Analysis Health Systems

Low-Income Tennesseans in 100-Page Fight to Keep Medicare Assistance

S. Heather Duncan

Thousands of Tennesseans were removed from a federal Medicare Savings Program because they didn’t complete paperwork. State officials say they mailed a warning—but advocates say few received notice.

Thomas Radford was stunned when he opened the letter telling him his next Social Security check, which pays all his bills, would drop by $200. The following month, the amount would drop by another $200. Radford, a double-amputee, didn’t know why. He didn’t how to ask the government.

But he did know who to ask in his Knoxville, Tennessee, neighborhood, where dogs patrol the small yards of 1940s bungalows clustered next to the interstate. He swung into his electric wheelchair and rolled across the homemade wooden ramp to see Dawn Schneider next door.

Once he told her the story, she began making phone calls.

Radford and thousands of other Tennesseans had been removed from a federal Medicare Savings Program (MSP), which covers Medicare Part B premiums and co-pays, because they didn’t complete paperwork verifying their income. State officials say they have mailed more than 50,000 recipients each a packet of forms over the last few months to determine eligibility for the MSP program before Social Security payments were cut.

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But advocates say few actually received any notice before the federal government docked months of “overpayments” from their Social Security checkssometimes all at once.

“I know three people within 15 houses who didn’t get them,” Schneider told Rewire. “The first they knew was when their Social Security checks were cut …. My neighborhe’s 67 …. Sorry, his bootstraps have broke a long time ago.”

In Tennessee, MSP enrollment is managed by the state Medicaid program, called TennCare. According to federal regulations, the financial eligibility of the 55,000 Tennesseans in MSPs is supposed to be “redetermined” each year. But due to the botched rollout of a new computer tracking system, Tennessee failed to check the eligibility of participants after 2013. Tennessee did not verify the eligibility of recipients again until early 2017, when re-determination packets started to be mailed.

The nonprofit Tennessee Justice Center and other advocates for people with disabilities say TennCare has botched the effort again by illegitimately ending coverage for thousands of people who never received the paperwork.

Chris Coleman, a staff attorney for the Nashville-based Tennessee Justice Center, said so many are being dropped from MSPs that he thinks many of the verification packets were never mailed properly. “But if TennCare says they sent it, it doesn’t matter that thousands and thousands of people didn’t get them,” he said.

TennCare spokesperson Sarah Tanksley said the state has no record of how many people lost their MSP coverage this year for failing to verify their income. “We are processing tens of thousands of re-determinations every month, of which individuals with MSP coverage make up a relatively small percentage,” she wrote to Rewire in an email. “There has been no practical or programmatic reason to segregate out this population for any specialized reporting.”

Tanksley said TennCare has no evidence there were problems with the mailing, which was handled by an outside contractor, adding that there are “several check and balance points throughout the mail cycle to ensure we are 100 percent accountable for each packet mailed.”

Tanksley said TennCare has agreed to improve its labeling of the packets. But Coleman said TennCare refuses to check Tennessee’s own databases for alternate addresses, phone numbers, or contact emails before terminating coverage.

This situation arises in Tennessee at a time when the Republican-controlled White House and Congress have health care in their crosshairs. Unsuccessful GOP health-care bills this summer would have affected Medicare Part B, although the details went unexplored in the rush to vote. The Graham-Cassidy Senate bill, which failed to muster enough support for a vote, aimed to give states more control over health care. In Tennessee, where President Donald Trump won with more than 60 percent of the vote, the bill likely would have shifted even more health-care management to TennCare—the same administrators who have struggled to manage MSP.

There have been enough stories like Radford’s that Tennessee Speaker of the House Beth Harwell (R-Nashville) asked the state comptroller’s office in August to investigate TennCare’s re-determination process. (Harwell, a longtime supporter of President Donald Trump, is also running for governor of the state in 2018.)

Comptroller spokesperson John Dunn said the office is conducting “a review, not an investigation,” and declined to detail what it includes. He said the office plans to complete its report before the state legislature reconvenes in January.

Coleman argued that until the comptroller’s report is complete, TennCare should stop cutting people off the Medical Savings Program. “We don’t know what the problem is, but we do know seniors are losing their Social Security checks across the state through no fault of their own,” said Coleman, adding that the Tennessee Justice Center has not ruled out suing the state on behalf of these recipients. “People are in dire straits,” he added.

However, he did praise TennCare for being willing to provide backdated reimbursement for paperwork that arrives up to 90 days late, which is not required by federal law. Even so, reimbursement and restored Social Security payments generally take three months to return to normal, Coleman said.

Peggy Ransom, a nurse and manager helping seniors at the Knoxville-Knox County Community Action Committee Office on Aging, said her office has fielded “many” calls from seniors whose Social Security checks had been slashed. According to Ransom, some people didn’t think the verification packet applied to them because the MSP paperwork was labeled as being “important information about your TennCare.” Many aren’t on TennCare and don’t know it administers the Medical Savings Program. Others were too intimidated by the 100-page packet that alternated between English and Spanish, Ransom said.

The Office on Aging has helped some with appeals, but Ransom said she hasn’t heard of anyone receiving reimbursements yet.

Radford, who lost his legs years ago because of working conditions in a meat packing plant, said he first hoped to make up some of his financial loss by cutting neighbors’ lawns on his riding mower. “But the mower messed up, and I had to have somebody push me back,” he said. The Vietnam veteran ended up eating less and shutting off his air conditioning during Tennessee’s 90-degree summer heat.

Selling odds and ends at an impromptu flea market in an empty lot last week, Radford ran his palm over his bald head as he recalled to Rewire the anxiety of trying to get his paperwork straightened out. Tennessee didn’t make it easy. The state doesn’t allow people to pick up a verification packet in person or fill one out online; he had to await the arrival of a new, 100-page packet through the mail. Twice TennCare returned his application, requesting more proof of income.

Finally, the deadline was so close Radford needed to fax his amended paperwork. But the state wouldn’t acknowledge receiving it on time unless he could get a fax verification page, scan it, and email it back, too.

His neighbor, Schneider, tried to help. But it’s expensive to send such a huge fax. The Office on Aging couldn’t provide a receipt, and her bank would only send encrypted faxes TennCare wouldn’t accept. With the clock ticking, Schneider called a state legislator in desperation. The Tennessee senator agreed to pick up the paperwork from Knoxville and deliver it halfway across the state to Nashville himself.

“These are populations that are just going to need some help,” said Coleman, adding that the state should never have eliminated in-person assistance three years ago. “When they get a 100-page packet in the mail, they just think, ‘Oh my God, I’ll never be able to do this.’”

Radford was finally reinstated into the Medical Savings Program, receiving a reimbursement and his full Social Security benefits. “But if it hadn’t have been for Dawn, I probably never would have got it,” he said.

Schneider, who is close to retirement, herself suffered brain-damage as a teenager in a car accident that killed her parents. In her free time, she DJs on a local radio show, her gravelly voice explaining disability issues between songs.

Schneider has helped three other neighbors and acquaintances with the TennCare paperwork. But most elderly and Tennesseans with disabilities don’t have someone like her next door. “Getting those enrollment numbers down was clearly a goal,” Coleman said. “At the top they see that and think that’s good, and don’t realize the human cost of their process, and don’t have any incentive to find out.”

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