Coverage Delays For TennCare Enrollees On Trial

Litigation challenging delays in TennCare coverage for people who qualify finally goes to trial this week, four years after a class action lawsuit was filed. TennCare argues the problems are sufficiently resolved, while the Southern Poverty Law Center presses for a more effective fix.

As part of the Affordable Care Act, most people who needed insurance were funneled into the
Marketplace website. This was true even for people with low income who qualify for Medicaid. So the local agency, known as TennCare, limited its in-person help and started building a computer system that could better interface with the federal portal.

But that computer system still hasn’t come online. 

In the process, hundreds of people were applying that TennCare didn’t even know about, often because the federal system was unable to resolve inconsistencies in their application compared to government databases. And that resulted in many people who were eligible not getting their benefits in the required 45 days.

After the lawsuit was
filed in 2014, U.S. District Judge Todd Campbell
made a temporary ruling that required TennCare to establish a new appeals process for those who never hear back. The agency now says
in a filing made last week that 99 percent of the average 40,000 applicants a month are being addressed in a timely way.

But attorney Sam Brooke with the Southern Poverty Law Center says too many people remain in limbo.

“It’s still hundreds a month,” Brooke says. “I mean, granted, that’s compared to thousands that aren’t having a problem. But it’s still hundreds a month that [TennCare’s] own data is showing are suffering delays.”

The plaintiffs include a mother who missed out on prenatal care and
a woman who delayed care for her high blood pressure and wound up in the hospital. They’re not seeking money, just changes to the process so others don’t have the same experience.

The class-action suit will be heard in federal court starting Tuesday, with a two-day trial exected.