Team Up for Your Child breaks through the confusion of dealing with doctors, therapists, school staff, insurers, and social agencies. 

by Wendy Lowe Besmann

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Team Up for Your Child in the News

Wendy, her son David and Team Up for Your Child were recently profiled in

http://www.knoxnews.com/news/2009/may/06/agony-autistic-child-prompts-writing-special-needs/


 

Team Up State-By-State Guide

(Team Up for Your Child began as a statewide community project in Tennessee.  Resources from that first TN edition are listed below.  We hope to include more state resources as this page develops.)

1. Resource Information for Tennesseans


PLEASE NOTE: Due to major budget cuts and reorganization in Tennessee government, some of these details may change in the coming months. One good source of information about TennCare is TPAL (TennCare Partners Advocacy Line), at 800-758-1638. Para obtener asistencia en español, por favor llame al 800-254-7568.

You can also findinformation at the official Tennessee state government website http://www.tennesseeanytime.org

Two excellent sources of general information for Tennessee families are the websites of NAMI Tennessee www.namitn.org and Tennessee Voices for Children www.tnvoices.org. Find out more about these organizations on this page.

We will update details on this site as they become available.

 

Tennessee Public Health Insurance: The Basics

Tennessee currently has two public health insurance plans that provide services to children whose families qualify because they cannot afford to buy insurance. These plans are called TennCare and CoverKids. TennCare, which is part of the federal Medicaid program, offers free or low-cost health care to families with low income, unpaid medical bills, or disabilities.

CoverKids is part of CoverTennessee, a fairly new state program for uninsured families that don’t qualify for TennCare. You have to apply for TennCare first before you can be considered for CoverTennessee.

Here’s how the process works:

 

1. Fill out an application for TennCare.

 

You can pick up the form at any office of the Department of Human Services. (Forms to help families apply for these services are often sent home by schools at the beginning of the year, too.) Fill out the form, sign it, and return it to the office in person, by mail, or by fax. DHS staff can help you complete the form.

If you need help finding the nearest DHS office, call Health Care for Children at 800-280-8682.

 

2. Wait for a DHS appointment letter.

DHS will send you a letter with an appointment day and time. This is called an intake appointment.

If you can’t meet your DHS appointment time, call the Family Assistance Service Center at 866-311-4287.

 

3. Gather Your Documents

 

You will need to take the papers listed below to the appointment. If you can’t find some of these papers, DHS staff can help. Bring the following:

  • Your photo ID
  • Your Child’s birth Certificate
  • Your child’s Social Security card
  • Proof of your child’s legal U.S. status
  • Proof of your address
  • Proof of your family’s income

DHS may also need proof of these other things listed below:

  • Any medical bills your family owes
  • Your family’s savings and resources
  • Whether your place of work offers health insurance

Be sure to get the DHS caseworker’s first and last name and a phone number. Put this in a safe place with your other important papers. A 2-inch three-ring binder is the best place to keep important papers, so they don’t get lost.

 

4. Wait for your DHS eligibility letter.

If your child’s application for TennCare is approved, the letter will give you details about your child’s health plan, the organizations (called an MCO—Managed Care Organization—or BHO—Behavioral Health Organization. This information will also tell which doctors your child can see for treatment. You will also be offered a health plan case manager. Be sure to say yes to this offer, because the case manager can help you work out any problems that may happen later.

How to keep tennCare: Once a year, kids with Medicaid (called TennCare in tennessee) have to recertify to show that they are still eligible. When it’s time to recertify, DHS will send your paperwork in the mail. Always do your DHS paperwork right away and turn in the forms on time. If you miss the dealine, your child will lose his or her insurance coverage and may not be able to get it back.

Many children lose their TennCare insurance because DHS does not have a current address for the family. If you have moved in the last year, call the Family Assistance Service Center at 866-311-4287 to check the address in your computer file. This number connects you to a state government office, so the staff can also help you with appeals.

If your child is not approved, you can apply for CoverKids.

 

Four Ways a Family Can Qualify for TennCare:

 

1. If your family is low-income.

 

TennCare Medicaid PLIS (“Poverty Level Income Standard”) is for children under age 19 and pregnant women whose family’s monthly income falls below a certain level. It doesn’t matter if the family has savings or other insurance. If you have employer insurance and it doesn’t include mental health benefits, it’s a good idea to apply for Medicaid for your child. It is easiest to get Medicaid if your child is under six.

2. If you have unpaid medical bills.

 

TennCare Medicaid Spend Down is for children under 21 and pregnant women who have unpaid medical bills and very few resources. There is no income limit to qualify for this program, and your child can have other insurance. “Resources” are defined as valuable things you own, such as your savings, a boat, land, or a home you don’t live in (the house you live in or the car you use to go to work don’t count). If you have too many resources, your child won’t qualify for this program.

3. If your child has a disability.

 

Both children and adults who get Supplemental Security Income (SSI) because of a disability (including mental illness) also qualify for TennCare Medicaid. To find out if your child can get SSI, and how to apply, call the Social Security Administration at 800-772-1213 or go to www.ssa.org

4. If your family is losing TennCare.

 

If your family no longer qualifies for Medicaid because your income is too high, your child may be able to get TennCare Standard health insurance. (This is called “rolling over.”) TennCare Standard has all the same benefits as Medicaid-based TennCare, but you will pay a low monthly premium (the amount you owe each month whether or not your child sees the doctor) and a co-payment for each visit.

 

How to Get CoverKids

 

CoverKids provides basic health coverage, including behavioral health care benefits, for kids from birth to age 19, and for pregnant women. Only people who don’t qualify for TennCare can get this insurance. With CoverKids, you will pay a small co-payment for some types of doctor visits, and a low rate for generic medications. Unless your child is losing TennCare, he or she must already have been without health insurance for six months to qualify for this program.

Your child must also be a U.S. citizen or eligible immigrant, and a Tennessee resident. (NOTE: YOU as a parent do not need to be a U.S. citizen or eligible immigrant. ) If your family doesn’t meet the income limits, you can still purchase a CoverKids policy, but the cost is very high.

IMPORTANT NOTE: Although the state helps pay for your child’s CoverKids plan, this is actually a private health insurance policy.

You will need to deal directly with the company that manages your plan, and you will not have a case manager unless you need (and usually ask for) one to deal with a specific problem. Helplines such as

HealthCare for Children, Tennessee Protection and Advocacy Line (TPAL), and the Family Assistance Service Center will not be able to help you, either.

To get information on how to apply for CoverKids, call 866-268-3786 (C-O-V-E-R-T-N) or go to www.covertn.gov. If you need help completing an application, call 866-620-8864.

 

TennCare Help by Phone

For help with questions about TennCare mental health or substance abuse coverage, the best place to call is TennCare Partners Advocacy Line, 800-758-1638. Staff can look at parts of your child’s TennCare computer file to answer questions about eligibility.They can tell you where to find treatment, and they can call other agencies to get problems solved.

 

Para obtener asistencia

en español, por favor llame al 800-254-7568.

 

You can appeal decisions about medical and prescription drug benefits by calling TennCare Solutions, a state government office, at 800 -878 -3192. If you use a TTY or TDD machine, call 800 -772-7647.

 

Other Tennessee Resources for Help and Information

 

How to Find Your Nearest NAMI

NAMI Tennessee is an affiliate of National Alliance on Mental Illness, the nation’s largest grassroots mental health organization. NAMI has affiliates in more than 1100 communities across America. NAMI Tennessee provides education, support, and public advocacy programs throughout the state through its Nashville-based headquarters and its 40-plus affiliates from Memphis to Mountain City.

A free, six-session course for “primary care providers” of children and teens with behavioral health problems is provided at many locations across the state. Parents, grandparents, aunts, uncles, respite care providers, or foster parents find a safe, supportive place to share experiences with other adults who also care for children with biologically-based illnesses such as ADHD, Anxiety and Panic Disorders, Bipolar Disorder, Conduct Disorder, Depression, Eating Disorders, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, and Schizophrenia. Specially trained volunteers who are also primary care providers for children with mental illness teach all classes. The course covers:


• Symptoms and treatment for specific disorders. • Organization and record keeping.
• Problem management and handling conflict. • Understanding the juvenile justice system.
•Working as allies with the school system. • Coping and self-care techniques.


Many local NAMI affiliates also provide regular support groups for family members of adults with mental illness and primary caregivers of children with mental illness. For information on these and other NAMI Tennessee programs or to find the nearest affiliate, go to www.namitn.org or call 800-467-3589.

 

Emergency Resources:

 

The state provides free Specialized Crisis Services for children and adolescents whose symptoms pose a serious risk of harm to themselves or others. Trained staff comes to the child’s location to assess (determine by using certain rules or standards) the child’s need for emergency services. This service is typically faster and less stressful than calling 911. If police answer a 911 call, officers may need to transport your child to a regular hospital emergency room; they’ll then call a specialized crisis services team to determine if your child needs emergency care.

 

To reach a Specialized Crisis Services unit, call the toll-free number for your region, listed below. Calls are answered 24 hours a day, seven day a week.

 

 

Memphis region: 866-791-9226

Rural West Tennessee: 866-791-9227

Rural Middle Tennessee: 866-791-9222

Nashville region: 866-791-9221

Upper Cumberland: 866-791-9223

Southeast Tennessee: 866-791-9225

Northeast Tennessee: 866-791-9224

 

Other Helpful Resources:

 


Tennessee Voices for Children
www.tnvoices.org
800-670-9882 (TN)

State and regional staff provide advocacy, training, assistance, and support to families through a broad array of community programs, including systems of care. The site has a wealth of information; for more TN community resources, see especially

http://tnvoices.org/resources.htm

 

Disability Law Advocacy
Center of Tennessee
www.dlactn.org
800-342-1660 (TN).
TTY 1-888-852-2852

Information, advice, and advocacy on legal issues affecting adults
and children with disabilities.

Support and Training for
Exceptional Parents (STEP)
www.tnstep.org
800-280-7837; TTY: 423-639-8802
800-975-2919 (Spanish)

Excellent free classes for parents on special education basics.