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They lost Medicaid when paperwork was sent to an empty field, signaling the mess to come

Brett Kelman, Kaiser Health News on

Published in News & Features

BELFAST, Tenn. — Three years ago, Mason Lester, a rambunctious toddler, tumbled off his family’s porch and broke his wrist. His mother, nine months pregnant, rushed him to a nearby hospital, where she made a confounding discovery: Their health insurance had vanished.

Alarmed, Katie Lester called the Tennessee Medicaid agency, TennCare, which had covered her during a prior pregnancy and insured Mason since the day he was born.

TennCare said they were no longer enrolled because the family failed to respond to a packet of essential paperwork. But Lester hadn’t seen the packet, nor a termination letter. Years would pass before it became clear what went wrong: Due to a clerical error, TennCare had mailed both to a horse pasture.

The loss of Medicaid was catastrophic for the Lesters, an impoverished family that owns a small lawn-cutting business in Belfast, a town of 600 about an hour south of Nashville. Lester and her husband appealed TennCare’s decision but were rejected. They reapplied and were denied after mailed paperwork once again failed to reach their home. The Lesters said they were left uninsured for most of the next three years, during which the coronavirus, injuries, and a cesarean birth buried them under more than $100,000 of debt, which savaged their credit and dashed plans to buy their first home.

“It was like we just got run over by a bus when I found out we didn’t have insurance,” Lester said.

The Lesters’ story may be a warning of what’s to come for many poor Americans. Because of the COVID-19 public health emergency, TennCare and Medicaid programs in other states largely have been barred from dropping anyone, and Medicaid enrollment has swelled to historical highs. But when the emergency is declared over, states will once again require families to prove they are poor enough to qualify for coverage. Millions are expected to lose their insurance in the year that follows, including countless people like the Lesters who meet the requirements for Medicaid but get lost in its labyrinthine bureaucracy.


“People are falling through the cracks. And we need something there to catch them before they are swallowed up in the abyss.”

Problems with the verification process have long shadowed TennCare, an agency that prides itself on keeping enrollment small and spending lean. State officials have for years been criticized for requiring Tennesseans to navigate a thicket of paperwork. Prior investigations of TennCare revealed that most people are dropped because of incomplete or unreturned forms. As few as 5% of those dropped are found to be ineligible.

Thirty-five TennCare members challenged its “defective” renewal process in a class-action lawsuit in 2020, and the ongoing case recently added plaintiffs, including the Lesters. The lawsuit accuses TennCare of befuddling its members with vague and contradictory instructions; demanding information it already has or does not need; ignoring the info that members provide; improperly rejecting termination appeals; and, sometimes, sending essential paperwork to addresses that it “knows, or should know,” are wrong.

Michele Johnson, executive director of the nonprofit Tennessee Justice Center, which leads the lawsuit, described TennCare’s renewal process as a “gotcha game.”


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