thedailytimes.com : Your 24/7 news source

Some Blount County residents may lose TennCare coverage as the state re-evaluates the eligibility of 150,000 enrollees statewide.

In January, the U.S. District Court granted the state permission to check the eligibility of a class of TennCare enrollees who are subject to a 21-year old court order known as Daniels.

All were once eligible for Supplemental Security Income (SSI), a federal benefits package that includes Medicaid, but the Daniels court order barred the state from checking their eligibility, effectively allowing some non-eligible individuals to remain on the program.

Some of the Daniels class members will remain eligible for TennCare, but some will not. This could include people who are no longer living in Tennessee, making too much money or no longer are disabled.

"On May 1, the first 40,000 letters go out," said Larry Drain of Hopeworks, the Blount County chapter of the Depression and Bipolar Support Alliance. "There is going to be an awful lot of scared people. Most of these people don't know they are going to be losing it and won't know it until they get a letter in the mail."

According to Kelly Gunderson, spokeswoman for TennCare, what the state is sending out on May 1 is a request for information from the targeted participants.

"We'll have a better sense of the percentages we're looking at once the results start coming in," Gunderson said.

During a preliminary review, TennCare has determined that "about 25,000 of the Daniels class qualify in another open Medicaid category, 90,000 also have Medicare coverage, so they will still have some sort of medical insurance," Gunderson said.

"In our opinion, it's really an issue of fairness. We ask this of all our enrollees -- they have to go through an annual reevaluation process. It's only fair that this group of people does the same thing to make sure they actually qualify for the benefits."

TennCare estimates that the state spends about $1.2 billion annually to provide health care insurance for the 150,000 Daniels class members. There are no estimates of how many people in Blount County might lose their coverage.

If just 10 percent of the statewide enrollees are found not to be eligible, the state could save as much as $120 million ($42 million of which is state funded) annually, according to a press release.

Public forum set

Hopeworks and the Tennessee Health Care Campaign are sponsoring a public forum on the issue at 7 p.m. on May 7 at the Blount County Public Library.

"Our hope is to provide some sort of direction to them so they know what their options and alternatives are," Drain said. "Blount County is a good place to live. It's a time to start reaching out our hands to help each other."

The Daniels class members will keep their benefits with no lapse in coverage through the determination process. The process is similar to one the court approved in 2005 for other TennCare members, which meets full approval of the federal Centers for Medicare and Medicaid Services (CMS), TennCare's federal partner.

The enrollees who could potentially lose their coverage are normal people, Drain said.

"These are people who depend on medication from the start of the day to the end of the day," he said. "They are the sickest of the sick. These are just ordinary people who have had the misfortune of being sick or being poor. ... It's not something that con men do. If you've had SSI, you've normally had some kind of disability that is going to affect you the rest of your life."