Tennessee Project focuses on Enrolling and Serving Shelter Children – Say Ahhh! A Children’s Health Policy Blog


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
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

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

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