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Judge Orders TennCare Eligibility Hearings

A federal judge has ordered state TennCare managers to hold hearings for Tennesseans who, because of application processing delays, have spent months waiting to find out if they qualify for taxpayer-finance health coverage.

U.S. District Court Judge Todd Campbell issued a preliminary injunction Tuesday — effective immediately — in a lawsuit against Tennessee’s Medicaid services agency that required the department to halt its refusal to provide hearings about delays in eligibility determinations within a certain number of days after one is requested. Those making the request have to prove that they have not learned the outcome of their application within 45 days if eligibility is based on income, while those seeking eligibility for a disability have to wait 90 days.

The lawsuit was also upgraded to class-action status.

“TennCare is committed to operationalizing the Judge’s Orders at this time,” TennCare spokesman John Goetz told TNReport Wednesday in an email.

The lawsuit was brought in July by the Southern Poverty Law Center, the National Health Law Program and the Tennessee Justice Center on behalf of several Tennesseans who felt their applications for assistance were not being heard in a timely enough manner, and that the state was not providing proper in-person assistance for applicants, instead sending them to the federal exchange.

The suit was filed shortly after the federal Centers for Medicare and Medicaid Services sent a letter to the state alleging it had failed to meet several of the requirements of the Affordable Care Act.

In his order, Campbell wrote that injuries suffered by the would-be TennCare enrollees “cannot be made whole by a retroactive award of money after the litigation process is complete.”

“The plaintiff class members are economically impoverished and, without TennCare benefits, have forgone or are forgoing vital medical treatments, services and prescriptions,” the judge added.

Tennessee Gov. Bill Haslam recently brushed off criticism that the state’s been dragging its feet signing up qualified applicants. Enrollment in 2014 is on record pace for the 20-year-old program’s history, the governor indicated.

One of TennCare’s attorneys argued that because of the issues the state has been having with getting its new eligibility system online, they had been given permission to send Medicaid applicants to the federal exchanges, and federal officials had failed to send necessary information to them about the plaintiffs that would help them process the applications faster.

Darin Gordon, the head of the agency, appeared before the General Assembly’s joint Fiscal Review Committee last week, and explained that Northrop Grumman — the company who won the bid to produce the system — was very much behind deadline, and the state had contracted with a third-party auditor to determine how much longer it would take for them to produce the necessary system.

However, Campbell wrote in his order that he was not persuaded that “the State can delegate its responsibilities under the Medicaid program to some other entity – whether that entity is a private party or the Federal Government.”

If a state decides to participate in Medicaid, “it is required to ensure that applications are adjudicated reasonably promptly and that hearings on delayed adjudications are held reasonably promptly,” Campbell continued in the injunction.

Additionally, according to the order, the federal government filed a “Statement of Interest” in the case, which said that TennCare “at all times retains the ultimate responsibility to ensure that a reasonably prompt decision is made on applications, including ones that have been submitted in the first instance to the federally facilitated Exchange in the State.”

Michele Johnson, executive director of the Tennessee Justice Center, said in a press release that her organization is “jubilant” that “vulnerable Tennesseans will now get the care upon which their lives and futures depend.”