Twelve Tennessee medical doctors

Guest columnists

Joe Zickafoose, MD, MS; Adriana Bialostozky, MD; Holly Miller, MSN, APRN, CPNP-BC; Anna Morad, MD; Anne-Laure Shelton, MD, PhD; Kathryn Carlson, MD, MMHC; Rosemary Hunter, MD; Rebecca Swan, MD; Barron Patterson, MD; Tamasyn Nelson, MD; S. Elizabeth Williams, MD, MPH; and Kecia Carroll, MD, MPH have submitted this op-ed as individuals. The views represented do not necessarily reflect the views of their affiliated institutions.

In April, the Tennessean reported that more than 120,000 children have been disenrolled from TennCare and CoverKids over the last two years. These two programs are the primary sources of health insurance for children in low-income families in Tennessee and crucial connections to health care for some of the most vulnerable children in our state. Although TennCare officials have disputed some details of the story, they have confirmed in testimony to the legislature that there was a decline of at least 100,000 children from 2016-2018.

As health care providers who serve children covered by TennCare and CoverKids, we are writing from the front lines of care to describe the consequences of this disenrollment. In late 2018 and early 2019, our clinic began to notice an increase in the number of families coming for visits only to discover that their child’s insurance had been cancelled. Although this is not unusual, we were struck by the sheer volume of families who had no idea their child was no longer insured.

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In the following months, we have seen the direct impacts on children. For example, one teenager was expressing thoughts of suicide for several months before her mother sought care. The child’s TennCare had been discontinued, and the family knew medical bills would make it a challenge for them to pay for other basic needs. The parents of another child who snores so badly she stops breathing at night have canceled an important sleep study multiple times because her TennCare was discontinued. She probably has obstructive sleep apnea, which can affect her ability to succeed in school and cause long-term harm to her heart and lungs.

TennCare officials state that these children would have been disenrolled earlier if there hadn’t been a pause in reenrollment requirements to update the program’s system. However, decades of research and our personal experience document that very few children who are disenrolled from public insurance programs like TennCare and CoverKids actually have changes that make them ineligible for the programs. More common causes are burdensome enrollment and reenrollment processes and out-of-date contact information for families.

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Most concerning, the rate of uninsured children in Tennessee went up in 2017 for the first time in more than a decade, suggesting that these children are not moving to private insurance. Tennessee has historically been a leader among states in insuring nearly all low-income children, but the recent TennCare disenrollment is a threat to that position and, more importantly, the health of children in our state.

To its credit, TennCare is building approaches that should make it easier for families to enroll and reenroll using pre-filled forms, call centers and even a phone app. However, those systems are under development and little solace to families who are struggling to access care for their children.

In the meantime, health care providers like us need to be on the lookout for children who have been disenrolled and get them connected to TennCare and advocacy resources to ensure they are getting the health care they need. And TennCare officials should provide numbers to legislators and the public on how many reenrollment packets were returned because of incorrect addresses and how many children were disenrolled because of unreturned paperwork, suggesting outdated contact information. Ultimately, TennCare, community advocates and health care providers will need to work together to identify approaches to getting eligible children reenrolled in coverage for the health care they need.

Joe Zickafoose, MD, MS; Adriana Bialostozky, MD; Holly Miller, MSN, APRN, CPNP-BC; Anna Morad, MD; Anne-Laure Shelton, MD, PhD; Kathryn Carlson, MD, MMHC; Rosemary Hunter, MD; Rebecca Swan, MD; Barron Patterson, MD; Tamasyn Nelson, MD; S. Elizabeth Williams, MD, MPH; and Kecia Carroll, MD, MPH have submitted this op-ed as individuals. The views represented do not necessarily reflect the views of their affiliated institutions.