Categories
Featured Health Care

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.”

Categories
Press Releases

Federal Court Grants Preliminary Injunction Against TennCare, Suit Upgraded

Press release from the Tennessee Justice Center; September 2, 2014:

NASHVILLE, Tenn. – A federal judge granted relief to residents across Tennessee today by ordering the state to provide hearings to residents whose Medicaid applications have been unreasonably delayed, according to a ruling in a case brought by a coalition of
civil rights groups.

The ruling by U.S. District Court Judge Todd Campbell granted a preliminary injunction sought by the groups and certified the
litigation as a class action lawsuit, meaning that it applies to all people in Tennessee who have waited months for a determination
on their applications for the program, TennCare. The Southern Poverty Law Center (SPLC), Tennessee Justice Center and the
National Health Law Program filed the lawsuit.

The court’s order takes immediate effect.

“This is a profound victory for all of Tennessee,” said Sara Zampierin, SPLC staff attorney. “The court’s ruling today will require TennCare to do their job and ensure that the people who have been stuck waiting for a decision for months will be able to finally receive the health care they deserve.”

The court rejected the state’s attempt to blame the federal government for its own failings, ruling instead that the state is responsible for its administration of the TennCare program, and noting that “[i]f a state decides to participate in the Medicaid
program, it is required to ensure that applications are adjudicated reasonably promptly.” The court further rejected the state’s claim that it has no “backlogs,” noting that the existence of this lawsuit proved that many people are suffering.

“We are jubilant that the vulnerable Tennesseans will now get the care upon which their lives and futures depend,” said Michele
Johnson, executive director of the Tennessee Justice Center. “We look forward to working with state officials to develop a process
that protects the health of Tennesseans and the infrastructure upon which we all rely.”

The court ordered that a fair hearing be provided to all class members who have proof of application and request such a hearing. The hearings will be held within 45 days, unless the person’s eligibility is based on a disability, in which case the State will have 90 days to conduct the hearing.

“We are pleased that Judge Campbell recognized this as a statewide problem,” said Elizabeth Edwards, Staff Attorney at the
National Health Law Program. “The law requires Medicaid applications to be processed promptly because low-income
individuals and people with disabilities often have a brutal need for health care that, without TennCare coverage, they will be unable to afford.”

A copy of the order can be viewed here: http://www.splcenter.org/get-informed/case-docket/Melissa-Wilson-et-al-v-Darin-Gordon-et-al.

Categories
Health Care NewsTracker

Court Puts Hold on Obamacare ‘Navigator’ Rules

State-based rules enacted to regulate who can help the uninsured sign up for health plans under the Affordable Care Act in Tennessee could have a chilling effect on free speech, a U.S. District Court judge in Nashville has ruled.

Judge Todd Campbell issued a 14-day restraining order Monday on regulations governing Obamacare activists, or “navigators,” trying to enroll Tennesseans in federally run health care exchanges.

The rules define who a navigator is, require them to submit to criminal background checks before they are allowed to offer any assistance and clarify navigators are not allowed to sell health insurance.

The legislation giving rise to the regulations passed last spring, with only one member of the Tennessee General Assembly, Senate Minority Leader Jim Kyle, D-Memphis, voting in opposition.

Judge Campbell, a Clinton administration nominee who worked for Al Gore’s presidential campaign committee in the 1980s, declared that the language defining a navigator is too broad and could inadvertently snare and inappropriately penalize librarians, union organizers, churches and others just seeking to help people sign up for government-subsidized health insurance.

Under the state regulations, navigator rule-breakers face a $1,000 fine per violation.

The federal lawsuit was filed by Service Employees International Union Local 205, which feared members could be targeted for helping others sign up over the Internet.

“These ‘emergency rules’ were never about protecting people from fraud, this was a political game by the governor and his allies,” Doug Collier, the union’s president, said following Judge Campbell’s ruling. “We believe it is every American’s right to have access to affordable health care and we are not going to let him play political games with people’s lives.”

The issue was also challenged last week in Davidson County Chancery Court by the Tennessee Justice Center, League of Women Voters and others. That suit also asked that a temporary restraining order be issued because the rules may limit navigators rights to free speech and because a navigator is broadly defined as “individuals and entities that facilitate enrollment in exchanges.”

But, unlike in the federal court, Chancellor Russell T. Perkins said the rules will probably not affect the exchanges or violate anyone’s First Amendment rights, as argued by the plaintiffs. Even so, the state afterward agreed to narrow the definition of “navigator” to only include those formally registered as such or certified application counselors.

In response to the TJC suit, state Commerce and Insurance Commissioner Julie Mix McPeak said the intent of the emergency rules are meant to protect the state’s citizens.

“Our focus is on protecting Tennesseans and taking reasonable and responsible steps to provide consumer safeguards,” she said, adding navigators will have access to individual’s personal financial and medical information.

“These rules are those reasonable and responsible steps,” she said.

Gov. Bill Haslam, a Republican, also defended the law, citing the strong bipartisan support it garnered in the General Assembly.

Noting that support for the legislation giving rise to the new rules was overwhelming, Haslam said the proposed regulations “are not intended to be a stumbling block.”