Tennessee Justice Center’s Statewide Fight for Access to Care

A demonstrated need for an organization like the Tennessee Justice Center was the driving force behind founding the statewide, non-profit, public interest law firm. Passion, mission … and a few miracles along the way … have kept the doors open for nearly two decades.

Michele Johnson, who helped launch the TJC along with colleague Gordon Bonnyman in 1996, said new federal restrictions at that time hampered legal aid programs across the country, making it nearly impossible to undertake certain activities … even if using private funds for work that fell under the new restrictions. Because of that change, Johnson said, leaders in the Tennessee Bar Association — many of them private attorneys at large corporate firms — stepped up to say they didn’t want see the poor receive second class legal services.

“They wanted to have an entity that was unrestricted,” explained Johnson, who succeeded Bonnyman as TJC’s executive director at the end of 2013. “It’s an amazing story of people … our friends … who saw they wanted a system where ‘equal justice under the law’ was real.”

With a mission to operate without government funding so that the TJC could advocate on behalf of low income Tennesseans in civil matters that federally funded programs would be prohibited from handling, the doors opened in January 1996 with no funding. Johnson said the Legal Services directors across the state asked the Tennessee Bar Foundation to give less money to their organizations and instead provide some to this new entity. To this day, Johnson marvels at that act of generosity from another non-profit group that always struggles for funding, as well.

“That’s really been our story since our founding. There have been miracles all along the way like that,” she said.

Today, the vast majority of the TJC’s funding comes from three sources – the Tennessee Bar Foundation, Baptist Healing Trust, and individual donors who contributed close to $275,000 in 2014. Johnson said there are also a number of smaller grants from multiple sources like the Frist Foundation and Memorial Foundation that are put to good use.

Initially, the staff was Johnson, Bonnyman and a few volunteers. Now there are a little over a dozen employed, which is still small considering the great need that exists. “We’re constantly forced to innovate because of our size,” noted Johnson. “We’re pretty tiny for the impact we have,” she added with a laugh.

In fact, Johnson counts the TJC staff as another miracle. “We’ve been so fortunate to have our staff. They could really, truly be hired and work anywhere, but they choose to work here because they feel passionate about the mission,” she noted.

Since the very beginning, much of the work has revolved around access to healthcare and is now almost exclusively the focus. Picking up where Legal Services could no longer go, TJC took over as lead plaintiff in Grier v. Goetz (now Binta B v. Gordon) and won a landmark ruling in 1996 to allow TennCare enrollees to challenge denials by their insurance plan. Three years later, a settlement further expanded those rights and led to a stronger appeals process for enrollees. Johnson said the ongoing consent decree gives physicians the final say in medical conditions and has resulted in lifesaving care for thousands of Tennesseans.

In one instance, a child needed heart surgery that was only being performed in Michigan at the time. Initially the family was told ‘no,’ but the TJC intervened. Today, that child is an active eight-year-old. In another case, a client found out she was pregnant the day after being diagnosed with ALS. After she delivered a healthy baby, she wanted to go home to be with her family and newborn but required a vent. Her physician felt strongly that she would require home health, which wasn’t part of TennCare services at the time. “If she couldn’t go home, she would have had to go to a nursing home, and she said that would have killed her,” recalled Johnson. The TJC advocated on her behalf so she could return home. Not only is the woman still alive, the ‘newborn’ is now a healthy, happy college student.

Much of Johnson’s work has focused on the standards of care for children – the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit — which calls for children to receive what they need to reach their full potential. Yet at one point in Tennessee, children who were hearing impaired couldn’t get hearing aids, managed care companies routinely refused speech therapy, and a child born with one eye was denied a prosthetic. “We went to the state and said, ‘Let’s breathe life into this law to protect children,’” said Johnson. “That brought about lots of positive outcomes for children across the state. From 1996 to 2011, it was my big work, and I’m really proud of the impact it has had on kids.”

The individual examples go on and on … one child with brain cancer was literally stopped while on the gurney on the way to surgery because he had lost his coverage. “His parents called us from the hospital. We knew the law, and we had it fixed within four hours,” Johnson said.

She added most days are spent talking to people in trouble. They call, Johnson said, because they know the staff has “this freakish knowledge of the health law.” They also know TJC has a reputation for compassion and for treating clients with dignity and respect … as well as being tenacious. “We won’t give up until we find an answer,” Johnson noted, adding that with nearly two decades of experience, the staff has developed friends and a tremendous network of resources all across the state.

“People can get pretty cynical, but if you hung out at TJC very long, you’d feel pretty hopeful about the world. It’s an overwhelming privilege to see all the good that is being done in this state,” she concluded.

To learn more about the work of the Tennessee Justice Center or to refer a patient to them, go online to tnjustice.org or call (615) 255-0331.

TennCare Eligibility

The Tennessee Justice Center undertook several measures in 2014 to help people better understand TennCare criteria and receive a determination of eligibility.

Last year, TJC made headlines when the public interest law firm joined forces with the Southern Poverty Law Center and National Health Law Program to sue the state over delays in determining eligibility. At a preliminary hearing, a judge ruled TennCare has to provide fair hearings upon request to anyone who applied for TennCare more than 45 days ago (or 90 days ago for CHOICES) and who has not received a decision.

Following negotiations last summer, the state also implemented a newborn presumptive eligibility program to ensure the newest Tennesseans meeting certain criteria have access to care even before formal paperwork is filed. TJC also began training healthcare providers, social workers and volunteers on eligibility rules. Last year, the staff conducted more than 90 statewide trainings and webinars.

TJC is in the process of going high tech with the new AskJane software. The program is named for Jane Beasley, TJC’s senior paralegal who is known as the eligibility wizard for her depth of knowledge about the complex enrollment criteria. Attorney Rob Watkins is turning that knowledge into an algorithm that will ultimately enable almost anyone to calculate eligibility after about an hour of instruction on the software.