Health care safety net case management--promoting access to care for the uninsured in Tennessee

In preparation for July 2005 reforms to the TennCare Waiver Program, multiple state government agencies worked in partnership with traditional safety net hospitals and community based primary care providers and mental health providers to strengthen and expand the Health Care Safety Net throughout the state. Pharmacy assistance, information hot lines, and programs specific to persons with selected chronic health conditions were put in place to "soften" the impact of the cutbacks in coverage. It soon became evident, however, that many of the more than 120,000 who were being "disenrolled" needed individualized assistance in connecting to Health Care Safety Net services. State officials sought to quickly assemble a case management team to respond to this need. Under the leadership of executive nurse administrators, advanced practice nurses and later a registered nurse, a certified Masters degreed social worker, and an experienced state administrative coordinator formed the case management team. They responded personally to phone calls, emails and letters from residents across the state who were suddently facing barriers to obtaining needed health care. The team worked within and across state departmental lines, across governmental jurisdictions, and together with public and private sector providers to find care and, when possible, other sources of coverage. They served as ombudspersons, listeners, educators, advocates, care coordinators, facilitators, and negotiators of care. The experience of this demonstration project paints a somewhat unexpected picture of the uninsured population throughout the state, and suggests types of public health initiatives and interventions needed to improve access to care for the uninsured.