Phil Bredesen, the health insurance executive turned governor, had an antidote to contain the spiraling costs of the state’s Medicaid program – disenroll elderly, sick and disabled Tennesseans from TennCare.
According to Gordon Bonnyman, co-founder of the Tennessee Justice Center, two years into Bredesen’s first term as governor, “[a]pproximately 200,000 of [TennCare’s] costliest patients lost their coverage over a four-month period in late 2005.” Bonnyman characterized this group as the “sickest subgroup of the TennCare population.”
The TNReport calculated that by the time Bredesen left office in 2011, approximately 350,000 Tennesseans were cut from TennCare which included an estimated 100,000 people with disabilities.
At the same time that Tennesseans were losing their TennCare coverage, refugees being resettled in the state were being assisted by refugee resettlement contractors to enroll into TennCare.
A spokesman for State Senator Bill Ketron’s office confirmed to The Tennessee Star that Holly Johnson, director of Catholic Charities’ Tennessee (CCTN) Office for Refugees (TOR) provided data requested by the Senator which included the number of arriving refugees being enrolled into TennCare. Senator Ketron’s office shared that data with The Star.
Bredesen’s action several years earlier of withdrawing Tennessee from administering the federal refugee program created the opportunity for the U.S. Office of Refugee Resettlement (ORR) to hand over running of the state’s program to Catholic Charities. With its new designation from the U.S.ORR and more federal funding, CCTN expanded refugee operations and established TOR to coordinate all refugee resettlement in the state.
Between 2003 and 2011, Bredesen’s last year as governor, over 9,000 refugees of multiple ethnicities were brought to Tennessee by federal contractors.
The data provided by TOR to Senator Ketron showed that in FY2010, federal contractors resettled 1,734 refugees in Tennessee and 1,157 in FY2011. Forty-eight percent of the refugees arriving in 2010 and 58 percent arriving in 2011, were assisted by refugee contractors to enroll into TennCare.
In 2010, when 834 refugees reported by TOR were applying for TennCare benefits, Tennesseans Ashley Manes and Jessica Pipkin, both of whom were paralyzed as a result of car accidents, were dropped from TennCare per Bredesen’s disenrollment plan.
Ashley Manes who was 14-years old in 2010, when her TennCare coverage was discontinued, had been paralyzed and ventilator dependent since age 4 when she was injured in the car accident.
Jessica Pipkin, a 28-year old mother of two in 2010, also lost the TennCare services that enabled her to live at home with her husband and children.
Ashley and Jessica were part of a group estimated at “[a]bout 100,000 people — mostly elderly or disabled residents — have been dropped since January 2009, including approximately 37,000 who had relied on the state program for all their health care needs.”
Jessica was reported to have been dropped from TennCare because she had lost her eligibility for SSI – the federal Supplemental Security Income benefit provided to help elderly, blind and people with disabilities to obtain food, clothing and shelter, but who have “little or no income.” When Jessica was able to qualify for Social Security Disability benefits which are separate from SSI, the $14,400 she received, combined with her husband’s $19,000 annual salary, was deemed too high to qualify for SSI, the benefit that made her eligible for TennCare.
Similar to other people who rely on nursing care, medications and assistance with many daily tasks in order to live with their families or in their communities as opposed to nursing homes, the cost of Jessica’s care outstripped her family’s income which was considered too high to have allowed her to keep her TennCare coverage.
Unlike other immigrants, refugees brought to the U.S. are immediately able to apply for all public assistance benefits such as food stamps, medicaid, cash welfare and public housing but must meet the same eligibility requirements as U.S. citizens in order to receive the benefits.
In March 2017, the Tennessee General Assembly representing the State, sued the federal government for violating the Tenth Amendment by forcing the state to use its revenue to pay certain costs related to refugees that were supposed to be paid for by the federal government. When a refugee enrolls into TennCare, only part of that cost is paid by the federal government with the remainder paid from state revenues.
The Thomas More Law Center is handling Tennessee’s lawsuit which has been appealed to the U.S. Court of Appeals for the Sixth Circuit.