City officials say more than 5,000 children in Hamilton County no longer have health insurance, and now they are trying to figure out why.

The cuts were made for families with TennCare or CoverKids, which are funded by the state.

Mayor Andy Berke says many of the families impacted will not know their children are not insured until they go see a doctor.

“I can't imagine what it is like to take your kid to the doctor or the ER knowing they need treatment and discovering that you don't have healthcare insurance," Mayor Berke said. 

That is what happened to Trish Sewell and her two boys. In March 2015, Sewell's six-year-old son Abel was diagnosed with leukemia. Last year, Abel beat cancer, but his trips to the doctor did not stop.

“He has to go monthly for blood routine workup to make sure the cancer doesn't come back,” Sewell explained.

Her 13-year-old son Jacob also sees a doctor monthly to treat his ADHD. Sewell says TennCare covered their visits and medication bills. But she says last year, she took Jacob to the doctor and was told he was not covered. The same thing happened to Abel during his visit last month.

“She said Mrs. Sewell you don't have insurance and I said what? It was unbelievable because I mean he was just now fighting cancer how could he not have insurance,” she said.

Sewell said her family's income and personal information have not changed. She calls her provider every day but has not gotten any answers.

“I talked to a lady last week, and I was on the phone for three hours,” she said. “Nobody knows why. I've been very adamant about that. I want to know what happened.”

Mayor Berke says something needs to be done.

"Much of this happened over the last year because for the last several years they haven't had a functioning computer program. When they started trying to get people re-enrolled last year, that's when you saw this dramatic drop in the number of kids who were receiving coverage," he said. “I've called for the legislature to have oversight at TennCare and get to the bottom of all the different problems so it doesn't happen again." 

In the meantime, parents are being urged to file an appeal and re-enroll.

“Those kids need help, my kids need help you know our kids need insurance you know they all do.”

 A spokesperson for TennCare sent the following statement:

We requested and received a waiver from performing re-determinations for calendar year 2014 while the state worked to implement many of new requirements within the newly enacted Affordable Care Act (ACA). In fact, nearly every state suspended eligibility re-determinations during this time.  We then began to ramp up our redetermination efforts again in 2015 through a combination of manual and other, slightly automated processes.  The result of this pause was that very few members came off the program for more than two years. 

Prior to the implementation of the ACA, TennCare served approximately 1.2 million Tennesseans.  This enrollment remained steady for about a decade. After implementation of the ACA, TennCare saw an increase in enrollment to nearly 1.6 million members – a more than 30% increase. This was due primarily to the pause in the eligibility redetermination process mentioned above. Due to this pause in redetermination, TennCare and CoverKids had members remain on these programs who no longer actually qualified for benefits and otherwise would have been deemed ineligible through the normal annual redetermination process. 

Before the redetermination process restarted, TennCare launched a significant outreach effort to encourage members to participate in the redetermination process and provide TennCare with all required information, including any address changes. We worked with our state partners, health plans, and the advocacy community to get the message out through publications, in-person assistance, and a quick easy-to-share video. We also included information on our website about the process, which included an instruction guide, and information on how to get in-person assistance.

The recent decreases in enrollment, which occurred over a two year period, is due to the restarting of required redetermination and the resulting total enrollment in TennCare and CoverKids is in line with expectations looking at historical data of members leaving and entering the program.

Today, TennCare enrollment is approximately 1.35 million. While the restart of the required redetermination process as well as an improved economy have resulted in a decrease in the record high level of enrollment, TennCare enrollment today is still approximately 205,000 members more than it was prior to the ACA. And enrollment includes approximately 87,000 more children than pre-ACA levels.  In fact, there are approximately 9,400 more members in Hamilton County enrolled in TennCare as of March 2019 than prior to the ACA. And that enrollment includes approximately 4,500 more children.   

It is worth noting, there are also other reasons, outside the redetermination process, that a member’s Medicaid eligibility would close. For example, TennCare receives many voluntary termination requests and also closes coverage after confirming that a member is actively receiving benefits in another state. Between 2016 and 2018, approximately 60,000 children stopped receiving coverage for a reason other than redetermination. This includes nearly 40,000 children whose families asked for their child to be removed from the program, or who moved out of state.

Finally, TennCare has a robust appeals process for anyone deemed ineligible for benefits and stands ready to assist eligible individuals and families in re-enrolling in the program. Anyone who needs such assistance should contact TennCare at 855-259-0701.