Judge rules TennCare unlawfully withheld healthcare benefits from thousands

A judge has ruled that TennCare unlawfully withheld healthcare benefits from thousands of Tennesseeans, violating their policies and practices under the Medicaid Act.

Plaintiff Arguments

In this four-year long class action lawsuit, the plaintiffs argued that if someone is losing TennCare coverage, though they are given a hearing, they are not given proper attention — "denying them an opportunity for a fair hearing to show that they have good cause for failing to meet TennCare eligibility or appeal requirements; and by failing to provide hearings and timely decisions on members appeals," the suit says.

They also argued that the Americans with Disabilities Act was being violated — saying even though lots of people with disabilities seek out TennCare, they often can't maintain coverage because of how the system works and how unequally the burden falls on enrollees.

Under federal law, TennCare enrollees have to undergo a renewal process every 12 months to redecide their eligibility — as well as if they have a change of circumstances like a birthday or a change in income.

"Poor, disabled, and otherwise disadvantaged Tennesseeans should not require luck, perseverance, or zealous lawyering to receive healthcare benefits they are entitled to under law," U.S. District Judge Waverly D. Crenshaw said in his ruling.

I covered a family whose circumstances changed and had to go through this process about a month ago. If you want to take a more in-depth look at a family losing TennCare, you can read their story.

Context: Back to 2020

In March of 2019, TennCare installed a new system called TennCare computerized Eligibility Determination System. There were programming errors in this system that the court said "failed to consistently consider all eligibility categories," meaning there were many errors concerning who was eligible for what in TennCare, and why.

In 2020, 35 children and adults sued TennCare, arguing that the system caused thousands to disenroll from insurance without notice .

The state argued it was because families didn't respond to mandatory renewal forms and programs were dropping children who no longer qualify. But advocates said it was caused by procedural errors, like the one previously mentioned, in TennCare's system.

Conclusion

The now 116-page decision from Crenshaw cites a long list of names who had issues with TennCare — including lengthy stems of time where filling out new paperwork and mailing it in, after talking to several representatives, nearly made people miss the deadine — because TennCare does not take documents over email.

"Plaintiffs have proven TennCare violated their rights under the Medicaid Act, the Due Process Clause of the Fourteenth Amendment, and the Americans with Disabilities Act," the final decision reads. "Now, the court must ensure they receive their deserved relief."

Have you experienced issues with TennCare? I want to hear about them. Email me at hannah.urban@newschannel5.com.

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Ben: https://ewscripps.brightspotcdn.com/df/c4/19fa7c504480938f39a431e3b276/ben-recommends-header.png

Amy: https://ewscripps.brightspotcdn.com/b9/b6/1408516a4a91b97639b178fc1ba9/amy-recommends-header.png

Rhori: https://ewscripps.brightspotcdn.com/5b/25/a224d13d47739165c92b94e643db/rhori-recommends-header.png

Rebecca: https://ewscripps.brightspotcdn.com/a2/d9/fb69982545c59e9836fbe80fe431/rebecca-recommends.png

Lelan: https://ewscripps.brightspotcdn.com/af/54/833bf879454097a398bd44f723de/lelan-recommends.png

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