A federal court said Tennessee’s Medicaid program broke the law when it mistakenly canceled coverage for thousands of people.
Several technical and management issues — including a faulty automation service — ended up marking people ineligible when in reality, they still qualified. Dozens of affected families filed the lawsuit in 2019. The court issued an order on Aug. 26, siding with the litigants.
This lawsuit is a great snapshot of Medicaid policy before the pandemic. But how has the conversation around Medicaid changed since then? WPLN’s health reporter Catherine Sweeney and afternoon host LaTonya Turner sat down to talk about that.
TURNER: Let’s start with this lawsuit. Who filed it, and what did they say?
SWEENEY: The nonprofit Tennessee Justice Center filed the lawsuit back in 2019, and they filed it on behalf of dozens of families who had at least one member of the family lose their health insurance through TennCare. So the lawsuit blamed several problems. A big one was computer issues.
There’s this program that automatically checks if somebody can re-up their coverage for the next year. It was flawed. It didn’t take into account people’s disability status or other things that would have made them qualify, and it rejected them.
Tennessee is not alone in that. On Thursday, Fortune and KFF Health News published this big investigation, and it found that around 25 states use a similar program to ours– and they all had these issues. It’s designed by the consulting firm Deloitte. That company has made $6 billion on these programs. The investigation says about $823 million of that came from Tennessee.
TURNER: Why was computer automation relied on so heavily by TennCare in the first place?
SWEENEY: Medicaid is just this really complicated program. The cutoff for how much money you can make is different for different people. So, for example, a new mom is going to have harder requirements to meet than somebody who’s still pregnant. People who have disabilities have different income requirements than people who don’t. It is tough, and a lot of states want to make that easier for people. So they create programs like this. But the programs — they can be faulty.
TURNER: Let’s talk some about the people who were impacted by this. Thousands of people lost health insurance through TennCare. What do you know about how that impacted some of them?
SWEENEY: For some of them, it was kind of a technicality. They realize they don’t have their health insurance, they go through this red tape-filled, difficult time to get it back. That unfortunately wasn’t the case for everyone. There was one example of a woman who needed surgery, but she didn’t have health insurance even though she was supposed to. So she had to put [the surgery] off. And then by the time she did have her health insurance back, she was pregnant and she couldn’t get the surgery while pregnant. But the condition she needed treated made her have these severe complications all the way through her pregnancy, and she shouldn’t have had them.
TURNER: That’s terrible. So what did the court have to say, now that it’s gone before a judge?
SWEENEY: The court said TennCare was breaking the law. It said that computer program was flawed and TennCare knew it was flawed, but “dragged its feet” on fixing the problem. And it also said the process was overly difficult for everyone, but also disabled people. And that violates the Americans with Disabilities Act. They said the two sides have to get together, sit down and go through mediation.
TURNER: Okay. The lawsuit was filed in 2019. Why are we just getting this decision?
SWEENEY: Medicaid was really different during the pandemic. Anybody who got on Medicaid or was in it during the pandemic could just stay on it, even if they started making too much money or if they, you know, for some other reason, lost their eligibility, they got to stay. So this whole lawsuit is about people trying to re-up their health insurance. Nobody was having their health insurance [cancelled] during the pandemic. So they said, let’s wait that one out.
TURNER: That’s not still happening, is it?
SWEENEY: No. When the the public health emergency ended, the federal government said, “Okay, everybody, you have to start doing these eligibility checks again.”
TURNER: Well, has anything else changed since the pandemic?
SWEENEY: The political conversation around it has really shifted. The Kaiser Family Foundation released a poll about Medicaid programs. And basically, there are two ways people look at that program, politically. One, people see it as a health insurance program to help the most vulnerable people, or they see it as a welfare program.
Most Democrats see it as number one, and most independents see it as number one. And it used to be that most Republicans saw it as a welfare program. But in that poll, Republicans were about 50-50.
So when I was covering Medicaid in Oklahoma, lawmakers there said, you know, it needs to be difficult to re-up your Medicaid enrollment so fewer people use it. You don’t really hear stuff like that in state capitols the way you used to.
The conversation around Medicaid expansion has changed, too. That’s a policy where basically more able-bodied adults are qualifying for Medicaid. So 40 states have done that. Tennessee is one of ten that hasn’t. And most of the states that have not done that are in the South. But even that is shifting. North Carolina expanded Medicaid late last year. Really high ranking lawmakers in Alabama and Georgia and Mississippi are warming up to the idea. They’re saying they don’t have this “absolutely not” stance that they’ve had for more than a decade.
TURNER: Has anything else influence the turnaround in these attitudes?
SWEENEY: The rural hospital crisis that has been especially pronounced in Tennessee. So a lot of more conservative lawmakers are seeing the rural hospitals in their district are closing. And part of that is because a lack of Medicaid expansion means too many people who don’t have health insurance.
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