare coverage was, “like a sentence to die,” said Ms. B. “I mean, if I don’t take my medicine, I’m dead.”

Brandon Byrd also faces the possibility of losing coverage. At age 24, Mr. Byrd became a tracheotomy-dependent quadriplegic when he fell off a trampoline while playing with his children, ages 5 and 11. Mr. Byrd requires constant care to keep his tracheotomy from clogging, which could be fatal. If Mr. Byrd loses coverage, he will be forced into a nursing home, where his “quality of care will go down,” said one healthcare worker. “They can’t make me go,” said Mr. Byrd. “I would stay at home as long as I could. I probably wouldn’t make it any longer than a week and a half. But I don’t want to go live in a place that could be even worse than prison, where I can’t even see my kids.”

Jacqueatha Philips was born with spina bifida, and needs catheterizations and help taking her medications. Her mother, Linda Fann, became a certified Personal Assistant (PA) so that she could care for her daughter. When TennCare tried to cut Ms. Philips’s in-home care, she appealed. At the hearing, Ms. Fann argued that she was actually saving TennCare money by becoming a PA. The judge agreed, and said Ms. Philips could keep her in-home care. But TennCare overruled the judge’s decision and reduced her care anyway.

Ms. Hearn indicated that the healthcare situation for low-income Tennesseans will probably get worse before it gets better: CoverKids, a program that covers low income children and pregnant women, will stop accepting new enrollees Nov. 30 despite increased federal matching funds. TennCare is also putting American Recovery and Reinvestment Act money into the reserves even though federal law requires that it be spent right away.

Jane Beasley Receives Award from Mayor’s Advisory Committee for People with Disabilities

2009-11-02T08:44:00.000-08:00

TJC's latest press release, regarding senior paralegal Jane Beasley's recent award!

Jane Beasley, senior client advocate and paralegal at the Tennessee Justice Center (TJC), has received the Professional Award from the Mayor’s Advisory Committee for People with Disabilities in recognition of her work in improving and enhancing the lives of people with disabilities. The award was presented to Beasley during an awards ceremony and reception held at the Frist Center in Nashville.

“I am truly honored to receive this award. It is a privilege to be an advocate for our disabled clients, who often cannot speak on their own behalf,” said Beasley. “Their courage and persistence is inspiring to me and everyone at the Tennessee Justice Center.”

Beasley joined TJC in 1998. She is an expert in the complex rules of eligibility for public programs, and assists disabled and sick clients who need help with TennCare and Families First. She also advocates on behalf of clients who have lost their benefits. Prior to joining TJC, Beasley was the coordinator of the Insurance Counseling and Assistance Program at the Legal Aid Society of Middle Tennessee, assisting clients on issues surrounding Medicare, TennCare, long-term health insurance, and Medicare supplement policies.

“Jane has improved life for thousands of Tennesseans with disabilities,” said Gordon Bonnyman, executive director of Tennessee Justice Center. “In some cases, she has enabled people to obtain medical care that they credited with saving their lives. Her advocacy for individuals and her contributions to systemic reforms have helped countless Tennesseans with disabilities maintain or enhance their independence.”

Since 1981, the Mayor’s Advisory Committee for People with Disabilities has presented awards of recognition to outstanding individuals whose efforts have enhanced the lives of those in the disability community in Nashville. Awards were presented in 13 categories this year.

The Tennessee Justice Center (TJC) is a non-profit public interest law and advocacy firm serving Tennessee’s families. It gives priority to policy issues and civil cases in which the most basic necessities of life are at stake and where advocacy can benefit needy families statewide. TJC works to empower its clients by holding government accountable for its policies and actions. TJC was established in 1996 and is located at 301 Charlotte Avenue, Nashville, TN. For additional information about the Tennessee Justice Center and its services, visit www.tnjustice.org or call 615-255-0331.

Health Care Story of the Week - 10/28/09

2009-10-28T10:00:00.000-07:00

Julie is a 40 year-old mother of 3 in Jackson, Tennessee. In 2005, Julie was in a car accident that left her paralyzed from the neck down. She has a tracheotomy and requires a ventilator to breathe. Nevertheless, she is able to raise her children, attend church, and remain active in the community because of the nurses that TennCare provides for her at home. Now, TennCare is telling her that she will lose her nurses, because it is cheaper to care for her in a nursing home that is almost 75 miles away.

After Julie’s accident and rehabilitation, she was transferred to a nursing home. Unfortunately, her needs were so persistent that the nursing home was unable to provide enough one-on-one care for her. She would frequently come down with pneumonia or develop bedsores. She spent several years of her life bouncing back and forth between nursing homes across the state that could not adequately care for her and hospitals that treated her when she got sick due to lack of care. On several occasions she lost her spot at a nursing home because her recovery in the hospital lasted so long.

In April of this year, she moved home with 24/7 private duty nursing services. Since then, her health has improved, she has not been hospitalized for avoidable illnesses, and she has spent time with her family every day. She lives with her mother, and her sons live with her husband in their old house. Her sons frequently spend the night at their grandmother’s so they can be with their mother, and she is able to help them with their homework after school and see them almost every day.

Recently, Julie was told that TennCare would reduce her nursing hours. TennCare rules say that they will not pay more for nursing than a nursing home would cost. This is called the “least-costly adequate alternative” clause of Tennessee’s medical necessity definition. Julie was also told that she only qualified for TennCare originally because she was institutionalized. Now that she has moved home, TennCare says that she no longer qualifies under that category or any other. Julie used to have private primary insurance, but she reached her lifetime benefit earlier this year and lost it.

Julie currently has a pro bono attorney helping her appeal both issues. She recently had her hearing about keeping her nursing hours. Her doctors and nurses testified that a nursing home would not be a safe place for her to live. Her eligibility hearing will be in November. Julie would be eligible under the Spend Down category, which Tennessee is obligated to keep open due to the state’s acceptance of federal stimulus money. However, this category remains closed. Julie’s story is a perfect example of how gaps in the health care system can tear apart families.

Health Care Story of the Week - 10/21/09

2009-10-21T14:05:00.000-07:00

Rylee Sandlin of Nashville is only eight years old, but she already faces health insurance barriers that threaten to shape her life for years to come.

Rylee is fortunate to have health coverage under her mother’s insurance plan. But like so many other parents, the Sandlins have found that even “good” coverage like theirs does not really protect a child with costly health care needs.

Rylee has autism. She has had a difficult, frustrating struggle to develop communication abilities that come effortlessly to most children. But with determination, and the aid of her parents and professional speech therapy, Rylee has come a long way.

She still has a long way to go, though, to develop the skills needed to achieve independence and to fully enjoy relationships with other people. Therapy, which costs $150 per session, remains essential, but Rylee’s insurance won’t cover it. The Sandlins have spent nearly $50,000 paying for the therapy themselves, but now they have exhausted their resources.

It is heartbreaking for the family to watch Rylee losing ground, knowing that it does not have to be that way. “There is nothing harder in this world than to see that your child is suffering, and to know that there is something available to help, but to not be able to provide it for them,” says Keely Sandlin, Rylee’s mom. “We just want for Rylee what every parent wants for their child. It is plain wrong that, even with two parents with decent incomes and ‘good’ insurance, children like Rylee should have to go without. Surely, in America, we can do better than that.”

Health Care Story of the Week - 10/14/09

2009-10-14T13:41:00.001-07:00

Shana Atchley, a beautiful young woman from Lebanon, Tennessee, represents the sort of medical miracles that America’s dedicated doctors and nurses perform every day. But now her life is in danger, and she embodies the tragic failures of a health insurance system that so often defeats the best efforts of our medical professionals.

When Shana was born with half of her heart missing, doctors did not think she would make it through the night. Thanks to extraordinary care, she survived. But then, at age five, her immune system shut down and she became very sick. “She was placed on the Heart Transplant list but we were informed that she would probably die waiting,” said Penny Shoemake, Shana’s mom. “Well lo and behold, our prayers had been answered, and two days after getting placed on the transplant list, a heart was available,” she said.

Since age 8, Shana has undergone four bouts of cancer and chemotherapy. The last bout of cancer, during her senior year of high school, was the worst. “She was deathly sick and in and out of the emergency room many times over the course of her treatment,” said Ms. Shoemake. But Shana never stopped fighting, and the treatment worked. Last April, Shana attended her senior prom. A few months later, she graduated from high school with a straight-A report card.

The cancers are caused by the anti-rejection medicine that Shana needs to take to live. Without the medicine, her body would attack the transplanted heart. Shana’s doctors say the anti-rejection medicine will continue to cause her to get cancer.

Shana started college this fall, and works part-time at a restaurant. Until recently, she was insured by TennCare. On September 17, 2009, Shana was cut from TennCare due to the lifting of the Daniels injunction. Now, she is totally uninsured.

“I don’t understand how TennCare can take away coverage on someone that needs it,” said Ms. Shoemake. “Our family does not make enough to pay for her $500 per month medication or her specialists and all the tests that are involved to keep a person alive who has had a transplant of any kind.”

“Considering all that this child has been through, she is an inspiration to me because she never gives up no matter how hard it gets,” said Ms. Shoemake. “I am asking that they let my daughter have health coverage in order to live a more healthy and abundant life.”

The current health care system, with its gaps and barriers, threatens to undo all the good work of Shana’s caregivers, and to defeat her own courageous efforts, by denying the preventive care without which she faces certain death. For Shana, her mother, and her Lebanon community, an investment in her well-being would pay dividends for years to come. Without reform, the present insurance system will rob us all of everything that Shana – and many other inspiring young Americans like her – has to give.

Health Care Story of the Week - 10/8/09

2009-10-07T14:29:00.000-07:00

Every week we post a health care story, and this week we share three! Some of these stories were shared at a rally held this week in front of the Blue Cross/ Blue Shield office in Nashville. TJC is partnering with other non-profits to show how the current system is failing many Americans, and why reform is urgently needed. Among the flaws that need to be fixed are the lack of coverage for people with serious health problems and the un-affordability of coverage for many small businesses and working families. Here are the stories of three of our fellow Tennesseans:

Mark runs a sawmill business in McMinnville. The insurance company has upped the price tag on his employees’ health insurance by 100% since 2001, putting health care among the company’s top expenses. “I don’t want to drop their insurance, because they’re my friends. I grew up with them,” he says. Mark is in a very difficult position; he must choose to either put more of an economic burden on his workers or drop their insurance to save the business and their jobs.

Beth of Blountville is 26 and has a rare, but treatable vascular disease. Since she had to quit her job as a general manager at a restaurant in order to manage her illness, she lost her employer-sponsored health insurance. No private health insurance company will touch her and she is not eligible for Medicaid. With her medical bills totaling six figures, Beth’s only hope is a public option.

Earl, 54, of Dickson received a successful heart transplant 12 years ago. Medicaid saved his life when private insurers denied him coverage. Now, he’s being dropped from Medicaid. Earl cannot afford the daily medications that keep his heart beating and relies on a spotty safety net to stay alive.

If you want to attend future rallies and forums in support of health care reform, be sure to visit our Facebook page.

Dean Andrews, who contributed to this piece, is a TJC intern, focusing on legal research and public information.

Health Care Story of the Week - 9/30/09

2009-09-30T08:27:00.000-07:00

Brittany is the mother of two-year-old identical twins Addleigh and Kennedi. She runs a church day care, and gets to work with children throughout the day. However, Brittany’s twins get her extra love and care not only because they are hers, but because they both have medical conditions that cause seizures, muscle weakness, and developmental delays. Neither Brittany nor her husband has health insurance through their jobs, so TennCare has been essential in caring for the twins’ special medical needs. Around the girls’ first birthday, normally a time for celebration, the family was notified that the girls’ TennCare coverage would be discontinued. Brittany was afraid their family might “lose everything that we’d ever worked for.” Brittany appealed the decision and called TJC for help.

TJC client advocates immediately recognized that the twins were still eligible for TennCare in another way. After a phone call from TJC to the Department of Human Services to correct the mistake, the girls’ TennCare was reinstated.

Brittany was overjoyed that her twin girls were safe. As she says, “Addleigh and Kennedi are my greatest blessing.” But she also wanted to ensure that all Tennessee children are protected from similar mistakes and oversights. She worked with TJC to write a letter to TennCare, sharing the twins’ story as well as experiences of other families. In response, TennCare described the new training it has implemented to improve the accuracy of eligibility screens.

In her fight for her twins, Brittany also spoke for many other parents struggling to receive care for their children. She said, “The thought of losing health insurance for my girls was terrifying. TJC helped me solve a problem I had thought was insurmountable, and put my mind at ease.” She continued, “I’m just a mom, and moms do whatever their kids need them to do. I will continue to do what I can to help other families.”

Click here to hear Brittany tell her story in her own voice.

The latest figures show that more than 126,000 Tennessee children age 0-18 are uninsured. For kids whose parents don’t get insurance through their employer (e.g. self-employed, work for a small business, laid off), programs like TennCare and CoverKids can help. But still, many children either do not qualify for or are not enrolled in these programs. Our current health care system, which leaves millions of innocent children without any health insurance, is broken. If children are our greatest resource for the future – we should treat them as such. Let’s invest in America’s success by insuring all children now! Learn more about this issue at the Children’s Defense Fund website.

Health Care Story of the Week - 9/22/09

2009-09-22T13:39:00.000-07:00

Michelle Fizer has a Bachelor of Fine Arts in graphic design with a minor in painting. Her paintings are figurative and express her emotions. One of her paintings, Confined, was included in The Frist Center’s exhibit, The Artist’s Voice. In the past, she has been able to do some free-lance graphic design. Thirteen years ago, at age 25, she was injured in a car accident. It left her a quadriplegic, unable to move or control anything below her chest. Because of her injuries, she needs about 4.5 hours of home health care a day. Her nurse helps her dress, eat, bathe, transfer to and from her wheelchair, perform wound care (since she has a decubitous ulcer, or bedsore) and with other medical needs. Her family members also do everything they can to care for her; her nurse and her family are essential to Michelle’s survival.

On August 25, she was dropped from TennCare and lost her home health nursing services. Though she is on Medicare, it does not cover any nursing services. Michelle’s monthly disability check of $1,081 is not sufficient to cover the nursing services she needs. Even if her whole check went towards nursing, Michelle could not get the hours her doctors have prescribed so that she will stay safe. And, of course, her whole check cannot go towards nursing. Michelle has to pay bills, buy food, and purchase other necessities.

This cut to Michelle’s TennCare and home health care has left her family stretched to the breaking point. Michelle’s mother, Patricia, age 58, is now responsible for taking care of all Michelle’s medical needs. Patricia also takes care of Michelle’s grandmother who is 86 years old and suffers from dementia. Patricia is exhausted from taking care of two generations.* She is not sure how much longer she can go on like this.

The health care system is failing Michelle, her mother, and the whole community of people who want and need Michelle to be a part of them. If Michelle has to enter a nursing home or gets sicker because she can’t get nurses, not only will she and her family suffer, but the larger community as well. Michelle has something beautiful to contribute – her art, her smile, her indefatigable spirit. All she asks is for a chance to keep sharing it with the world.

*For films about health care and about people in the “sandwich” generation – caring for an older and a younger generation at once – visit filmmakers Julie Winokur and Ed Kashi’s website, “Talking Eyes Media” at http://www.talkingeyesmedia.org/.

TJC Director Gordon Bonnyman Wins National Award!

2009-09-18T12:45:00.000-07:00

We're proud to announce that Gordon Bonnyman, Executive Director of the Tennessee Justice Center, has just been awarded the prestigious Morris Dees Justice Award by the University of Alabama School of Law. Read the Nashville Post's coverage.

TJC's Susanne Bennett, Shares Her Experiences from Speaking with Foster Parents

2009-09-17T12:26:00.000-07:00

Through my outreach, I’ve met many caring foster families who face challenges accessing necessary care for their foster children. They receive children with open arms but are often not provided with the appropriate resources to help foster children on their path to permanency.

Some of the resources foster parents are left without are related to accessing healthcare services for foster children. I’ve talked with foster parents who did not have TennCare cards for their foster children, did not know which providers to take their foster children to, experienced a delay in their foster child’s enrollment in TennCare, or had a foster child who was waiting for dental care or glasses.

I encourage foster parents to insist that TennCare provide the care their foster children need by filling out a TennCare appeal form. Foster parents have a right to file TennCare appeals and doing so can go a long way towards helping a foster child get needed care. Sadly, many foster parents don’t know that they have this right and feel powerless watching their foster child wait for needed care.

That’s where the LEASE project – Legal Education, Advocacy, Services and Empowerment – comes in. The LEASE project helps middle Tennessee foster children enrolled in TennCare obtain needed health and mental health services. LEASE assists middle Tennessee foster families with legal advocacy techniques and individualized legal advice. Through the LEASE project, I’m lucky to have the chance to help folks like Rebecca.*

* See yesterday's (9/16/09) post to read Rebecca's story

Health Care Story of the Week - 9/16/09

2009-09-16T11:49:00.000-07:00

Velma’s teenage granddaughter and foster daughter, Rebecca, struggles with scoliosis and ADHD (attention deficit/hyperactivity disorder). Rebecca loves animals and the outdoors. She plans to continue her education and hopes to become a nurse’s assistant. She requires physical therapy for severe back pain and medication for her ADHD. At age 18 she aged out of state custody, but due to a bureaucratic oversight she was dropped from TennCare. At this vulnerable time in Rebecca’s life, as she entered adulthood, the healthcare safety net showed gaping holes.

During the period she went uninsured, Rebecca’s scoliosis and ADHD persisted. While Velma managed to pay for her granddaughter’s prescriptions out of pocket, Rebecca lost valuable physical therapy time. Velma worked with TJC to get Rebecca’s TennCare reinstated, and to file an appeal for her out-of-pocket expenses, which were eventually reimbursed. Velma also worked with TJC to write a letter to the state, asking that other children not encounter the same barriers to getting needed care that Rebecca experienced.

Velma said, “With the Tennessee Justice Center’s help, I was able to get Rebecca’s TennCare back. Now, she will be able to go out into the world with the insurance she needs to stay healthy.” She continued, “I would do anything to help Rebecca and other young people keep their health care.” In her fight to reinstate Rebecca’s care, Velma also spoke for many other parents struggling to obtain care for their children.

There are several ways for Tennessee children to get public health insurance. If your child (under 21 years old) is uninsured or needs more health insurance, call our office to see if she might qualify for TennCare or CoverKids. Call us toll free at 1-877-608-1009. Is your child or foster child having trouble getting services under TennCare? We can help! Call us toll free at 1-877-608-1009. Also visit our website at http://www.tnjustice.org/.

Health Care Story of the Week - 9/9/09

2009-09-09T13:38:00.000-07:00

“Last Thursday, September 3, was the three year anniversary of Dylan’s wreck. That day, I told Dylan’s story in front of a 400-person crowd in Murfreesboro. It was my way of honoring my son and helping move our country toward a health system that cares for all Americans.” – Dottie Cordle

Dylan Cordle was born and raised in Middle Tennessee, but he was forced to leave his home in order to get medical care. At age 17, a senior in high school, Dylan suffered a traumatic brain injury in a motor vehicle accident. He was in a coma for four months, but eventually came to, and began therapies to help him regain life skills. A little over 2 years post-accident, Dylan completed high school and received his diploma.

During Dylan’s slow recovery, his mother Dottie Cordle was there for him each step of the way. Dottie owns a small embroidery shop called “Eye for Sewing,” and juggling a business and her son’s medical care became more than a full time job.

Dylan had private insurance through his mother’s work, and also qualified for TennCare. Even with two insurance plans, Dylan was unable to get the care he needed in Tennessee. Although children under 21 on TennCare are by law supposed to receive all medically necessary care, Dylan was turned down for acute inpatient rehabilitation which his doctors prescribed. Dottie fought TennCare to cover the service, but she lost.

Likewise, Dylan’s eye doctor said that he clearly needed neuro-rehabilitation, but many insurers, including TennCare routinely deny it, calling it “experimental.” Meanwhile, Medicare recognizes the treatment as safe, and with this treatment, his doctor thinks Dylan would have been better able to perform basic daily activities.

Without the medical care he needed, Dylan’s progress slowed. He remained unable to care for himself, and was socially isolated from his peers. His family and his doctors knew it was not a physical limitation that was holding Dylan back, but an insurance one.

Then, Dottie heard that Kentucky has a traumatic brain injury program for kids like Dylan. Since Dylan’s grandmother lives in Kentucky, the family made the difficult but clear decision to move Dylan out of state for treatment.

The care Dylan had fought so hard for in Tennessee but was unable to get was readily available across state lines. Dylan has already been in the program for about one month and is making progress. In addition to getting the therapies and doctor visits he needs, he participates in community outings with other individuals with brain injuries.

In Tennessee with TennCare, Dylan could not get the care that doctors ordered for him. A few hours away, getting the care he needs is easy. Ms. Cordle thinks there is something wrong with this picture. Her family has been in Tennessee for since 1984, and Dylan was born and raised here, yet he had to leave to get care. “Tennessee ought to provide its children with the best chance to reach their potential,” she said, “or else we risk pushing our kids out of state and draining Tennessee of its most valuable natural resource.”

Video Conference for Advocates and Consumers 9/17/09 (rescheduled date)

2009-09-08T13:22:00.000-07:00

Were you, a loved one, or a patient/client in the Daniels class and now being cut off TennCare?

September 17 (rescheduled date) you're invited to join an expert panel on at 9:30 Central/ 10:30 Eastern Time for a 1.5 hour video conference. The conference, which will include time for questions, will tell you what you can do to keep TennCare if you are eligible. If you are not eligible, it will cover other options.

Please visit the TJC website again for instructions on how to sign in to the video conference and links to presentation materials.

Health Care Story of the Week - 9/2/09

2009-09-02T15:12:00.000-07:00

Ann B., though sick, is full of life. Ann wants to live for her son, to see him go to college. She lives in Memphis with her husband and 18 year-old. Her husband is a military veteran and receives his health care through the VA, and her son, who will graduate high school this year, is on TennCare. These programs help her husband, who is 67 years old, nearly blind, on oxygen, and barely able to walk and her healthy son get the medical care they need. Ann, however, was recently cut from TennCare due to a change in the program’s eligibility categories. TennCare sent a list of private companies from which Ann could purchase insurance. She called them all, and the lowest monthly premium was $600, almost 30% of the family’s monthly income, and much more than they can afford.

Ann relies on about 15 medications daily, as well as regular lab visits and doctor’s appointments to stay healthy enough to care for her son, husband, and herself. She suffers from rheumatoid arthritis, and without a chemotherapy medicine and regular lab checks, she would not be able to bathe, brush her teeth, cook, write, or drive. With the medication, she can do all of these things. Ann also has thyroid disease, congestive heart failure, blood clots, anemia, and other serious conditions, all of which require medicines and ongoing medical treatment.

She’s 62 years old – too young for Medicare – and she cannot get onto the Medicare program through a disability determination because she stopped working due to illness one quarter too early to qualify. Ann is calling prescription assistance programs, calling her elected officials, and telling her story to the media in hopes that someone will help her get her medicines and afford the doctor’s visits. But, Ann feels hopeless, as if there is no help to be found. She says that losing her TennCare is like a “sentence to die.”

Right now, Ann is completely out of her chemo pills and is already foregoing care. The household relies entirely on the fixed retirement income of less than $25,000 per year. After paying their house note, utilities, and gas, there’s virtually nothing left. They applied for Food Stamps, but were a few dollars over the limit. Ann knows from previous experience what it feels like to choose between food and medicines. She said that “when your stomach is grumbling, you’ll always choose the peanut butter sandwich over a pill.”

Ann is one of the thousands of Tennesseans who have fallen into the cracks in the health care system. She warns others, “don’t get sick like me,” for there may be little help to be found. For now, Ann looks for help wherever she can, and wonders why the richest country on earth continues to leave behind its own citizens.

Health Care Story of the Week - 8/26/09

2009-08-26T09:49:00.000-07:00

Brandon has two young sons, ages 11 and 5. In 2004, he was playing with his son on a trampoline when a fall caused severe injuries to his spine. A quadriplegic as a result of this accident, Brandon now relies on TennCare-provided nurses and aides to care for him. Brandon went from working full time with his father as an industrial laborer, to needing constant care. In his words, he “depends on someone else’s hands” for everything he does. He also has a tracheostomy, which causes breathing problems and requires skilled care. Brandon is an active father despite his disabilities, and enjoys spending time with his sons. He’s also a college student, and is in the middle of his fifth term towards a degree in Business and Accounting. The one-on-one attention that his nurses and aides provide is working miracles for his health, and Brandon is slowly regaining some movement in his left arm.

A change to TennCare’s home health policies last fall, and the disappearance of a TennCare eligibility category, now threaten the life that Brandon has built since his accident. Essentially, TennCare is now requiring Tennesseans who need extensive care to make do with a dramatic reduction in home health hours or go into nursing homes, where the care would ostensibly be cheaper. Adding insult to injury, Brandon may lose his TennCare altogether because TennCare closed the category of eligibility Brandon qualified for.

Brandon says that there is more to care than its price tag, and his doctors agree that Brandon’s health would suffer in a nursing home. His tracheostomy requires frequent suctioning, and his doctors fear that he wouldn’t get the attention needed to keep him safe in a nursing home. Brandon lives with his grandmother, who does what she can to help, but is not physically able or properly trained to keep her grandson healthy and safe. Without constant in-home care, Brandon will be forced into a nursing home, to drop out of school, and to leave the community where his sons live. If Brandon loses his TennCare entirely, he’ll lose all his services and be left with no option but institutionalization, all before his 30th birthday.

The cuts that threaten Brandon’s family are in stark contrast to the recent promises to increase home and community based services for disabled Tennesseans. Cutting disabled individuals from TennCare flies in the face of the national movement to provide quality affordable choices for all Americans. Tennessee ranks among the worst states for home and community based options. Solutions such as the Long Term Care Choices Act were touted as improvements that would help keep families like Brandon’s together. Unfortunately, the State has not honored its promises, and many families now find themselves with no choice but to split up or face inadequate care. Likewise, the state has promised for years to open the Standard Spend Down program, a way for people losing TennCare to get back on if their medical bills are nearly equal to their monthly income. Still, the program remains closed, TennCare retains a surplus of millions of dollars, and Tennesseans like Brandon suffer.

Determined to keep his family together and to stand up for disabled parents across Tennessee, Brandon contacted the Tennessee Justice Center (TJC). With the help of TJC and Memphis attorney Linda Casals, Brandon is fighting his home health cuts in Chancery Court. Brandon has shared his story with legislators on the State and Federal level, and continues to be a strong advocate for all families struggling with health care issues. TJC recognized Brandon as a Father of the Year in 2009, and held a reception in Memphis in his honor.

New! Healthcare Story Series

2009-08-19T12:11:00.000-07:00

Check our blog each week for a different health care story highlighting the current state of health care in Tennessee. Let us know what you think!

Health Care Story of the Week

2009-08-19T11:59:00.000-07:00

Jennifer Perry is an energetic 32 year old. She volunteers at the Montgomery Christian Academy, where music students know her as “pretty Miss Jennifer.” Jennifer likes singing opera and art music, and has a Bachelor of Arts with a vocal concentration. Many of the people she met as President of the Handicap Educational Liaison Partners were surprised to learn that she is disabled, because she looks able-bodied and healthy. But Jennifer has advanced multiple sclerosis (MS), a disease that makes the brain and spinal cord unable to communicate with each other.

Jennifer had been on TennCare for about seven years when she received a letter that said she would be cut off later this month.

Among other symptoms, MS gives Jennifer blurry vision, numbness in her fingers, difficulty balancing, breathing, and moving, urinary and bowel difficulty, hypersomnia (similar to narcolepsy), hives, a weak immune system, severe allergies, muscle spasms, chronic pain, severe migraines, blackouts, mood disorder, and depression. She has had to have her front teeth replaced multiple times due to falling, and was recently forced to quit her job at a household appliance store because her symptoms were getting so bad.

Due to the two year waiting period, Jennifer will not be eligible for Medicare until late 2010. Without TennCare or Medicare, she will not be able to afford most of the roughly 25 medications she needs to remain stable. Her medications cost about $60,000 per year, but her annual income is below $10,000. “If I don’t have my medicine, something bad is going to happen to me,” she said.

Despite her disability, Jennifer worked from age 16 until just a few months ago, when her symptoms got so bad that she was forced to stop. Then, Jennifer’s father passed away suddenly. This and her escalating symptoms made her decide to move in with her elderly mother, who is also disabled. But Jennifer’s troubles weren’t over yet. Soon afterwards, she received the letter about her TennCare ending. Jennifer and her mother pray that Jennifer will find some way to get the health care her life depends upon.

TJC's Emily Einstein Shares Her Thoughts

2009-06-23T12:02:00.000-07:00

I’m a paralegal/client-advocate at the Tennessee Justice Center. One of my duties includes taking calls from Tennesseans who are having trouble getting medically necessary services through TennCare. I listen to their stories and then help them get the services they need. By the time Ms. Dixon called me about helping her get Terrell’s wheelchair, she was worn out with trying to carry Terrell and all of his heavy medical machinery to doctors appointments. After we spoke, I helped her file a TennCare appeal and wrote a letter on Terrell’s behalf to the State’s attorneys. Later, I contacted the wheelchair company every few days until the wheelchair was delivered.

This was my first client success story since I started working at TJC. It felt so good to be able to help a child in need get a service that allows him to live a better life. When Ms. Dixon called me about the wheelchair, it had been months since the doctor had ordered the wheelchair but it still had not been delivered. I thought how difficult it must have been to have a sick child to transport without the aid of a wheelchair. Terrell definitely needed a wheelchair and I was glad that I could help him get one.

Working for TJC has opened my eyes to how hard it is for many children in Tennessee to get the medical services they need. Some of these families give up hope once their child is denied a service; I’m thankful that TJC steps in for families who are exhausted of fighting for care. Being a part of helping children, like Terrell, get services has been so meaningful.

2009-05-15T13:20:00.000-07:00

Tennessee Legislature Undecided About Home Health Limits

On Monday, March 30, TennCare recipients hurt by the fall 2008 home health limits testified before the legislature's Joint Committee on Government Operations. They asked the committee to make a negative recommendation on these TennCare rules, so they could receive adequate care in their homes. The committee, moved by this testimony, made a neutral recommendation, which means the rules will be reviewed again. ACTION ALERT: Your calls are needed! Contact your legislator and ask that he or she fix the rules. If not on the committees, ask that he or she contact committee members about this issue. Here is a list of legislators on the key committees who will decide this issue. Click here to find your legislator. Click here for ideas on what to say to your legislator. Want to do more? Start a petition at your local school, church, or neighborhood group to oppose the cuts! See a sample petition.

2009-05-15T13:02:00.000-07:00

2009 Mothers of the Year Announced and Honored

Six mothers from across the state have been selected as this year's TJC Mothers of the Year. A reception was held in their honor on May 7, 2009 in downtown Nashville. The public was invited to join us at this free annual event. Read the stories of these courageous women. The Mother's of the Year Awards have received media coverage across the state. See a sampling of media outlets that have carried these stories.

At the reception, we announced the winners of the first annual TJC Pro Bono Awards! Mike Abelow was honored as the TJC Pro Bono Attorney of the Year. Bradley Arant Boult Cummings LLP was chosen as the Pro Bono Firm of the Year.

Also for the first time this year, TJC honors two Community Mothers of the Year. These mothers were nominated by their children and selected by TJC. Read their stories.

2009-03-18T08:19:00.000-07:00

Kids' Contest: Calling All Mother's of the Year!
Did your mom or foster mom help get you health care? You can nominate her as a Mother of the Year! <more>

2009-02-23T17:13:00.000-08:00

Daniels Class: Are you on TennCare? And did you use to get SSI checks?

Here's what to do to help keep your TennCare. <more>

2009-02-23T17:06:00.000-08:00

Are You or a Loved One Suffering from the Home Health Cuts?

Court Has Ruled: Cuts Violate the Americans with Disabilities Act

Get more information about how to appeal here. For updates about Crabtree v. Goetz, a case challenging the home health cuts, click here. If TennCare plans to cut, or has already cut, home nursing services for you or someone you know, and you or that person may need hospital or nursing home care as a result, you can call us at 1-877-608-1009 to see if the Crabtree case might help you.