Patients Sue TennCare For Giving Them The Runaround

Gov. Bill Haslam and TennCare director Darin Gordon address reporters in 2013. Gordon has put most of the blame for delays in a new computer system on the contractor hired to build it. Credit: Blake Farmer / WPLN

5:30 pm Updated with response from TennCare

Infants waiting on vaccinations, pregnant women forgoing prenatal care and people with deadly infections refusing to go to the hospital: These are the kinds of anecdotes contained in a lawsuit against Tennessee’s Medicaid program filed Wednesday in federal court.

“Tennessee has created an array of bureaucratic barriers to enrolling in TennCare,” the complaint says. “The State’s acts and omissions deprive thousands of low-income Tennesseans of all ages timely access to essential medical care for which they are eligible under state and federal law.”

TennCare, as the state’s Medicaid program is known, has discontinued most of its in-person help for people who qualify for benefits. The agency has also struggled to bring online a new eligibility computer system, instead referring people to the federal health insurance portal known as the Marketplace.

The state has already been chided by federal authorities for the delayed computer system, and now patients represented by attorneys from the Southern Poverty Law Center and the Tennessee Justice Center have sued.

“I do think that they have had plenty of opportunity to fix this and to address this,” SPLC staff attorney Sam Brooke. “We have been meeting with TennCare officials for months trying to get this worked out.”

For people who qualify for Medicaid, federal guidelines give states 45 days to approve coverage. But patients have spent months waiting.

Melissa Wilson of Cookeville, who is named in the lawsuit, has a monthly household income of $1,100 and suffers from renal failure that requires regular blood transfusions. According to the complaint, she applied for TennCare benefits in February. She was told as recently as this month that her application remained in “limbo” and that there is no option to have a hearing.

“There’s always going to be some difficult cases,” attorney Brooke says. “But what Tennessee has opted to do is say we’re not going to do any of this ourselves. We’re just going to say sorry, we can’t help you. And every other state has said no, we have an obligation. We need to try.”

The plaintiffs’ lawyers are asking for federal courts to require TennCare to process applications and provide benefits to those who qualify.

Defendants named in the case include TennCare director Darin Gordon. A spokesperson says the agency has just received “hundreds of pages of documents” in association with the lawsuit. “We are in the process of reviewing everything that we have received and have no comment at this time.”