Ten things to know
about TennCare

1. What is TennCare?

TennCare is Tennessee's Medicaid program. It provides health coverage for low-income children, pregnant women, parents of minor children, and people with disabilities. It also includes some programs for the elderly.

The program includes $1.2 million people, and has a $10 million budget — 65 percent federally-funded, and 35 percent Tennessee-funded.

2. What is the controversy over TennCare about?

The controversy is all about months-long delays people who are applying for TennCare have faced since January, 2014, which was when the TennCare program completely changed its application process. People have repeatedly said they apply for coverage, then never hear back, or that when they call to inquire about their application that it has gone missing.

3. How has the application process changed?

Before, most people applied for TennCare by going to their local Department of Human Services and then submitting an application with the help of a caseworker.

But now, people must apply for TennCare through Healthcare.gov, or by calling the federal hotline. The federal government then decides whether the person who applied is eligible, and sends that information to the state.

4. Why is TennCare sending people through Healthcare.gov?

The Affordable Care Act changed the income calculation that Medicaid programs must use to decide who gets benefits.

To be able to use that new calculation, Tennessee needed a new computer system. A contractor was supposed to finish building the system by October 2013. But the project was so far behind schedule that for now, TennCare is sending people through Healthcare.gov.

5. Do other states have this problem?

Other states have reported Medicaid enrollment backlogs, and the federal government reprimanded six states for failing to comply with Medicaid eligibility requirements in July. Tennessee failed more requirements than any state, and federal officials said Tennessee "have repeatedly expressed reluctance to deploy resources" to fix the problems.

National health policy experts have called Tennessee the “worst of the worst” when it comes to how it’s handling Medicaid enrollment. But Tennessee blames the federal government for the backlog.

6. Why was a lawsuit filed against Tenncare?

The Southern Poverty Law Center, the Tennessee Justice Center and the National Health Law Program together filed a lawsuit on behalf of 11 Tennessee plaintiffs who had not been able to access coverage for months.

The lawsuit — Melissa Wilson, et al. vs. Darin Gordon, et al — sought to grant the plaintiffs some kind of immediate decision about their coverage, and also sought to become a class action lawsuit, meaning that hundreds of other people in the state could join the lawsuit.

7. What did the judge decide?

The lawsuit is ongoing. But the judge ruled against TennCare in a preliminary injunction, saying that the plaintiffs and other Tennesseans have a right to a hearing on their eligibility decision.

U.S. District Court Judge Todd J. Campbell said the hearings were necessary to stop what he said was clearly “irreparable harm” while the lawsuit continues to play out.

The ruling means that if Tennesseans have not gotten a decision about their eligibility after 45 days, they have the right to ask for a hearing. Another 45 days after that appeal, TennCare must grant a hearing.

Meanwhile, TennCare has appealed the judge’s ruling.

8. How long will it take TennCare to get its own system set up?

It remains unclear. Tennessee officials are having a third party assess the status of the computer system TEDS, but so far there is no projected completion date.

9. What does that have to do with TennCare expansion?

The problems with the computer system have nothing to do with Medicaid expansion. But some advocates have said that the issues have added strain to the state’s relationship with federal officials.

10. How can I figure out the status of my application?

If you have waited for a decision for more than 45 days (or more than 90 days if you applied for long-term care) you can ask TennCare for a "delay hearing".

To start the process, call 1-855-259-0701 or visit http://www.tn.gov/tenncare/mem-eligibappeal.shtml to print out a form and find mailing instructions.

It is very important to keep track of all of your dealings with TennCare. Take screenshots of your application online. Keep logs of your phone calls, and record them if possible.