TennCare Choices -- Is it doing enough?

TennCare Choices examined

When you get older, you hope the care you need is available and affordable.

TennCare is Tennessee's Medicaid program. Two years ago, the state implemented some changes that the state says better identifies who should go in a nursing home and who should receive care or help at home.

We talked with Mary Tilson. She has cerebral palsy and has limited use of her arms and legs, so she needs help doing what many of us take for granted: getting out of bed, bathing, and using the bathroom.

Mary's mom used to be her sole caregiver, but it's become too much. She now relies on others to come into their home everyday, three hours in the morning and three hours in the evening.

Sam Ward is one of Mary's caregivers now. She says, "If we didn't show up, she would be laying there basically all day, with bedsores. That's no way to live."

Giving senior citizens and people with disabilities the choice of how and where to live is the basis of the TennCare Choices program. We looked into the program and here's what we found - people who don't want to go to a nursing home, don't have to. They can receive services at home or in community programs, but they have to apply for that assistance. They are then graded on their needs. The higher the score, the more help they get.

We talked to critics of the program who say the scoring system is not realistic and families are suffering.

Carol Westlake, Executive Director of the Tennessee Disability Coalition says, "Sometimes the choice isn't really there." Westlake says by the time someone applies for choices, they need action immediately. If they don't score high enough on the evaluation they  could get limited services or no services at all.
"Our concern is you can spend a lot less now and then spend more later by then someone's health is ruined and they are losing the ability to take care of themselves and then the cost is even more, for longer. "

In recent years, there's been a shift to home care and community based services. In the past, more than 82% of the people served by TennCare were in nursing homes, today it's about half that.  That coupled with the issues with enrollment into the choices program and the eligibility requirements, nursing homes have taken a hit.

We checked out this strict scoring system and found that some people who would have received nursing home care in the past, now don't make the cut.

Suzanne Rich is the Cambridge House Administrator. She says, "You have to not be able to not take medicine, transfer, bathe, you can't do any of these things in order to qualify."

For those who do qualify medically, Rich says there can be delays in getting the financial approval, which means no money for the nursing homes, at least not right away.

We talked to a Patti Killingsworth, Assistant Commissioner and Chief of Long-Term Services and Supports, who says Choices wasn't set up as a cost savings initiative, but as good business that can meet people's needs at the same time. "It was a chance for us to use the state's resources more effectively and begin over time to serve more people in home and community based settings where that was possible and appropriate."

But people like the Tilsons worry saving money could come at a great cost.

Linda Tilson says, "If we accept small cuts now, we can't get it back and they will continue to chip away, chip away, chip away at it."

We asked one more question, What if someone is turned down for nursing care? They can appeal if they believe they should receive more at home or community based services. That is what Mary Tilson is currently doing.  She's appealing a decision to cut her hours of in-home care, but she's been waiting for 30 days and hasn't heard anything yet.
We learned there have been many meetings with lawmakers, TennCare Choices officials and representatives from the different support organizations as well as legal groups. They have submitted recommendations and are waiting for Choices to review them and hopefully make changes.

Sincere there is a lot of information on the Tenncare Choices website about the program. It's recommended you reach out to a lawyer or talk with your local long-term-care ombudsman for information. Click here for more information.

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