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

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

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

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

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.