While Tennesseans who have waited months to find out whether they are eligible for the state's Medicaid program say they are still in the dark, TennCare officials say they are resolving the lengthy application delays ahead of a court-ordered schedule.
Since early this year, TennCare has faced criticism for long delays that left hundreds of Tennesseans - including newborns - in coverage-status limbo.
On Sept. 2, a federal judge ruled that TennCare needed to hold hearings for people who had waited more than 45 days for an answer on their status. It has now been 56 days since that ruling, and there have been no hearings.
TennCare officials say that is because they have gone beyond judge's order, resolving the issues that led to the delays and making eligibility decisions within that 45-day limit - without needing to resort to a hearing.
But one of the advocacy groups that sued TennCare earlier this year says the agency's claim runs counter to the frantic calls they continue to get from Tennesseans who say TennCare has told them they don't have enough evidence to file an appeal, or that they missed a deadline and must restart the appeals process.
"Clients who have asked for a hearing continue to get the run-around, while they are dunned for health care bills they incurred after they applied and they are suffering with pain and worry," said Michele Johnson, director of the Tennessee Justice Center.
Leslie Smiley, a 37-year-old Clarksville woman who originally applied for TennCare in August has recently had to start the entire process over.
Smiley applied for coverage through the Healthcare.gov hotline shortly after being hospitalized for a kidney stone. She is uninsured, but her children have TennCare. Since that initial application, she has spent hours on the phone with the both federal and state hotlines, trying in vain to find out the status of her application.
"It's just extremely irritating to sit there talking to everyone and trying to get everyone on the same page," said Smiley. "It's just stuck. It's like there's nothing I can do."
Finally on Oct. 17, Smiley says someone at the TennCare hotline told her that she would have to start the whole process over again. She recently completed another application through Healthcare.gov.
TennCare officials said they could not comment on Smiley's application Monday because of privacy restrictions.
But TennCare spokeswoman Kelly Gunderson said that in the vast majority of the delayed cases, applications got stuck in the federal system because the applicant's reported income did not match what the federal government had on file.
Because the federal marketplace is unable to validate the income, TennCare is doing it instead and will then approve or deny eligibility accordingly, Gunderson said.
"When this is accomplished within the 45-day window, the case does not proceed to hearing because the delay has been resolved. Thus far there has been no need to hold a hearing," Gunderson said.
That appears to be the case for Marcus Reed, a Murfreesboro father with muscular dystrophy who applied for TennCare back in June. He went four months with no update on the status of his eligibility and filed an appeal on Sept. 8, just six days after the judge's ruling.
A month later he still had not heard anything about the hearing, and when he called earlier this month to inquire, call center employees said they could give him no information about a scheduled hearing or about what steps to take next.
When Reed called the state's TennCare eligibility hotline on Monday with a Times Free Press reporter on the line, a staff member told him that he had been approved for TennCare and enrolled as of Oct. 22 - exactly 45 days after he initially appealed.
Though Reed was baffled that he had not received any notice that his coverage was finally approved, he said he was "thanking Jesus" that the issue was finally resolved.
"I understand that it's a process, but it should not have taken so long to get some kind of assistance," Reed said.
TennCare says their more recent ability to resolve the delays is because 10 days after the judge's order, federal Medicaid officials began sharing more comprehensive applicant information - months after the state agency first requested it, Gunderson said.
The agency has long blamed problems with Healthcare.gov for the delays, though the reason that the state has resorted to using the federal website is because its own $35 million computer system to determine eligibility remains unfinished one year after it was supposed to be completed.
"Not one other state in the nation has shirked its responsibility to its citizens in the way Tennessee has. They continue to point fingers and blame the federal system for not doing Tennessee's job better," said Johnson. "It's time for them to address the critical needs of the citizens of this state who deserve health coverage."
She added that approving people without telling them they are enrolled "isn't worth much."
Federal officials have also criticized the state for relying so heavily on the website for state Medicaid eligibility determination - something it was not intended for.
"The Federal Exchange was not designed to replace the State's Medicaid application process, and it is not particularly surprising that the system has had operational problems and difficulties in handling that task," U.S. District Court Judge Todd J. Campbell said in his ruling in September.
Besides ordering the hearings, Campbell also granted the lawsuit against TennCare class-action status, meaning that potentially hundreds of Tennesseans can join in. TennCare officials have since appealed Campbell's decision.
Contact staff writer Kate Harrison Belz at kbelz@timesfreepress.com or 423-757-6673.