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Report
Health Access and
Health Department
Resources
Becky Brumley, RDH, MPH
Care Coordination Director
Tennessee Chapter of the American Academy Pediatrics
[email protected]
TennCare Medicaid
 TennCare Medicaid is for Tennesseans who are
eligible for a Medicaid program. You can apply anytime
for TennCare Medicaid.
 There are several different groups of people that may
qualify. And, each group has different income limits.
Some of the groups also have limits on how much you
own-your "resources." These are things like bank
accounts, cars, and land. The number of people who
live in your household count too.
TennCare Medicaid covers are:
 Children under age 21 that are financially eligible, income limits vary by age of
child
 Low income pregnant women
 Parents or caretakers relatives of a minor child(ren)
 Newborns-children who are born to Medicaid eligible women
 Medically Needy –low income person who are also one of the following:
 Some children up to age 21
 A pregnant woman or child under age 18
 Supplemental Security Income (SSI) - low income age, blind and/or disabled
individuals.
 Low income persons who require care in a nursing facility or intermediate
care facility for the mentally retarded r who receive Home and Communitybased Services
 Tennessee women who are uninsured or whose insurance does not cover
treatment for breast or cervical cancer, who are under age 65, and who have
been determined by the County Health Department to need treatment for
breast or cervical cancer need of treatment for breast or cervical cancer
TennCare Standard
 Uninsured - is only available for children under age 19
whose TennCare Medicaid eligibility is ending, who o
not have access to insurance through a job or a
family’s member job, and whose family incomes are
below 212% poverty.
 Medically eligible – is available only to children under
age 19 whose TennCare Medicaid eligibility is ending
and whose family income equals or is greater than
212% of poverty. To be medically eligible, the child
must have health conditions that make the childe
“uninsurable.” The family is unable to purchase
healthcare insurance for the child in the private market
because of the child’s health conditions.
 Eligibility is determined by TennCare
Medicare Cost Sharing Programs
 Cost sharing assistance for low income Medicare
beneficiaries.
 Low income disabled working individuals under 65
who are entitled to Medicare Part A.
 Low income persons eligible for Medicare Part A.
 Low income Medicare beneficiaries
 All categories must meet one of the other Medicaid
categories for low income and resource limits.
 Applications are provided from the Tennessee
Health Connection at 1-855-259-0701.
How to Apply for TennCare
If you need assistance with TennCare
Tennessee Health Connection
1-800-259-0701
Health Insurance marketplace
 1-800-318-2596
 can apply online at the Health Insurance marketplace
 https://www.healthcare.gov
 Print an application
 http://marketplace.cms.gov/getofficialresources/publicationsand-articles/marketplace-application-for-family.pdf
Cover Kids

Age 18 or younger

Household income up to 250% of federal poverty level (FPL)

Buy-in is available for children with higher incomes

A Tennessee resident

U.S. citizen or qualified legal alien (babies born in the U.S. will be considered U.S. citizens)

“Go Bare” (without health coverage): three months. Waived for newborns up to 4 months of age,
waived for children moving to CoverKids from TennCare or from another state SCHIP program

Screened first for TennCare eligibility or access to other state-sponsored insurance

Federal guidelines prohibit children of state em-12 teachers and full-time support staff from
participating in this program

Maternity coverage available for pregnant women at or below 250% of the federal poverty level who
meet other eligibility criteri.

CoverKids must be your only health plan. To get benefits, your child cannot be part of any other plan.
You cannot use CoverKids as a second health plan

HealthyTNBabies covers pregnant women who do not have maternity health benefits, you cannot use
CoverKids HealthyTNBabies as a second health plan.
Cover RX
To be eligible to participate in CoverRx, applicants must meet the following
eligibility guidelines.
 Tennessee resident (six months)
 Age 19-64
 U.S. citizen or qualified legal alien
 Household income below the federal poverty level (FPL)
 Cannot have pharmacy coverage such as TennCare or employer insurance
 Cannot have Medicare (any part including A, B, C or D)
 CoverRx members may participate in other discount drug programs, such as
those offered by retail stores
 Effective January 1, 2014, income guidelines for eligibility changed and only
individuals with a household income below 100% federal poverty level will be
eligible to apply for CoverRx benefits.
To Apply for Cover TN programs
 http://www.covertn.gov/
 http://www.coverkids.com/
Federal Poverty Rates
2013 POVERTY GUIDELINES
ALL STATES (EXCEPT ALASKA AND HAWAII) AND D.C.
ANNUAL GUIDELINES
FAMILY
SIZE
1
2
3
4
5
6
7
8
100%
11,490.00
15,510.00
19,530.00
23,550.00
27,570.00
31,590.00
35,610.00
39,630.00
120%
13,788.00
18,612.00
23,436.00
28,260.00
33,084.00
37,908.00
42,732.00
47,556.00
133%
15,281.70
20,628.30
25,974.90
31,321.50
36,668.10
42,014.70
47,361.30
52,707.90
PERCENT OF POVERTY GUIDELINE
135%
150%
175%
15,511.50
17,235.00
20,107.50
20,938.50
23,265.00
27,142.50
26,365.50
29,295.00
34,177.50
31,792.50
35,325.00
41,212.50
37,219.50
41,355.00
48,247.50
42,646.50
47,385.00
55,282.50
48,073.50
53,415.00
62,317.50
53,500.50
59,445.00
69,352.50
185%
21,256.50
28,693.50
36,130.50
43,567.50
51,004.50
58,441.50
65,878.50
73,315.50
200%
22,980.00
31,020.00
39,060.00
47,100.00
55,140.00
63,180.00
71,220.00
79,260.00
250%
28,725.00
38,775.00
48,825.00
58,875.00
68,925.00
78,975.00
89,025.00
99,075.00
185%
1,771.38
2,391.13
3,010.88
3,630.63
4,250.38
4,870.13
5,489.88
6,109.63
200%
1,915.00
2,585.00
3,255.00
3,925.00
4,595.00
5,265.00
5,935.00
6,605.00
250%
2,393.75
3,231.25
4,068.75
4,906.25
5,743.75
6,581.25
7,418.75
8,256.25
For family units of more than 8 members, add $4,020 for each additional member.
MONTHLY GUIDELINES
FAMILY
SIZE
1
2
3
4
5
6
7
8
100%
957.50
1,292.50
1,627.50
1,962.50
2,297.50
2,632.50
2,967.50
3,302.50
120%
1,149.00
1,551.00
1,953.00
2,355.00
2,757.00
3,159.00
3,561.00
3,963.00
Produced by: CMCS/CAHPG/DEEO
133%
1,273.48
1,719.03
2,164.58
2,610.13
3,055.68
3,501.23
3,946.78
4,392.33
PERCENT OF POVERTY GUIDELINE
135%
150%
175%
1,292.63
1,436.25
1,675.63
1,744.88
1,938.75
2,261.88
2,197.13
2,441.25
2,848.13
2,649.38
2,943.75
3,434.38
3,101.63
3,446.25
4,020.63
3,553.88
3,948.75
4,606.88
4,006.13
4,451.25
5,193.13
4,458.38
4,953.75
5,779.38
HEALTH INSURANCE
MARKETPLACE
Health Insurance marketplace
 1-800-318-2596
 can apply online at the Health Insurance marketplace
 https://www.healthcare.gov
 Print an application
 http://marketplace.cms.gov/getofficialresources/publicationsand-articles/marketplace-application-for-family.pdf
HEALTH INSURANCE
MARKETPLACE
 2014 Enrollment ended March 31, 2014
 2015 Open Enrollment
 November 15, 2014- February 15, 2015
 Special Enrollment
 60 days following certain life events
 Change in life status
 Marriage
 Birth of a child
 Loss of other health coverage
Health Assist Tennessee
Help Line
Toll Free
Local (Nashville)
English
1-800-269-4038
313-9972
Spanish
1-800-254-7568
227-7568
Kurdish/Arabic
1-877-652-3046
313-9840
Bosnian
1-877-652-3069
313-9382
• Help the uninsured receive medical care, dental, vision and medications
Screening all callers for federal medical programs such as TennCare,
QMB, and SLMB; and state programs such as Cover Kids and Access TN
• Counsel Medicare recipients on Part D and other Medicare related issues,
and give accurate summaries of available pre-existing plans
• Language Services/Medical Interpretation continues to help providers and
organizations when dealing with language barriers in any setting
1-855-CRISIS-1
1-855-274-7471
The ONE Number to call for Mental Health and
Substance Abuse Crisis Services in Tennessee
 Triage
 Early Intervention
 Prevention
 Diversion
 Crisis Assessment &
 Stabilization
Evaluation
TENNESSEE DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
TAADAS
Tennessee Association of Alcohol, Drug and other
Addiction Services
 www.taddas.org
 Tennessee REDLINE Clearinghouse
 (800) 889-9789
 Training
Patient Assistant Programs (PAP)
 NeedyMeds
www.needymeds.org
 RX Outreach
 Drug Companies
Dispensary of Hope
 The Dispensary of Hope works with healthcare
providers, clinics, and pharmaceutical companies
nationwide to provide patients with necessary
prescription care. They do this by distributing unused
sample medications and surplus medications
generated within the manufacturing process-medications that would otherwise be thrown away--to
people without prescription coverage.
 http://www.dispensaryofhope.org
 1-888-428-HOPE
Access Sites
 Centerville
 Chattanooga
 Hohenwald
 Jackson
 Johnson City
 Maryville
 Memphis
 Murfreesboro
 Nashville
www.sightforstudents.org
 Sight for Students is a Vision Sight Plan charity that provides free
vision exams and glasses to low-income, uninsured children. The
program operates nationally through a network of community
partners who identify children in need and VSP network doctors
who provide the eyecare services.
 Community Partners

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




Boy and Girls Clubs
National Head Start Association
National Association of Community Health Centers
National Association of School Nurses
Communities in Schools
Prevent Blindness America
National Council of La Raza
Tennessee
Department of Health
Resources
Family Health and Wellness

Adolescent and Young
Adult Health Initiative

Adolescent Pregnancy
Prevention



Asthma Management
Initiative

Maternal and Child
Health

Diabetes

Newborn Genetic
Screening

Family Planning

Newborn Hearing
Screening

Nutrition Services
Fetal Infant Mortality
Review

Tobacco Use Prevention
and Control
Governor's Council on
Physical Fitness and
Health

Women, Infants and
Children

Farmers Market
Nutritional Program
Breastfeeding

Breast and Cervical
Cancer Screening


Child Fatality Review

Child Nutrition and
Wellness

Special Health Care
Needs (CYSHCN)

Children and Youth with 
Home Visitation
Injury Prevention
Women, Infants and Children
(WIC)
 Federal program through USDA
 Provides a combination of nutrition education, supplemental foods,
breastfeeding promotion and support, and referrals for health care.
 Effective in preventing and improving nutrition related health problems.
 Provides supplemental food to low-income pregnant, postpartum and
breastfeeding women, infants and children until the age of five.
 Types of foods include fruits and vegetables, whole grain foods, low fat milk,
cheese, eggs, peanut butter and dry beans and special foods like soy
beverages and tofu.
 Vouchers are issued to participants and can be used to purchase approved
food items at any of the 900+ participating WIC authorized grocery stores and
pharmacies.
Qualifications for WIC
 Household gross income must be equal to or less than
these WIC income guidelines (185% of Federal
poverty).
 Income eligibility is determined at the county health
department.
 Must be a Tennessee resident
 For women you must be pregnant or breastfeeding
 Children must be present for certification and
recertification
Breast and Cervical Cancer
Program (BCS)
 Provides breast and cervical cancer screening to
eligible women and diagnostic follow up tests for those
with suspicious results.
 Women diagnosed with breast or cervical cancer or
pre-cancerous conditions for these cancers are
enrolled for treatment coverage through the state’s
TennCare Program.
Eligibility Requirements for
BCS
 All women must meet the following general eligibility requirements:
 Age: between 40 and 64
 Income: 250% FPL or less
 Insurance: uninsured or underinsured
 Mammograms are only available for women 50-64. If a woman has
family history of breast cancer she can receive screening services
starting at age 40.
 Women 40 and older can receive Pap tests and other needed
cervical services.
 Women younger than 40 who meet these general eligibility
requirements can be enrolled for diagnosis and/or treatment
services when they have suspicious results from screening
services.
State Hemophilia Program
 Participants must be financially eligible (300% of the Federal
Poverty Guideline) and meet the medical criteria.
 Services covered directly associated with the bleeding disorder
include:
 Blood and blood products (maximum program expenditure for a 12






month period per patient is $15,000)
Recombinate clotting factors
Emergency room services
Professional fees
Clinic fees and Laboratory
Special medical services (i.e., orthopedic appliances, dental and
other extraordinary services, limited to $3000 for a 12-month period).
Insurance premiums: TennCare or COBRA Inpatient, must be bleed
related, with prior authorization
Ancillary Supplies (i.e., syringes, needles, swabs, etc., when related
to bleeding)
Tennessee Renal Disease Program
 Financially eligible at or below 200% of the federal poverty level
 Cost of prescription/over-the-counter drugs required for treatment of
end stage renal disease and not covered by a participant’s third party
insurer.
 In center dialysis services for patients who do not have health
insurance and are ineligible for TennCare during the waiting period
before Medicare eligibility begins
 Payment of Medicare insurance premiums for eligible program
participants including both “Part A” and “Part B” payments
 Costs of a dental evaluation and up to $500.00 on recommended
restoration work with prior approval
 Medicare co-insurance of a participant to dialysis out-of-state for a
maximum of six (6) treatments per year
Program eligibility
 Breast and Cervical
>250%
 TennCare
>200%
 WIC
>185%
 Hemophilia
>300%
 Renal
>200%
Help Us Grow Successfully
(HUGS)
 is a targeted case management program that provides
home-based intervention services to
pregnant/postpartum women, children birth through the
age of five (5) years and their primary caregivers.
 Home visitors screen for and identify potential
problems, provide education, and connect families with
resources in their communities.
 Home visitors form a unique and voluntary relationship
with a family.
 Is available in all counties in Tennessee
Family Planning
 provides the following medical services: physical
exams, cervical cancer screening, breast/testicular
cancer screening, sexually transmitted infection testing,
STI treatment, high blood pressure screening, anemia
screening, pregnancy testing and contraceptive
methods.
 also provides counseling and education regarding
reproductive and other health related topics.
Traumatic Brain Injury (TBI)
 Toll Free 1-800-882-0611
 Service Coordinators are located in various non-profit agencies across the
state providing assistance to survivors and family members.
 Service coordinator works with survivors and their families to assess their
current resources and needs. The service coordinator:




develops a comprehensive plan of care
provides referrals to available resources
coordinates services for individual client advocacy
bridges gaps in the service delivery system.
 provide grants to county and municipal governments and/or non-profit
organizations for home and community based programs to serve the
needs of traumatic brain injury survivors and their families.
Communicable and Environmental Disease
and Emergency Preparedness (CEDEP)
 Appropriate Antibiotic Use
 Emergency Preparedness
 Emerging Infections
 Surveillance and Epidemiology
 Reportable Diseases
 Immunizations
 Sexually Transmitted Infections
 Tuberculosis
Health Statistics
 Health Professional Licensure Data
 Behavioral Risk Factor Surveillance
 Hospital Discharge Data
 Traumatic Brain Injury Data
 CODES (TN Crash Outcome Evaluation System)
 Health Information Tennessee
 Searchable Database




Births
Deaths
Population
Facilities

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