3 legal groups sue TennCare, saying state is 'depriving residents of Medicaid coverage'

3 legal groups sue TennCare, saying state is 'depriving residents of Medicaid coverage'

July 23rd, 2014 by Kate Belz in Local - Breaking News

Document: Complaint against TennCare

Trial document against TennCare.

Darin Gordon

Darin Gordon

Three legal advocacy organizations filed a federal class action lawsuit today against TennCare, Tennessee's Medicaid program, saying that the state has "broken a decades-old promise to its most vulnerable residents" by implementing new policies the groups say deprive thousands of eligible people - including newborns, pregnant women and the elderly - from coverage.

"Each day that Tennessee fails to follow the law, the health and lives of more Tennesseans are put at risk," said Jane Perkins, legal director at the National Health Law Program, which joined the Southern Poverty Law Center and the Tennessee Justice Center to file the suit in U.S. District Court for the Middle District of Tennessee in Nashville.

Perkins added that "Tennessee is among the worst, if not the worst, offenders" in its failure to connect eligible applicants with coverage.

The lawsuit comes several weeks after the U.S. Centers for Medicare and Medicaid Services sent state officials a harsh letter, saying that the state's Medicaid program was failing to meet six of seven "critical success factors" required by federal health care law - more than any other state highlighted for such failings.

The complaint recites a litany of TennCare problems that Tenneseans have been reporting since early this year, when new state policies went into effect that meant people wanting to apply for TennCare - including pregnant women, mothers trying to get coverage for infants, and senior citizens trying to access special state programs - could only apply for the coverage through HealthCare.gov.

The new process, the lawsuit says, means many residents have remained without coverage two to three times longer than the federally-mandated maximum waiting period of 45 days, the lawsuit states, largely because HealthCare.gov cannot determine eligibility for people who fall within certain coverage categories.

The federal site was never intended or designed for such a wide array of Medicaid applicants, experts have said.

The lawsuit also claims that the state is "arbitrarily terminating coverage for newborns after they are carried out the hospital door."

"It is disgraceful to see our state fall so far short of its legal obligations to provide basic health care to our most vulnerable citizens, including babies who are days old," said Michele Johnson, TJC executive director.

TennCare officials were not immediately available for comment Wednesday. They have previously said that they strongly disagree with the federal government's critique of the program, and have pointed to record-high enrollment numbers as proof that there are not barriers to coverage. They have repeatedly blamed any delays in people getting coverage on problems on HealthCare.gov, though it continues to send Tennesseans through the system.

That response has angered advocates, who indicated two weeks ago that they might take the state agency to court.

"Tennessee officials are sacrificing the health of the state's most vulnerable citizens just to score political points," said Sam Brooke, staff attorney with the Southern Poverty Law Center.

"They're throwing a monkey wrench into their own Medicaid program so they can demonize the federal government. People in dire need of medical care are being sacrificed."

While the TJC has been working with a large number of Tennesseans dealing with TennCare problems since January, the lawsuit includes more than a dozen plaintiffs from across the state, including a Soddy-Daisy mother identified only as "T.V."

The complaint alleges that T.V. applied for TennCare coverage in January during her pregnancy, was initially approved, yet still remains without coverage.

Because she has not been approved, her now 3-month-old son also remains without coverage, meaning the mother has been putting off doctor's appointments and vaccinations, the lawsuit says.

The lawsuit states that T.V. has called the Tennessee Health Connection - the state's new hotline to handle TennCare inquiries - more than 30 times, without having her application resolved and without any callbacks from the state, despite repeated assurances that her call would be "escalated."

T.V. most recently called the hotline last week, and was told her application was not in the state's system, the lawsuit says.

For more information, read Thursday's Times Free Press.

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