published Wednesday, August 13th, 2014

Federal hearing looms for TennCare lawsuit

Local and national coverage

While a group of civil rights attorneys demands that TennCare officials turn over a series of documents related to delays to its enrollment process, TennCare attorneys Tuesday called the motion an “11th-hour” attempt to gather information as a federal hearing looms.

The Aug. 29 emergency hearing in Nashville will be key for the 11 Tennesseans named as plaintiffs in the lawsuit, who say they have waited months to get Medicaid coverage they are entitled to under law.

U.S. District Judge Todd Campbell will determine whether the lawsuit against the Medicaid agency will take on class-action status, and whether the 11 plaintiffs, and potentially hundreds of other Tennesseans, will get quicker access coverage while the lawsuit is argued — a process that could take months.

The civil rights groups that filed the lawsuit, the Southern Poverty Law Center, the National Health Law Program and the Tennessee Justice Center, have pushed for a speedy hearing because of the plaintiffs’ “explicit and immediate medical needs which are going unaddressed” — everything from kidney failure to newborn vaccinations.

The lawsuit, filed last month, argues that thousands of Tennesseans — including newborns, pregnant women and the elderly — have been forced to wait more than two or three times the federal 45-day limit to find out whether they will be covered.

The delays are rooted in a new enrollment process that was supposed to be handled by a new computer system, called the Tennessee Eligibility Determination system, or TEDS, which remains unfinished nearly a year after its expected completion date.

The process, which has created coverage delays as long as six months, has made Tennessee a national outlier in barriers to access, health policy experts say.

TennCare Director Darin Gordon has repeatedly referenced record-high enrollment numbers as proof that there are not barriers to coverage, and has blamed delays on the federal government.

The TennCare documents the civil rights attorneys asked for Monday include: Reports that identify TennCare applications that have been pending more than 45 days; any reports that indicate when the TEDS computer system will be finished; and the phone scripts used by workers for the state’s new TennCare hotline, which was set up to replace the traditional face-to-face application process.

But TennCare attorneys said Tuesday that the request was unreasonable given the time it will take to pull all of the requested information together, and have asked a judge to dismiss the motion.

Tennessee Justice Center Executive Director Michele Johnson says the lawsuit has already begun to show results, claiming that it prompted the state to extend coverage to the lawsuit’s lead plaintiff, Melissa Wilson, a Cookeville, Tenn., woman who has been unable to get a life-saving blood transfusion while she waited for an answer on her coverage.

Contact staff writer Kate Harrison Belz at kbelz@timesfreepress.com or 423-757-6673.

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