Patients fear life without TennCare

Review could find thousands ineligible By Chas Sisk • THE TENNESSEAN • July 7, 2009 Three decades of life with quadriplegia have done little to deter Jacqueline Hopkins. Unable to move her limbs, Hopkins nonetheless graduated from college, using a mind that was never dulled by the 1978 car accident that snapped her spine. Unable to speak above a whisper, Hopkins has maintained a social network that includes many others with the same disability, using a computer outfitted to respond to the movements of her forehead. But at 51, the East Nashville resident says she has been able to remain so active only because of the aid of her parents, who have helped care for her since the accident on Interstate 65 disrupted her life as a sophomore at Middle Tennessee State University. Now, she may lose the TennCare funding that makes that support possible. "I think it's just terrible," Hopkins said with the assistance of her father, who after 31 years can more easily comprehend her soft voice. "There are so many people I know that qualify that don't have families to help them get the support they need." Hopkins faces a reduction in state health-care benefits through an effort under way this summer to re-evaluate TennCare coverage for 154,000 Tennesseans. Many of them are having their eligibility reviewed for the first time in decades. After a 22-year-old court order was lifted earlier this year, TennCare is now asking people like Hopkins to prove that they are truly worthy of coverage. The group, known as the Daniels class for the court case that led to the order, includes thousands of people with chronic medical conditions, including those with severe disabilities and mental illnesses. The state spends about $400 million annually caring for those people, and the federal government an additional $800 million. But for two decades, TennCare had been barred even from checking whether members of the Daniels class still qualified to receive state aid — or if their medical conditions still warranted coverage at taxpayer expense. Many advocates believe 130,000 or more Daniels recipients could be cut from the rolls, a figure that TennCare officials vigorously dispute. But at a minimum, tens of thousands of people will see their coverage reduced or eliminated. Hopkins and her family believe she will be one of them. "I don't know how it would be (without TennCare coverage)," said her father, Andrew. "We've just had to have optimism." State defends reviewsTennCare officials say they are looking at the Daniels class only because a federal law requires states to check the eligibility of recipients of public health insurance at least once a year. But groups that lobby on behalf of TennCare recipients say the state had little interest in complying with that law until the program's financial woes began to mount. The issue hinges on how the two sides look at the way in which TennCare is reviewing the status of Daniels patients, some of whom have not had to show they deserve coverage in more than 20 years. TennCare officials say they have simply asked these people to fill out the same financial disclosure forms as others in the program, which serves about 1.2 million Tennesseans. Opponents of the change say the tight deadlines and voluminous disclosure requirements are meant to maximize the number of people who will lose coverage. Either way, the policy represents a big change for the Daniels class. Under the 1987 court order that created it, members of this group qualified automatically for coverage if they received Supplemental Security Income, a federal program for the elderly, blind and disabled. Once enrolled, these people did not have to go through the same annual checks of income and medical eligibility as others in TennCare. But with the state government's budget tightening, TennCare officials convinced a federal judge to lift that order in January and allow individual reviews. The program contacted the first batch of those Daniels class members in May, a group of about 40,000 people. As of last week, TennCare had told 11,000 of those people that they were no longer qualified, and it had found 2,700 people who could remain in TennCare, the program said. An additional 24,000 cases were still pending. Opponents of the new policy say the fact that most people who have been reviewed so far were terminated confirms their concerns. By giving Daniels class recipients only 30 days to fill out the form — a packet that asks for everything from recipients' income to the market value of cemetery plots — the state is trying to trip people up, said people like Gordon Bonnyman, executive director for the Tennessee Justice Center, which fought to keep the court order in place. "It's like a really complex tax return, and you've got a majority of them that have disabilities," Bonnyman said. "Instead of the state looking to save eligibility, it is summarily terminating them." State savings unknownTennCare officials have declined to say how many people it expects will have their coverage cut through the reviews. They have also declined to estimate how much they think the state will save or to say specifically what will be done with the money. Tracy Purcell, TennCare's director of member service, said the money probably would be used to fund other TennCare programs. But she said the move is not a money grab or a bid to deny coverage to people who qualify and need it. The state expects 106,000 people to receive some public coverage once the checks are completed later this summer. Before the first mailing was sent, TennCare identified 28,000 people who can switch to coverage through the federal Medicaid program, officials said. They also said the early returns do not indicate the portion that eventually will be denied coverage because the first batch of reviews went to people who have out-of-state addresses and those who have been on the program the longest. These people may no longer live in Tennessee — and thus shouldn't be covered through a state program — and they are more likely to have experienced an increase in income or change in their medical status that would call for a cut in coverage. "We don't know enough about these individuals today to determine whether the individuals are eligible or not," Purcell said. "I don't think we can make any assumptions that they're not going to qualify."