Eric Murray, TennCare Shelter Enrollment Coordinator
More than 16,000 Tennessee children experienced homelessness in the 2005-06 school year, according to the America’s Youngest Outcasts: State Report Card on Child Homelessness, and this number has likely grown in the wake of the national economic crisis of the past several years. These children are almost twice as likely to have moderate or severe health problems as children in middle-income families. Although most homeless children in Tennessee meet eligibility criteria for TennCare, the state’s Medicaid Waiver Program, many displaced families are unaware of TennCare services, struggle to navigate confusing application and enrollment procedures, lack transportation to enrollment sites and health care facilities, or have difficulty finding medical providers who will see their children, once they are enrolled. Through its TennCare Shelter Enrollment Project, the Nashville-based National Health Care for the Homeless Council is working to abate these challenges and improve the health of homeless children.
Funded by the state of Tennessee, the TennCare Shelter Enrollment Project organizes regional trainings, educational visits, and networking meetings that help agencies understand the barriers faced by the homeless family and increase the chances of children getting the medical care they need. The project focuses on both enrollment during shelter stays (about 10% of children enter Tennessee shelters uninsured, and half of those are enrolled during their typically brief stays) and on arranging ESDPT and sick-child visits during shelter stays, often creating new treatment relationships for families.
Collaboration is central to the TennCare Shelter Enrollment Project’s approach. The Project Coordinator, its only staff person, builds partnerships with state and local agencies, shelters, volunteers, and school systems across the state. At periodic regional trainings the Project Coordinator educates homeless shelter staff and service providers about well-child screenings, how to enroll children and families in TennCare, and TennCare policy, and evaluates the need for mobile screenings within the community. The connections made among community organizations and representatives during these trainings are as important an outcome as the well-child screenings themselves.
A common result of regional trainings is the creation of a venue for discussion of the service needs of the community and how the members of the community can fix identified problems, especially after the TennCare Shelter Enrollment Project is no longer present. A 2009 networking meeting in Cookeville, TN, for example, culminated in a Resource Fair nearly one year later. The resource fair made possible 21 well-child screenings, 30 dental screenings, 12 families applying for Department of Human Services services, and 110 families receiving answers regarding DHS benefits.
As transportation is a common and significant barrier to care among families experiencing homelessness, mobile screening events serve an important function in the TennCare Shelter Enrollment Project. With the use of mobile health vans operated by Public Health Departments or private providers, care is brought directly to shelters where children dwell. Going forward, the project anticipates needing to better identify children experiencing homelessness who are not in shelters and employ creative, person-centered strategies to reach these individuals.
With its collaborative approach and emphasis and meeting people where they are, the TennCare Shelter Enrollment project can serve as a model program for addressing the difficulties that families and children without homes face in accessing health insurance and care. As the Congressional Budget Office (CBO) anticipates there will be 16 million Americans newly eligible for Medicaid under the provisions of the Affordable Care Act, strong outreach and enrollment campaigns will be critical to successful implementation.
