Daughter’s caregiver coverage restored after having ‘too many resources’ to qualify

Investigations

MADISONVILLE, Tenn. (WATE) – The mother of a disabled adult child has been having a struggle with TennCare. The state’s Medicaid program says the young woman has too much money in her bank account.

According to documents, she was over the eligible coverage limit by $43.

As a practice, TennCare routinely asks recipients to provide financial statements from checking or savings accounts. If they go over a certain limit, TennCare’s service can be cut.

For a while, a young woman in Madisonville lost her caregiver service. Her mother appealed and WATE 6 On Your Side made some calls.

Merita Anderson is devoted to her daughter, Amanda, who has Down syndrome. She’s 30 and has never left her mother’s house.

Anderson is a widow and has depended on TennCare, which has provided caregivers to Amanda for years while Anderson was at work.

In May, TennCare sent a letter to Anderson requesting that she send financial statements about her daughter’s accounts.

Having sent information like this off before, 11 pages of financials were faxed to Nashville in June.

Anderson showed the statements to WATE 6 On Your Side.

“The last page that I faxed to them. She has a balance of $2,042.92,” Anderson read. Then another letter arrived dated Aug. 22, a Notice of Decision.

“‘You have too many resources. The most you can have in total resources in your case is $2,000. Our records show your resources are more than the limit for any kind of TennCare Medicaid.'”

She was $43 dollars over the limit. Then, on Aug. 23, Anderson was told that Medicaid had dropped her from the program, stating that Amanda would no longer have caregivers.

For several weeks, her service was cut.

“I need her Medicaid reinstated so she can get her medicine and continue to see her doctors,” Anderson said.

She quickly filed an appeal. While it was under consideration, Amanda’s caregiver service was resumed temporarily for 40 hours a week. But Anderson was nervous when we met her earlier this month.

“It’s heart-breaking, because you don’t know what the next step is. You don’t know if you’re going to have a caregiver tomorrow,” Anderson said.

But, it all eventually worked out – Amanda will have her caregiver.

After we contacted TennCare, Anderson was sent a letter saying Amanda is eligible for homecare and her benefits are renewed.

I’m very pleased with knowing she’s back on the Medicaid program. She’s home where she wants to be,” Anderson said.

She also says she hopes to never experience the anxiety she has gone through since mid-August, when Amanda’s caregiver service suddenly ended.

She has been given some assurances by her daughter’s case worker that Amanda’s TennCare coverage is fully restored.

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