The wellbeing of Tennessee’s children is improving, and there is a recent focus on providing healthcare coverage to accelerate progress. Tennessee’s ranking in terms of child wellbeing has improved from 38th to 35th in the nation. Providing health insurance to 95.8 percent of Tennessee’s children contributed to that improvement.

TennCare and CoverKids are instrumental programs, combining to cover over 1 million children in the state. But, there are almost 50,000 uninsured children in Tennessee who qualify for TennCare and CoverKids, yet are not enrolled. A new campaign – “Insure Our Kids” –aims to change that by making the public aware that there are positive, long-term effects of insuring children, almost every child is eligible for free or low-cost coverage, and enrollment assistance is available.

The American Academy of Pediatrics states it should be a national priority to ensure that children will have reached their full potential at the time they transition into adulthood, and health coverage is crucial to that goal. Research has shown that providing comprehensive health coverage to children improves health, education, and economic outcomes. Children who have health insurance do better in school, miss fewer school days due to illness or injury, are more likely to finish high school, attend college and graduate, have fewer emergency room visits and hospitalizations as adults, and earn more as adults.

TennCare and CoverKids cover regular checkups, immunizations, doctor and dentist visits, hospital care, mental health services, prescriptions and more. Having health insurance protects families from financial hardship caused by medical debt, which is the leading cause of personal bankruptcy. Covering children to ensure they have access to healthcare, including routine screening for developmental delays, is a cost-effective way to help children reach their full potential.

Insure Our Kids partners have experience and expertise about the complex eligibility rules that might intimidate the average person … the TennCare eligibility policy is 529 pages long! There are numerous eligibility categories depending on age, income, household size and other factors, but generally, children (and pregnant women) in families with incomes up to 250 percent of the federal poverty level ($61,500 for a family of four) are eligible for TennCare or CoverKids. Even children in families that have incomes above this limit could qualify if the child has significant healthcare expenses under the “medically needy spend-down” provision of TennCare.

Almost every child is eligible for coverage, but one key limitation on eligibility stems from Tennessee’s decision not to eliminate a five-year wait for lawfully residing immigrant children and pregnant women to enroll in TennCare or CoverKids. However, prenatal care and delivery is covered for pregnant women regardless of immigration status, and, of course, children born in the state are eligible for these programs notwithstanding their parents’ immigration status. Also, Tennessee has not expanded Medicaid eligibility under the Affordable Care Act to cover more adults, which impacts children’s access to care. Children with Medicaid whose parents enrolled after expansion were 29 percent more likely to get annual well child visits.

In addition to the complexity and limitations on eligibility, the lack of a state application portal creates a barrier for families seeking coverage. Delays in developing the TennCare Eligibility Determination System (TEDS) have resulted in Tennessee being the only state without an automated Medicaid eligibility system, which forces all families and children to apply for Medicaid via the federal marketplace. The marketplace is incapable of assessing eligibility for several types of coverage (e.g., medically needy spend-down) that are particularly important to children with complex needs. Also, the state limits presumptive eligibility to pregnant women, infants and hospitalized children, parents and caretaker relatives, while other states have adopted more streamlined eligibility and enrollment processes. Tennessee is one of only four states that does not use an automated process for Medicaid renewals.

Despite not having an updated computer system, the Bureau of TennCare resumed redeterminations in the summer of 2016 to comply with the Affordable Care Act. The redetermination process, which hinges on members receiving and timely returning a 98-page packet, has resulted in the inadvertent loss of coverage of many people who remain eligible. Some families have learned that they have been disenrolled only after visiting the doctor. The Tennessee Comptroller launched a review of TennCare processes, which led to several findings regarding problems along with recommendations to address them. CoverKids is separately administered by BlueCross BlueShield of Tennessee, so it does not have the same problems as TennCare, but there is no in-person assistance.

To overcome these hurdles, the Insure Our Kids campaign is providing free assistance to help children get enrolled in TennCare and CoverKids. The Tennessee Justice Center is leading the campaign and has partnered with several organizations to provide trainings to people who encounter uninsured children and to share information with the public. Enrollment assistance is currently available via telephone and may be provided at in-person events in the future. For more information, including a list of partners, volunteer opportunities and resources, visit


NMN April Blog.Insure Kids.Kinika YoungKinika Young is director of Children’s Health for the Tennessee Justice Center. A graduate of Tulane Law School and former member at Bass, Berry & Sims, Young focuses her efforts on building partnerships and increasing education to protect and strengthen the safety net for the state’s most vulnerable children.TAGS: 





Insure Our Kids Campaign

Tennessee Justice Center