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Tennessee Supreme Court strikes TennCare cap on emergency room payments

Health care workers are seen at Vanderbilt University Medical Center. Tennessee taxpayers could, under a new court ruling, be liable for years of back payments to emergency room doctors. / Tennessee Lookout photo by John Partipilo Health care workers are seen at Vanderbilt University Medical Center. Tennessee taxpayers could, under a new court ruling, be liable for years of back payments to emergency room doctors. / Tennessee Lookout photo by John Partipilo

By Anita Wadhwani / Tennessee Lookout June 6, 2023 2 min read

For more than a decade, Tennessee’s Medicaid program set a $50 cap on its payments to emergency room doctors treating low-income patients who show up at hospitals without experiencing a genuine medical emergency.

The Tennessee Supreme Court has now ruled that TennCare failed to follow the rules in setting the cap, a decision that potentially opens up taxpayers to years of back claims from the state’s hospitals and doctors over being underpaid for patient care since 2011.

The cap is now void. It was originally included in a set of cost-cutting measures amid a $100 million shortfall for TennCare, the state’s publicly funded health insurer for low-income Tennesseans — mostly covering women, children and people with disabilities.

At the time, the agency promised to go through a standard rule-making process to put the cap in place, but that never occurred.