ADVERTISEMENT
ADVERTISEMENT
Staff file photo by Doug StricklandOrthopedist Dr. Jad Dorizas gives a patient a viscosupplementation injection in this June photo in the offices of UT Erlanger OrthoSouth at Erlanger hospital in Chattanooga. TennCare, the state's Medicaid program, is switching vendors in hopes of getting its dysfunctional telephone help line working properly at last.

In early 2014, Tennesseans trying to get enrolled in the state's Medicaid program faced a strange new landscape with few guides to help them.

Changes under the Affordable Care Act meant the state's rules for determining Medicaid eligibility had changed. But TennCare, far behind on finishing a computer system that would make those determinations, was telling people to enroll through the still-glitchy federal site, HealthCare.gov.

Meanwhile, the TennCare staffers at all Department of Human Services offices were removed. People who had questions about their applications were handed a little blue card and told to call a new help line, the Tennessee Health Connection.

For pregnant mothers, new parents trying to get coverage for their children, and people with disabilities, the 1-800 number was supposed to be a human connection to help them wade through the complexities of TennCare.

But for many, it has been just the opposite. While problems with the new state system mounted, some reported being sent in circles to other state or federal agencies. Others said they were told they could not access programs they should have been eligible for.

"A help line was supposed to lighten the impact of the changes, but it only added to the confusion and the mess. It made it all worse," said Michele Johnson, director of the Tennessee Justice Center, which has sued the state for months-long delays applicants faced when trying to get coverage last year.

TennCare officials are now acknowledging problems with the hot line as they terminate their $31 million contract with the previous vendor, Cognosante, LLC, and bring on a new vendor, Automated Health System, with a $56.4 million contract.

"Cognosante also was not consistently meeting all of the performance measures included in the contract," said TennCare spokeswoman Kelly Gunderson, adding that the contract was mutually terminated.

The vendor switch comes as TennCare is going back to the drawing board with a related tech project more than two years behind schedule: The $37.5 million computer system that was supposed to determine people's TennCare eligibility in the first place.

A consultant's report released in January said the Tennessee Eligibility Determination System — dubbed TEDS — was nowhere near completion and consistently has missed ongoing performance benchmarks.

The state paid Northrop Grumman more than $6 million for the largely-failed system. Because 90 percent of the project was funded by the federal government, the state is out about $600,000.

For the Tennessee Health Connection system, the state had already paid about half of the $31 million contract to Cognosante, Gunderson said.

The contract with Automated Health Systems is set for three years and five months.

"This transition to a new call center vendor is another example of the state continuously improving processes and customer experience and holding our contracted vendors accountable," said Gunderson.

Johnson said that while the programs have led to unnecessary woes for Tennesseans, "it is good that the state has recognized that Tennessee taxpayers are not getting their money's worth."

The lawsuit filed by the Tennessee Justice Center, the Southern Poverty Law Center and the National Health Law Program against TennCare for the delays is pending in federal court in Nashville, while TennCare appeals a judge's ruling that forced the agency to speed up its eligibility decisions to less than 45 days and gave the lawsuit class action status.

For the time being, people who have been waiting more than 45 days for determinations about their coverage have the right to a hearing, the U.S. District Judge Todd J. Campbell decided last fall.

Gunderson said the state "continues to resolve such appeals by making an eligibility determination in the case so that a hearing is not necessary."

Contact staff writer Kate Belz at kbelz@timesfreepress.com or 423-757-6673.

ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT