A judge ruled earlier this week that thousands of people had been removed from the TennCare roll illegally. That case was filed before the COVID-19 pandemic paused the insurance provider’s yearly enrollment churn. 

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Now health care advocacy group Tennessee Justice Center (one of the parties in the 2020 lawsuit) is reckoning with the latest round of patients wrongfully terminated as part of the insurance provider’s latest redetermination. Many TennCare users are still finding out they lost coverage because they didn’t know it was gone until they needed to use it. 

From April 2023 through March, more than 500,000 were terminated from the TennCare roll following a restatement of yearly eligibility evaluations after more than three years on pause. Confusion and clerical errors impeded the process, as the Post reported, while "Obamacare" enrollment spiked.

One person affected is Nashville resident Zahira Rodriguez, who did not know that her TennCare coverage was terminated until she took her son, who has diabetes, to the emergency room in July. 

“I said, why? Because I sent everything — papers, documents — for the renewal,” she told the Post. “I sent everything in, and never had problems.” 

Having been enrolled in TennCare for nine years, Rodriguez knew the redetermination process was coming and completed the necessary packet. TennCare received the initial packet via mail, but an additional request for proof of residency for her minor children got lost in the shuffle. She’s one of the more than 40,000 in the state who had the same experience, completing the initial packet, but not completing additional documents, at least in TennCare’s eyes. In addition, TennCare states more than 325,000 did not respond to the packet. 

Because of the lapse in coverage, Rodriguez amassed $5,000 in medical bills — not to mention the care she didn’t access because she could not afford it. 

Tennessee Justice Center advocates sent an appeal as well as a new application that was ultimately approved, but are still working to get her coverage backdated. Katherine Zelaya, Insure Our Kids program client advocate, tells the Post that retroactive coverage is something TennCare allows, including in Rodriguez’s case, but it does not always come through.  

“I think a lot of families know they have to do a renewal packet, and that's about it,” Zelaya said. “I think the additional information request — a lot of people may not be aware that there's another step. Sending that renewal packet may not necessarily renew your coverage. It's not clear.” 

Michele Johnson, executive director of Tennessee Justice Center, points out in the final unwinding report from TennCare that 72 percent of those who lost coverage were not deemed ineligible, but were denied coverage because they did not complete the paperwork. Or, she asserts, they did not receive notice or they responded, and TennCare did not receive it. 

“When you have this mass administrative thing, you expect there to be mistakes like that,” she said. “What you don’t expect is TennCare’s position. … If we bring things to their attention, people are not being put back on.”

Johnson argues that people who have yet to receive a packet should be able to retain coverage until they get their packet at the correct address. Members can reapply, but that process can take months. 

It gets more complicated with appealable issues. Even if a person never received a packet, they have 90 days to appeal losing their coverage, and often times that window has closed. 

“You can't cut someone off without first giving someone notice, and if [TennCare staff] admit that the notice was sent to the wrong place, that is the very definition of what would be an appealable issue. But TennCare says it's not an appealable issue, and so therefore people are cut off improperly” Johnson told the Post. 

TennCare spokesperson Amy Lawrence told the Post in a statement: "TennCare maintains open lines of communication with the advocacy community, including the Tennessee Justice Center. If they ever encountered an issue that couldn’t be resolved through the normal processes, such as appeals, outreach to TennCare can provide a resolution."

The proliferation of clerical errors is not different from what’s been happening before the pandemic, Johnson said. Still, one improvement is a computer system launched in 2019 that patients can log on to track if they are covered, when they are set to renew their coverage and whether TennCare received their packet. Tennessee Justice Center does this on behalf of many of its clients. 

What makes the past year or so different than before is that it involved more people — 500,000 or so who are now without coverage. 

This article was first published by our sister publication the Nashville Post.