WSMV Channel 4 TennCare opens to certain adults

TennCare opens to certain adults

People who desperately need medical care will have a chance to apply for a few thousand slots that are opening in the TennCare program.

Applications will be taken for the standard spend down category on Sept. 12.

People may qualify if they are disabled, age 65 or older, or a parent or caretaker-relative of a child under 18.

Kenita Brewer hopes to apply.

Her son James is 9 years old, but because of his autism, he's mentally about 3 or 4 years old.  She knows she will need to care for James  for  the rest of her life, but she's afraid she won't be able to if her health declines.

"I need to be in the best health that I can be in so that I can take care of him, because it is a full-time job, " Brewer said.

It's not easy because she has diabetes,  rheumatoid arthritis and other problems - and she has no insurance. To see a doctor, she has to pay cash.  

"What hits the pocketbook the most are the doctor visits," Brewer said.

TennCare is opening what's called the "spend down" category.

"This is a category that will let people qualify for Tenncare that had not previously qualified," said Kelly Gunderson, a spokesperson for TennCare.

People can qualify if they meet certain criteria.

"People eligible are adults who are disabled or take care of a Medicaid-eligible child and have very high medical bills," Gunderson said.

The funding comes from a special hospital tax. In all, TennCare expects to add about 7,000 people to the rolls over a period of time.

Life has been tough for Kenita Brewer. Last year, her husband died of cancer. The family is struggling with medical bills. For her, getting on TennCare would be a life saver.

"I realize there is such a huge need for uninsured people, and budget concerns, but people need medical care," she said.

Only 2,500 people will be accepted into the program at this time. To qualify, you have to call on Sept. 12.  The phone lines open at 6:00 p.m. and are scheduled to stay open until 8:30 p.m.; however, the slots generally are filled within the first few minutes.

TennCare encourages people to review the criteria online first to see if they would qualify. The first 2,500 people who call will be mailed applications.

Here are the guidelines published by the Bureau of TennCare:

Standard Spend Down Program

1. Who is eligible for the Adult Standard Spend Down Category?

To be eligible for the Standard Spend Down (or SSD) program, you must meet all

of the following criteria:

You must be age 21 or older and not pregnant.

AND

You must be US citizens or legal resident alien.

AND

You must be Tennessee resident.

AND

You must not be incarcerated.

AND

You must be either aged (65 or older), blind, or disabled, or you must be a

caretaker relative of a Medicaid eligible child. To be considered blind or disabled,

you must meet standards set by the Social Security Administration (SSA).

AND

You must have a sufficient amount of medical bills that have not been written off

by the provider and that are your responsibility. The sum of these bills, when

subtracted from your income, must be enough to "spend down" to the state's

Medically Needy Income Standard, which is $241 for a family of 1, $258 for a

family of 2, $317 for a family of 3, etc.

AND

You must have resources that do not exceed $2,000 for a family of 1 and $3,000

for a family of 2, with an additional $100 added per additional individual in the

family.

*Children and pregnant women have a similar eligibility category under

Medicaid.

(Access to insurance does not prevent a person from qualifying)

2. When will the program be open again to applicants?

The program is scheduled to be open for enrollment September 12, 2011. A

dedicated DHS phone line will be available on Monday September 12, 2011 from

6:00 p.m. to 8:30 p.m. Central Standard Time. The number for that line is

1.866.358.3230. The phone line will close after approximately 2,500 calls are

received.

3. What is the cap on enrollment?

7,000 enrollees. On September 12, 2011, the program will again open enrollment

to approximately 2,500 applicants. Once those applicants are processed,

enrollment will once again be opened up to more applicants. We cannot take in

more applications at one time than we can process within the "timeliness"

standards that CMS requires.

4. When do I apply and will I apply at the county DHS offices?

New applicants will apply initially over the phone during established open

enrollment periods. The first of those periods was October 4, 2010, the second

on February 22, 2011, and the next period is scheduled for September 12, 2011

from 6:00 p.m. to 8:30 p.m. Central Standard Time. The call-in line will be

available until approximately 2,500 calls are received. (As stated above, we

cannot accept more applications at one time than DHS can process within CMS's

timeliness standards.) The number for this dedicated call center is

1.866.358.3230.

Staff persons on the call-in line will collect basic demographic information from

callers. Those who are not already on TennCare will be sent a written application

to be returned to DHS within 30 days. DHS will process those applications as they

come in. Once all the applications from one open enrollment period have been

processed, the state will conduct another enrollment period. These open

enrollment periods will continue to occur until the target enrollment (7,000) is

reached. The public and other stakeholders will be notified in advance before the

next open enrollment period.

5. Does having access to health insurance prevent me from qualifying?

No.

6. How much coverage will I receive? Will the start date for coverage be three

months retroactive to the date of application? If not, what will be the first date of

coverage?

Enrollees in the SSD program will be eligible for all TennCare benefits for adults

except long-term care (meaning Nursing Facility care and care in a Home and

Community Based Services Waiver). If you are a Medicare beneficiary, you will

be eligible for TennCare to participate in payment of your Medicare deductibles

and coinsurance.

The start date of coverage for the SSD program will be the later of:

a. The date your call was received by the call-in line; or

b. The date spend-down is met (which must be no later than the end of the

month of the original call to the call-in line).

7. How is this program different from the Medically Needy Spend Down Program for

pregnant women and children?

The application process is somewhat different, in that pregnant women and

children apply at DHS offices, whereas applicants for the SSD program apply

through the Call-in Line discussed above. The benefits for all children enrolled in

TennCare, including those enrolled in the Medically Needy Spend Down program,

exceed benefits that are available for adults, since children are entitled to EPSDT.

Otherwise, the SSD program is very much like the Medically Needy Spend Down

program for pregnant women and children.

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