Stakes high in TennCare re-verification process

By Megan R. Harrell
STAR STAFF
mharrell@starhq.com

   Fast approaching re-verification deadlines have left thousands of TennCare enrollees scrambling to file paperwork at Human Services Departments across the state. Here in East Tennessee, local state officials have been working overtime to process paperwork and answer questions.
   A federal waiver requires the TennCare Bureau to re-verify all non-Medicaid enrollees by Jan. 1. The first re-verification deadline for thousands of Tennesseeans is Oct. 29.
   Richard Proffit, 705 Tipton St., Elizabethton, is among the first group of TennCare enrollees facing the Oct. 29 deadline. Proffit received notification last week he no longer qualified for TennCare under the new guidelines.
   The 25-year-old has been on the state's health care system since its inception nearly four years ago, but after his re-verification was completed, he no longer qualified.
   "We received a letter Tuesday, Oct. 16 saying Richard's, my daughter's, and my TennCare had been dropped," Proffit's mother, Beverly Humphreys, said. "The re-verification had Richard's income above requirements."
   Proffit, who is waiting for life saving surgery, has until Oct. 29th to appeal the decision. He is suffering from diabetes, high blood pressure, and morbid obesity.
   Dr. Glenn Birkitt, a bariatric surgeon with Bristol Surgical Associates, placed Proffit on a waiting list with over 700 other patients for gastric by-pass surgery. According to Proffit's doctors, the surgery is necessary because of the immediate dangers associated with his diabetes and high blood pressure.
   "If he cannot get the surgery, and he cannot get the weight off, his diabetes could get so bad that he could not have the surgery and he would die," Humphreys said.
   Proffit was nearing his surgery when he received notification his TennCare had been dropped. TennCare had covered the cost of several tests leading up to the by-pass surgery. Proffit works at Fairfield Marketing in Johnson City and is not eligible for health care benefits because of his part time employment status.
   With the deadline for TennCare appeals less than 10 business days away, Proffit and his mother turned to the Elizabethton/Carter County Department of Human Services for help.
   Vicky Harris, who is with the local DHS, helped to push Proffit's appeal through the state system. "She worked with us for over two and a half hours trying to help," Humphreys said. "She was the sweetest and most dedicated person."
   Humphreys said Harris located errors that were made during the re-verification process. According to Humphreys, the errors contributed to Proffit's disqualification from the state's health care program.
   Harris' findings, along with help from Sen. Rusty Crowe (R-Johnson City), led to the temporary reinstatement of Proffit's TennCare. "I talked to Sen. Crowe one day, and the next day we had a letter saying Richard's TennCare was reinstated until after he has the surgery," Humphreys said.
   Crowe said his office cut through government red tape in order to help Proffit. "What we are going through is an adjustment. The intent is to try and clean TennCare up, and make sure those who really need it get it, but what Richard needed done just made sense," Crowe said.
   There are 222,000 people in the same group as Proffit, and as of Oct. 19, TennCare had only processed paperwork on 109,617 enrollees. The large number of enrollees facing the re-verification deadline has prompted state representatives to petition Gov. Sundquist for an extended deadline.
   Rep. Kathryn Bowers (D-Memphis) asked the governor to reconsider the deadline after receiving a large number of complaints from concerned TennCare recipients. Bowers cited the fact that many of the people trying to appeal cannot get through at their local DHS offices.
   Crowe stated he hopes the governor's office extends the deadline because it is not the enrollees' fault if they don't get through at the DHS offices. He said he would fight to make sure enrollees have a chance to finish their paperwork.
   Despite legislators' appeals, top TennCare officials do not anticipate postponing the deadline. Officials stated an extension would carry the system into the next budget year, and violate the TennCare Reform Act which states the population must be separated into different benefit packages by Jan. 1.
   The state DHS has taken some steps to help the enrollees and staffs through the TennCare re-verification process. All DHS offices in Tennessee will have extended hours during the period.
   "We are opening offices early, closing them late and working on Saturdays in many locations," DHS Commissioner, Natasha K. Metcalf said. "We're making home visits, completing eligibility interviews over the telephone, and we are conducting group interviews at our offices and at alternative locations."
   Proffit is one of the fortunate TennCare enrollees who have made it through the system before the deadline at the end of the month. With his TennCare reinstated temporarily, Proffit's doctors are looking at performing the gastric by-pass surgery by the end of the year.