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September 6th, 2009, Last Updated for content at 7:56 AM

Calm Like A Bomb...
Facebook Friends Rally for ALS Victim Facing Loss of TennCare

Shiloh, TN - Sometimes, as a reporter, a story comes along in the most mundane of ways. Half literate e-mails, tips of a "hot story", rumors in a barbershop all melding their way into half truths, leaving you with the single question that defines the majority of headlines these days. Whats my angle? Like a pool hustler setting up shot after shot, news most days becomes a game of angle and spin.

Leads in the 21st century are a curious thing. Starting with a tweet via twitter, that tweet links to a Facebook page. Then the e-mails fly back and forth, and there it is..a simple, unpolished plea...no angle or spin; just four hundred and fifty people with one simple request: Save Anthony "Tank" Meeks TennCare Coverage.

I read Tank Meeks headline on his MySpace page and chuckled, "Calm like a bomb". Skimming the rest of his page was pretty much what you would expect from a self-described "average, ordinary, everyday, superhero", a guy that spends his time between watching too much TV, reading too many books and designing "skins" for computer apps. If I didn't know that Tank couldn't move his limbs, couldn't breath or swallow or feed himself and that he was under 24 hour nursing care for Lou Gehrig's Disease (ALS), I could have easily mistaken him for another hapless Gen X'er like me.

In October of 1997, at the age of 29, Anthony Meeks was diagnosed with ALS. Meeks, employed by the MagneTek Corporation, continued working full time as his disease became even more debilitating. He further supplemented his income with part-time jobs, including a job as a bouncer in a Pickwick nightclub, an easy role when you stand 6'4" tall and weigh in at over three hundred pounds.

Within a few years, "Tank", as his friends call him, was partially bed ridden as the disease wasted away the motor neurons (muscle nerve cells) that control limb movement. Simple tasks like speaking, swallowing and breathing became almost impossible. He left the workforce with a 375.00 monthly income, the proceeds of a long term disability insurance policy from MagneTek. The fact that he was a terminally disabled adult, below poverty level qualified him under the Federal guidelines for Supplemental Security Income, which, along with a mountain of medical bills, automatically triggered his eligibility for TennCare.

His eligibility for SSI also exempted him from re-evaluation or denial of TennCare benefits because he fell in a group of TennCare recipients called the "Daniels Class". Effective in November 1987, the Daniels Case ruling required the state government to maintain TennCare benefits for anyone who has ever received SSI in their lives regardless of whether they currently qualify for the state’s health care program.

Lifting of the Daniels Case Injunction

In January 2009, a federal judge lifted a 21-year-old court injunction which prevented the Bureau from re-verifying the eligibility of those individual enrollees in the Daniels class. The approximately 147,000 enrollees in the Daniels class once received Supplemental Security Income (SSI) but no longer do.

This 'reversal' of the Daniels Case injunction, meant that people receiving TennCare benefits under the original guidelines, like Anthony Meeks, had to have their cases re-evaluated for eligibility. Although all TennCare recipients are required to undergo annual re-certification, the Daniels Class enrollees were sent a request for information packet (RFI), commonly known as the "Peach Pages". The peach pages for Daniels re-evaluations are seven pages long and require even more additional documentation. MALS, the Memphis Paralegal Association, the Tennessee Health Care Campaign and the Tennessee Justice Center have been holding free informational sessions just to help Daniels members with the paperwork.

The overhaul and recertification of the Daniels class enrollees started with 40,000 "Peach Pages" packets mailed monthly starting from May 1st thru August 1st. According to Meeks, who communicates primarily by electronic means, and his mother Maebelle, they received their packet in late summer, followed by a letter on August 17th stating that Meeks TennCare benefits would stop on September 9th, his 41st birthday.

The letter, according to Meeks, stated that he was 20% over the income guidlines. His total income is 1365.00 a month. At issue is whether or not the State eligibility guidelines factor in his out of pocket expense for the utility cost of running a ventilator 24 hours a day, and the lotions, creams and medications like Ativan (a muscle relaxant) that TennCare does not cover. Additionally, he has to purchase distilled and bottled water to protect against respiratory infections, the primary cause of ALS deaths. All of these out of pocket expenses leave him with little money left over. The small comfort that TennCare has provided comes in the form of 24 hour home health care, and the dignity of remaining close to family and friends as the disease runs its course.

Tank Meeks and ALS

ALS is a degenerative form of muscular dystrophy. As muscle nerve cells (motor neurons) "die", the initial symptoms include muscle twitches, cramping, difficulty breathing and swallowing, and a decreased autoimmune response to respiratory and lung infections.

Tank is in one of the more advanced stages of the disease, and cannot swallow, or breath on his own. A feeding tube, attached to his stomach, provides nutrition, and a tracheostomy (breathing tube inserted in the throat) and ventilator regulate the inflation/deflation of his lungs. More often than not, ALS patients do not die from ALS, but rather lung and respiratory infections, or "drowning" from the inability to swallow, allowing fluid to enter the lungs.

For two years, the TennCare coverage that he has received has covered his round the clock home nursing care. The care is critical, because he has to receive nebulizer and expectorant treatment every four hours, followed by "suctioning" of excess fluid build up. Although his vocal communication skills have degenerated slowly, he has been able to communicate electronically via a laser pointer, positioned below his eyes, that transmits a signal to a desktop receiver which in turn controls a computer cursor. He's no slouch either, as we spent an evening chatting via email I had to keep up with him.

Losing his TennCare benefits, which primarily provide his nursing care, would mean that he would have to be placed in nursing home care. Adding insult to injury, the closest nursing homes that accept terminal patients on 24 hour ventilation are a minimum of 150 miles away from family and friends in the Pickwick/Shiloh area that Tank has called home for most of his life.

TennCare and the Recovery Act

Critics of the Daniels Class re-evaluation have cited the paperwork and appeals process as some of the largest hurdles to remaining covered under TennCare. Although TennCare officials have stated they are merely trying to force the Daniels Class recipients to abide by the same rules as other TennCare enrollees, the Daniels Class recipients are the only recipients that the state has mailed the seven page 'Peach Pages', and the additional paperwork associated with these requests for information.

Other critics have cited a recent 1.1 billion dollar Recovery Act funding process for TennCare, which would allow for a continuous benefit stream for Daniels Class recipients. The State TennCare Department responded, on their website:

"The Recovery Act money Tennessee will draw in through Medicaid is not meant to be used solely for the Medicaid program. As Governor Bredesen explained in his State of the State address, these funds should be considered “Tennessee Funds”. This means that Medicaid is a way for the state to bring in more federal dollars to financially assist the state as a whole."

In a July 23rd edition of the Memphis Daily News, Emily Fulmer, of the Tennessee Health Care Campaign reported,

“Since the economic recovery package has passed, that would have meant increased matching funds for Medicaid spending. So there’s potential to draw down more federal dollars,” Fulmer said. “If we would spend the money that we have, we would bring in billions of dollars from the federal government. We don’t know why (that won’t happen). It certainly doesn’t make sense financially from our perspective.”

Tony Garr, Director of the Tennessee Health Care Campaign, recently testified at a TennCare Oversight Committee, on August 20, 2009, saying,

"SSI/Daniels has been a contentious issue. When our state takes health insurance away from its citizens and leaves most of them with no good alternatives, this creates distrust among government and its responsibility to protect its citizens."

The MDN July 23rd Article also states in part that "SSI Daniels patients tend to be a medically vulnerable group. About 147,000 Tennesseans are in the class, including about 18,000 medically fragile children (many born prematurely) and adults with debilitating disorders, such as paralysis and seizures."

The Appeal Process

Tank Meeks' case is currently under appeal, and his home nursing care will continue through the appeal process. According to his mother, the outlook for Meeks appeal is bleak, based on conversations she has had with members of the legal community regarding the TennCare appeals process. If you would like to get involved, please e-mail this article to any of the following, or call where provided:

The Anthony 'Tank' Meeks Facebook Group
(ed note: this story first ran on Sept. 6th...the Facebook Group as of 9/7 at 1:25 PM is almost 600 strong)

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