Judge rule says TennCare unlawfully withheld healthcare benefits from thousands – News Channel 5 Nashville

NASHVILLE, Tenn. (WTVF) — A judge has ruled that the company violated its policies and practices under Tennessee health care law and illegally withheld health care benefits from thousands of Tennesseans.

Plaintiff’s arguments

In the four-year-old class action lawsuit, the plaintiffs allege that people who lose their Tennessee Medicaid status are not given a fair hearing to demonstrate why they do not meet Tennessee Medicaid’s eligibility or appeal requirements, and that their appeals are not heard or timely decided,” according to the complaint.

They also argue that the Americans with Disabilities Act is being violated, and that although many people with disabilities seek TennesseeCare, they often cannot keep their insurance because of the way the system is structured and the unequal costs it imposes on enrollees.

Under federal law, TennCare enrollees must go through the renewal process every 12 months to have their eligibility redetermined, as well as any changes in their circumstances, such as their birthday or income.

“Poor, disabled and other disadvantaged Tennesseans should not have to rely on luck, perseverance or diligent legal work to obtain the health care benefits to which their law allows them,” U.S. District Judge Waverly D. Crenshaw wrote in the ruling.

About a month ago, I interviewed a family whose circumstances had changed and they had to go through this process. You can read stories of families who have lost TennCare.

Background: Back to 2020

In March 2019, TennCare introduced a new system called the TennCare Computer Eligibility Determination System, which had programming errors and the court said “did not consistently consider all eligibility categories,” meaning there were a lot of errors in who was eligible for what under TennCare and why.

In 2020, 35 children and adults sued Tennessee, alleging that the program resulted in thousands of people being dropped from their insurance without notice.

The state argued that this was because families didn’t respond to mandatory renewal forms and children who were no longer eligible were removed from the program, but advocates argued that it was the result of procedural errors in TennesseeCare’s system, as mentioned above.

Conclusion

Crenshaw’s 116-page ruling lists a long list of people who have had problems with TennCare, including lengthy delays when TennCare wouldn’t accept documents by email, leading people to fill out new forms and mail them after speaking with multiple representatives, only to then miss deadlines.

“Plaintiffs have demonstrated that TennesseeCare violated their rights under Medicaid law, the Due Process Clause of the Fourteenth Amendment, and the Americans with Disabilities Act,” the final decision states. “Now the Court must ensure that they receive the relief they deserve.”