Paul Sanchez
Tennessee has a history of providing health insurance for children from low-income families through its TennCare and CoverKids programs. However, over the years, the state has been accused of erasing insurance coverage for thousands of children, with an estimated 128,000 to 220,000 kids losing their health insurance due to bureaucratic hurdles and stringent eligibility criteria. This has sparked concerns about the well-being of vulnerable children and raised questions about the state's commitment to ensuring access to healthcare for its youngest residents.
| Characteristics | Values |
|---|---|
| Number of children who lost insurance coverage | At least 128,000 |
| Time period | Over a two-year span |
| Insurance programs | TennCare, Medicaid, CoverKids |
| Reasons for disenrollment | Families did not respond to renewal forms, no longer qualified |
| Counties with biggest decreases | Nashville, Memphis, Cheatham County |
| Percentage change in CoverKids enrollment since January 2018 | 39% decrease |
| Alternative insurance program | CoverKids (for families who make too much money for TennCare) |
| Eligibility for CoverKids | Household income below $64,000, cannot be part of any other health plan |
| Recent updates to TennCare | Replaced mailed forms with a new system for applications and renewals |
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What You'll Learn
TennCare and CoverKids disenrollment
TennCare is Tennessee's state-run Medicaid program, which provides health coverage for over a million low-income Tennesseans. It is a joint effort between the state of Tennessee and the federal government, providing healthcare services to those who would otherwise be unable to afford it. Eligibility for TennCare is based on several factors, including income, immigration status, and asset limits.
CoverKids is an extension of TennCare, providing full health coverage for children under 18 and pregnant women whose families cannot afford employer-sponsored or individual insurance but earn too much to qualify for TennCare. CoverKids is part of the Children's Health Insurance Program (CHIP), which provides health insurance to uninsured children in all 50 states.
In 2019, it was reported that at least 128,000 children in Tennessee had lost their health insurance coverage due to disenrollment from TennCare and CoverKids. This was a result of the state's efforts to reduce enrollment in these programs, which had been allowed to swell in previous years. Families were disenrolled if they no longer met the eligibility criteria or failed to respond to mandatory renewal forms. The consequences of this were severe, with reports of children being denied healthcare due to their insurance being unknowingly lapsed.
The disenrollment disproportionately impacted certain counties, with Nashville and Memphis experiencing the biggest decreases in coverage, with about 14,000 and 22,000 losing insurance, respectively. The single largest drop occurred in Cheatham County, where nearly one in five kids lost their TennCare coverage. The decrease in CoverKids enrollment was even more pronounced, with 39% of recipients being disenrolled since January 2018.
The sharp rise in disenrollment from TennCare and CoverKids resulted in a corresponding increase in the number of uninsured children in Tennessee, contributing to the state's poor health rankings.
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Lack of eligibility and paperwork issues
Tennessee's state-run Medicaid program, TennCare, provides healthcare for the state's poorest and most vulnerable residents. The eligibility criteria for TennCare are notoriously complicated, but the program is most generous with children, paying for the care of kids from families that live close to or below the poverty line. The poverty line for a family of four is about $25,000 of household income. Families that make too much money for TennCare can enroll in CoverKids, a smaller program for children who live below 250% of the poverty line. CoverKids is part of the Children's Health Insurance Program (CHIP), which provides health insurance to uninsured children in all 50 states.
In 2019, it was reported that Tennessee had erased insurance for at least 128,000 kids, with many parents unaware of the change. This was due to a sharp increase in disenrollment from TennCare and CoverKids. State officials attributed this to the programs pruning their enrollment after years of allowing them to swell. However, it appears that many of the children who lost coverage did not acquire private insurance, contributing to the growing number of uninsured residents in Tennessee.
One of the reasons cited for the disenrollment was a lack of eligibility. As part of the renewal process, families were required to complete mailed forms to confirm their eligibility for state insurance. However, the analysis of the data indicated that TennCare representatives struggled to determine eligibility based on the paperwork provided. This issue was further exacerbated by late, incomplete, and unreturned paperwork, making it challenging to assess which families still qualified for the program.
Additionally, the complex eligibility criteria for TennCare likely contributed to the challenge of determining eligibility. The criteria consider various factors, such as income levels, family size, and other financial circumstances. Families who no longer met the eligibility requirements and failed to respond to the mandatory renewal forms were disenrolled from the program.
To address the issues with the paperwork process, TennCare replaced the system in 2021. However, it is important to note that the previous system's impact on families was significant, with Tennessee disenrolling more children than any other state Medicaid system in the nation. The new system for applications and renewals is designed to be more modern and convenient, aiming to improve the efficiency of the enrollment process and ensure that eligible individuals receive coverage.
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Failure to inform families
In 2019, it was reported that Tennessee had erased insurance for at least 128,000 kids, with many parents unaware of the situation. This was due to the state's decision to purge families from two government health insurance programs for low-income families: TennCare and CoverKids. TennCare is Tennessee's state-run Medicaid program, which uses federal funding to provide healthcare for the state's poorest and most vulnerable residents. CoverKids is a similar program for children from families that earn too much for TennCare but still struggle to afford private insurance.
The sharp cuts to these programs were a result of a renewed focus on enrollment qualifications and a failure to complete necessary paperwork. TennCare and CoverKids began tightening their enrollment processes, requiring families to prove their continued eligibility. Many families were disenrolled because they did not respond to mandatory renewal forms mailed over the past three years. However, TennCare officials could not estimate how many families were cut solely due to a lack of paperwork.
The impact of these disenrollments was significant, with scenes of worried grandparents and parents rushing to medical clinics only to discover that their children's insurance coverage had lapsed. The rate of uninsured children in Tennessee climbed sharply, and the state already struggled with being one of the unhealthiest in the nation. The consequences of losing coverage could be dire, as illustrated by a family whose grandchildren had pneumonia and were denied care due to the lapse in insurance.
While TennCare and CoverKids asserted that their new systems for applications and renewals were more modern and convenient, advocates and healthcare providers argued that the programs had not done enough to inform families across the state about their lapsed insurance coverage. This failure to communicate left many families vulnerable and unaware of their changing insurance status, potentially delaying or preventing access to necessary medical care.
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Impact on uninsured rates
In 2019, it was reported that Tennessee had erased insurance for at least 128,000 kids, with many parents unaware of the situation. This number rose to 220,000 in 2021. The children were disenrolled from TennCare, the state's largest government program and a federally funded Medicaid system, and CoverKids, a smaller program for children from families with incomes up to 250% of the poverty line. TennCare is notoriously complicated in terms of eligibility, but it is most generous with children, paying for the care of kids from families that live close to or below the poverty line.
The sharp cuts in coverage were a result of TennCare and CoverKids pruning their enrollment after years of allowing the programs to swell. Families were disenrolled if they were no longer eligible or if they did not respond to mandatory renewal forms mailed over the past three years. State officials claimed that it was difficult to determine eligibility due to late, incomplete, or unreturned paperwork. TennCare representatives said they could not estimate how many families were cut solely due to a lack of paperwork.
The impact of these disenrollments was significant, with Tennessee already being one of the unhealthiest states in the nation. Studies from Georgetown University and the University of Tennessee confirmed that the number of uninsured children in the state sharply increased as a result of the cuts. The biggest decreases in enrollment were seen in Nashville and Memphis, with about 14,000 and 22,000 losing coverage, respectively. The single largest drop occurred in Cheatham County, where nearly one in five kids lost their TennCare coverage. The drop in the CoverKids program was even more pronounced, with a 39% disenrollment rate since January 2018.
The rate of uninsured children in Tennessee is climbing statewide, and there are concerns about the potential unintended consequences of the TennCare overhaul plan. The sharp increase in uninsured rates has caught the attention of advocates and highlights the challenges faced by low-income families in accessing healthcare services for their children.
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Medicaid funding
Tennessee's Medicaid program, called TennCare, is a federal-state partnership that provides health insurance to many children, low-income pregnant women, and individuals who are elderly or have disabilities. In 2019, Tennessee erased insurance for at least 128,000 kids, with many parents unaware of this change. This was due to the state's decision to tighten eligibility requirements for TennCare and CoverKids, another health insurance program for low-income families. The state's actions resulted in a rapid disenrollment from these programs, with the biggest decreases occurring in Nashville and Memphis.
The issue of Medicaid funding in Tennessee has been a contentious topic in recent years. Tennessee has historically been reluctant to expand Medicaid, with Republican lawmakers opposing such expansion. However, in mid-2024, Tennessee received federal permission to expand Medicaid eligibility for low-income parents, eliminating the "coverage gap" for parents of minor children. This expansion allowed parents with a household income of up to 105% FPL to be eligible for Medicaid and those above that income level to receive Marketplace subsidies.
In 2021, the Trump administration approved Tennessee's Medicaid block grant waiver proposal, allowing the state to utilize a block grant approach to federal Medicaid funding. This decision was controversial, with a lawsuit filed by several beneficiaries and the Tennessee Justice Center alleging that the approval exceeded statutory authority and was arbitrary. The Biden administration later reopened a public comment period on the TennCare III waiver and requested significant changes from Tennessee officials, including a return to a traditional per-member cap.
Tennessee has also explored the concept of "shared savings" in Medicaid funding through its TennCare III demonstration. This approach allows the state to replace state dollars spent on certain programs with federal Medicaid funds, freeing up state funds for other purposes. While some have touted the success of this model, critics argue that capping federal Medicaid spending simply shifts costs to states over time and could lead to negative consequences such as limiting eligibility or reducing benefits.
The refusal to expand Medicaid has had significant implications for Tennessee. The state has lost billions of dollars in federal funding and left over 300,000 residents uninsured. Medicaid expansion could improve healthcare coverage, enhance long-term health outcomes, and provide economic benefits to the state, including supporting new jobs and strengthening the workforce. However, despite these potential advantages, Tennessee lawmakers have not yet opted to expand Medicaid coverage.
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Frequently asked questions
Yes, at least 128,000 Tennessee children lost their insurance coverage when the state purged families from low-income programs TennCare and CoverKids.
TennCare and CoverKids pruned their enrollment after years of allowing the programs to swell. Families were cut from the programs if they no longer met the eligibility criteria or if they did not respond to mandatory renewal forms.
TennCare is Tennessee's state-run Medicaid program, which uses billions in federal funding to pay for healthcare for the state's poorest and most vulnerable residents. TennCare is most generous with children, paying for the care of kids from families that live close to or below the poverty line.
CoverKids is part of the Children's Health Insurance Program, which provides health insurance to uninsured children in all 50 states. CoverKids provides full health insurance with an emphasis on preventive health services for children aged 18 and under, and pregnant women whose families cannot afford employer-sponsored insurance or individual insurance.
