published Thursday, July 24th, 2014

TennCare sued over delays in coverage

Complaint against TennCare
Complaint against TennCare
Local and national coverage

Using the words “disgraceful” and “atrocious” to describe long delays in the TennCare application process, three legal advocacy groups say they hope a federal class-action lawsuit filed against the state agency will put more pressure on state officials to overhaul the system.

Announcing the lawsuit on Wednesday, the Southern Poverty Law Center, the National Health Law Program and the Tennessee Justice Center said the state has broken federal law and “broken a decades-old promise to its most vulnerable residents” by using a new enrollment system that created delays in coverage as long as six months for newborns, pregnant women and the elderly.

The lawsuit against TennCare is the first of its kind filed against a state for how it has handled its Medicaid enrollment since the Affordable Care Act went into effect, said Jane Perkins, legal director at the National Health Law Program.

But Perkins said Tennessee “is among the worst, if not the worst, offenders” among states in its failure to connect eligible applicants with coverage, and a “national outlier” in how it sends applicants to apply for TennCare programs solely through Healthcare.gov — which was never designed or intended to screen for such a wide array of Medicaid programs, experts have said.

“The delays that are underway are atrocious,” she said.

On Wednesday, TennCare spokeswoman Sarah Tanksley said the agency was reviewing the documents and had no comment about the lawsuit now.

Federal law mandates that states respond to Medicaid applicants about whether or not they will be covered within 45 days of submitting their applications. But Tennesseans are being forced to wait more than two or three times that long, the lawsuit alleges.

All of the 11 plaintiffs named in the lawsuit have had applications pending for more than 140 days, with some as long as six months, said Sam Brooke, staff attorney with the Southern Poverty Law Center, who likened the doorway to TennCare to “the eye of a needle.”

One of the plaintiffs includes a Soddy-Daisy mother identified in the complaint only as “T.V.”

T.V. applied for TennCare coverage in January during her pregnancy, was initially approved, yet remains without coverage, the lawsuit states.

Because she has not been approved, her now-3-month-old baby 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 receiving 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 at all, the lawsuit says.

Lawyers contend 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, executive director of the Tennessee Justice Center.

The lawsuit seeks an injunction that would force TennCare to abide by the 45-day limit and find ways to get people signed up more quickly.

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.

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

That response has angered advocates, who have indicated that Tennessee’s non-compliance is politically motivated.

“They’re throwing a monkey wrench into their own Medicaid program so they can demonize the federal government,” Brooke said. “People in dire need of medical care are being sacrificed.”

The complaint asks the judge to give the lawsuit class-action status that, if granted, could allow it to carry more weight in court and ultimately could have an impact on a larger number of people who have been similarly affected.

The groups hope that an emergency hearing will be arranged within the next two weeks or “as fast as possible,” said Johnson, who called the lawsuit a “last resort” after months of meeting with TennCare officials.

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

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