TennCare applicants still awaiting answers

HOW TO APPEALIf you have waited more than 45 days to hear about the status of your TennCare application, call the Tennessee Health Connection at 1-855-259-0701.Explain that your application has experienced a delay, and request to file an appeal of that delay.Source: TennCare

For many Tennesseans struggling to get Medicaid coverage this year, a federal judge's decision appeared to signal an end to a months-long limbo.

The judge this month ordered that they receive hearings about the long delays they have been dealing with, and finally be given decisions about whether they qualify for coverage.

But the path to actually get to that resolution is still not clear for some.

That includes a disabled veteran in Cleveland, Tenn., who has been trying since May to get TennCare coverage for his daughter, who needs medicine for severe asthma, allergies and ADHD.

For months, the man has spent hours on the phone with state and federal agencies, only to hear that his documents are missing or unprocessed, said Gordon Bonnyman, an attorney with the Tennessee Justice Coalition.

The TJC, a legal advocacy group, and two national civil rights groups sued TennCare over the delays this summer.

U.S. District Judge Todd J. Campbell ruled two weeks ago that TennCare must begin holding hearings for people whose coverage decisions were delayed more than 45 days after their application.

Within another 45 days, TennCare must provide those people with a hearing.

The Cleveland veteran would qualify for an appeal, Bonnyman says. But it has taken multiple phone calls between agencies to make that formal request. On Friday, the veteran was told to expect to hear back within 10 days. But he has heard that line from TennCare before, Bonnyman said, and has never been called back.

Others, Bonnyman said, have called to check on the status of an appeal only to hear that there is no record of it.

"When families try to appeal, it is important that TennCare not subject them to the same bureaucratic hassles that have made their appeals necessary," Bonnyman said.

"These are vulnerable people who have already been waiting far too long. The state needs to move quickly to fix their problems."

TennCare spokesman John Goetz said the agency is accepting appeals, as Campbell ordered.

"TennCare continues to finalize the appeal process and, as we do, more details of it will be forthcoming," Goetz said.

Meanwhile, he said, TennCare is "currently evaluating all of our legal options regarding the injunction."

Campbell's order came after months of complaints from Tennesseans who said their TennCare applications had gone unanswered.

The delays led first to a federal reprimand, then a lawsuit filed in July on behalf of 11 people, including newborns and people with chronic health problems.

State officials blamed the delays on the federal government, since the state has been using the federal health exchange, Healthcare.gov, to decide eligibility.

But Campbell wasn't persuaded by that argument, and said hearings were necessary to stop what he said was clearly "irreparable harm" while the lawsuit continues to play out.

"The plaintiff class members are economically impoverished and, without TennCare benefits, have forgone or are forgoing vital medical treatments, services and prescriptions," Campbell said.

The delays began when TennCare switched how it handles applications back in January.

Because Medicaid eligibility requirements changed in 2010 under the Affordable Care Act, Tennessee had to create a new computer system to handle enrollment decisions, called the Tennessee Eligibility Determination System.

But nearly a year past its deadline, the $35 million system is still not operating. TennCare Director Darin Gordon has told state lawmakers he couldn't say when it will be finished.

Contact staff writer Kate Harrison Belz at kbelz@timesfreepress.com or 423-757-6673.

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