LOUDON (WATE) – The mother of an adult son is fighting for his rights to keep 24 hour nursing care seven days a week. Now that the young man has turned 21, his hours are being cut.
His mother was aware of changes, but didn’t expect them to be this drastic.
There’s a Medicaid program in every state designed for children, the Early and Periodic Screening, Diagnosis and Treatment program designed to improve the health of low-income youngsters.
These kids receive protections in benefits not available to adults, but that changes when they become an adult.
TennCare is Tennessee’s Medicaid program and a single mother with two other children is in a “David vs. Goliath” battle with the agency.
Kerry Brummitt is now 21. His time of receiving around the clock skilled nursing care, paid by TennCare, has run out.
“The state has stepped in because he turned 21 on December 26 and has said ‘benefit limit exceeded,’ explained his mother Tammy.
Kerry received 24 hour, seven days a week care for six years since suffering a brain aneurism when he was 15. Now the state says Kerry’s assistance will be cut from 168 hours a week to only 40 hours.
“You know I understand there are limitations and things, and there are always benefit limits. But everything is not in black and white. We need to step up and say, ‘This is gray. There is a gray area for things of this nature,'” said Tammy.
A letter from TennCare sent in early January says “TennCare can’t pay” for special medication applied to Kerry’s eye to keep it from drying out.
When he turned 21, TennCare said Kerry is limited to five prescription drugs and refills a month. Doctors had prescribed 19 different pills. His mother appealed and got some medications restored, but not all.
“We are still in appeals. I filed that last week. There are still seven that they are not giving me back.”
Before his stroke, Kerry had been a normal kid, playing football and receiving academic achievements in middle school.
WATE 6 On Your Side first met him in fall 2012 when his mother was fighting TennCare to provide a bed long enough to fit Kerry’s 6 feet 5 inches frame
After we contacted TennCare asking about the state’s decision, Kerry received a longer special order bed. Now there’s a new battle.
Kerry’s around the clock care was extended for one month, but ends at the end of January.
TennCare told WATE 6 On Your Side that while they are not permitted to limit home health services for children under 21, when transition to adult status occurs, like it has for Kerry, home health services are limited to eight hours per day up to 40 hours per week for those qualified for level two nursing facility care.
“This is a kid who had everything going for him, but no one wants to put their kid in a nursing home. No parent does. You know that would be detrimental to him, to our whole family. The big thing is, Kerry would give up,” said Tammy.
Typing on a device that allows a vocal response, Kerry was direct when asked what he thinks about the drastic reductions in his benefits.
“Dumb,” he said.
With Kerry’s disability, you wouldn’t think that a birthday would change everything, but it has.
“What I want for him right now is to be able to get the care that he needs. This was awful. He’s a fragile little guy. I want to keep him home,” said Tammy.
TennCare says they talked with Tammy about enrolling Kerry into the state’s Choices program where he can stay at home. Choices, designed for adults with physical disabilites, helps them with everyday activities like bathing, dressing, preparing meals and getting around the home.
Since skilled nursing care is not part of choices, Tammy respectfully declined the service saying her son needs more intense skilled attention.
You can appeal decisions by TennCare. Tammy says her hope is to take her plea before a judge who could make the ultimate decision about Kerry’s care.