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NASHVILLE, - A federal appeals court has thrown out a 15-year-old legal agreement that mandated regular medical and dental care for the 750,000 children on TennCare, more than a third of all children in the state.

The Tennessean reported the U.S. Court of Appeals for the 6th Circuit in an opinion published Thursday voided an agreement mandating compliance with federal requirements governing the state's version of Medicaid. The consent decree arose out of a 1998 lawsuit alleging that children were not getting regular checkups.

Last year, a federal judge ruled that the state was in substantial compliance and dismissed the case. The appeals court upheld that ruling.

Michele Johnson, an attorney with the Tennessee Justice Center that originally filed the suit, called the court's ruling a disappointment and said more was needed for children covered by the program.

"Our daily contact with families and professionals who care for TennCare children makes us painfully aware that TennCare continues to shortchange some children, many of whom have great needs," Johnson said in a written statement.

Fifteen years ago, a federal court found that Tennessee was not providing adequate care to children on TennCare and a consent decree made 80 percent of children on TennCare receive regular checkups and medical and dental care.

For children in state custody, the agreement went even further, requiring the state to give all of them regular checkups and medical care. The lawsuit was known as John B., named after one of the original plaintiffs.

State lawyers sought to have the consent decree dismissed in 2006, arguing that it was no longer necessary. Lawyers for some of the children disagreed, and the case stalled through years of appeals, disagreements and allegations of improper behavior by judges.

"TennCare had vastly improved its delivery of services to enrollees, and indeed become a national leader in its compliance with the Medicaid statute," according to the opinion.

"The ruling of the Sixth Circuit Court of Appeals recognizes the dramatic improvements TennCare has made over the 15-year history of this case," Gov. Bill Haslam said in a written statement. "It also recognizes TennCare as a national leader in the delivery of services to children, which will continue to be a top priority in Tennessee."

TennCare Director Darin Gordon said in a statement that they were pleased with the appeals court's opinion.

"Today's ruling confirms TennCare as a national leader among Medicaid programs. We are pleased that the court recognizes the dramatic improvements TennCare has made over the 15-year history of the case. We continue to strive to provide high quality comprehensive health coverage to the 1.2 million members we serve."