METHODS

Planning and coordination of the three rural focus groups in Tennessee was tasked to the State Department of Health (DPH), and the Tennessee Valley Authority (TVA).  Mr. Jeffery Johnson, DPH, worked with local county offices to identify potential focus group participants.  Because the non-custodial fathers were considered to be the most difficult group from which to solicit volunteers for the focus group meetings; the State drew an over sampling of 45 fathers and sent appointment letters to each.  For the custodial mothers’ and fathers’ groups, 15 letters were sent.  Where telephone numbers were identified, follow up calls were made to encourage participation.  Unfortunately, very few of the individuals had telephones, and as there was poor written response to the mailed invitations, very few respondents confirmed they were going to appear for the focus groups.  Of the seventy five (75) individuals invited to attend, two (2) non-custodial fathers, ten (10) custodial mothers, and five (5) custodial fathers comprised the three rural focus groups.  Most of the participant’s were Caucasian, with the exception of one (1) African­American, non-custodial father, and two (2) African­American custodial mothers.  No other ethnic groups or races were represented.  All participants have had some prior experience with Medicaid or TennCare, as either beneficiaries of the programs, or by using these programs to provide health care for their children.

Mr. George Barber of the TVA served as facilitator for each focus group meeting.  As in the urban study, all participants were told why they were selected to participate in the focus groups, and HCFA’s purpose for convening these focus groups.  They were given consent forms to sign.  Their permission was needed to use their statements and comments in the report.  Although confidentiality was assured in each session, and maintained by using only participants’ first names, signed consent forms were obtained from each participant.

Questions for each focus group were formulated and submitted in advance to the State by HCFA.  Once the sessions began, the participants were asked each question individually; they could either respond or decline to answer, as they wished.  Each session was recorded on audio tape, and extensive notes were also taken by Ms. Melissa Sharits, a professional associate from TVA.

Sessions ranged from 90 - 120 minutes.  Each session was held in a local restaurant within the community, and the participants were provided with a dinner meal before the session began.  At the conclusion of each session, participants were paid a $50.00 honoraria as compensation for their attendance.

Present for each meeting were HCFA representatives (Mr. Chris Howe, Ms. Nancy Olsen, Ms. Megan Arts, and Mr. Mel Schmerler), the Tennessee Department of Health (Mr. Jeffery Johnson), and a representative of TennCare (Mr. William Huffines).  These representatives were available to answer specific questions regarding the Medicaid program and TennCare.  The questions asked of the TennCare representative usually involved coverage of services, and access (lack of access) to care.  The specific questions and answers can be seen in the following transcript portion of this report.