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Help for Families Who are Losing TennCare

Find out why kids lose TennCare, what you can do about it, and where to go for help when your TennCare ends.

Why Kids Lose TennCare

There are lots of reasons why children lose their TennCare:

  • The child’s family moves and doesn’t report the new address to DHS . DHS no longer knows how to contact the family and doesn’t know if they are still in Tennessee. Eventually the kids lose TennCare. (Note: Are your kids on Medicaid as part of your Families First? Make sure to stay in touch with DHS after your Families First ends!!! That way, you’ll have a chance to keep Medicaid or get TennCare Standard. This is especially important for kids with medical problems! Don’t miss your chance!)
  • The child has Medicaid and the parent or guardian doesn’t turn in a recertification packet on time. Perhaps the family didn’t let DHS know when they moved. DHS mailed the packet to an old address. The family didn’t receive it and therefore didn’t return it on time. Or perhaps the family received the packet, but wasn’t able to fill it out. If you aren’t able to return it on time because you are sick, because you don’t understand the questions, or for another good reason, call DHS before the deadlineand ask for more time. Did you lose your first packet? Call and ask for a new one. 1 (866) 311-4287.
  • The child’s parent DOES turn in the recertification packet on time, but the child is no longer eligible for Medicaid and can’t get TennCare Standard. Examples of why a child might lose Medicaid at recertification.
  • The child has TennCare Standard and is responsible for a small monthly premium. The family falls behind on paying the premiums. Eventually, the child loses TennCare. The child can apply for TennCare again, but the family will have to get all their premiums paid up first.
  • The child has TennCare Standard, and the family misses a renewal deadline. Like the recertification packets, Standard Renewal packets are sent in the mail. Parents MUST call DHS any time the family moves! 1 (866) 311-4287. If the family misses the deadline and the kids LOSE Standard, they’ll have to start all over again with a new application. They won’t get TennCare back unless they are eligible for Medicaid.
  • The family renews on time, but the child is no longer eligible for TennCare Standard. Examples of why a child might lose TennCare Standard at renewal.

 What You Can Do About It

If your child is losing TennCare, and you think DHS made a mistake, file an appeal RIGHT AWAY!!! See some examples of mistakes that sometimes happen. Call TennCare Advocacy at 1 (800) 722-7474 for help filing an appeal. They can look up your child’s record, check for mistakes, and work with DHS to help you solve the problem.

Has it been more than 30 days since your child’s coverage ended? You will have to apply again as a new applicant. This means your child will have to meet the requirements for one of the Medicaid programs to get back on (PLIS, Spend Down, SSI or Families First.) If your child isn’t eligible for Medicaid, look into CoverKids—a new public health insurance program for kids under 19. Click here for more information.

Getting By After TennCare: Resources for the Uninsured

 As a parent, you want to give your child every advantage you possibly can. At the same time, you’re doing your best to keep the family afloat financially. Let us offer this one piece of advice: study up on resources in your area! Most counties have health centers and clinics for the uninsured. In non-emergency situations, you will be MUCH better off taking your child to one of these clinics than to the ER. So, arm yourself with as much information as possible!

Start now by visiting www.Tennhelp.com . You can find all kinds of resources listed by county. If you don’t have easy internet access, call 2-1-1 or look in your local phone book for publicly funded or faith-based clinics. Finally, find out about services at your local health department. Most offer vaccines and other basic health services. Some even have primary care centers.

When you call a clinic or health center, learn what to ask. For suggested questions, click here .

Finally, if you DO have to take your child to the hospital for emergency care, remember to file a new TennCare Application! DHS can use the bills from this visit to qualify your children for one year of TennCare Medicaid Spend Down. You can fax it in to DHS from the hospital. Just ask a receptionist or nurse for help. (Want to keep DHS’s fax number on hand, just in case? Click here for local office information.)

TIP: Fax in your application on the FIRST day your child enters the hospital. If your medical bills are high enough, TennCare may help cover your hospital costs!