TennCare violated healthcare rights of Tennessee Medicaid beneficiaries, judge rules

By Noah Tong / August 28, 2024

TennCare, the state of Tennessee’s Medicaid program, intentionally prevented families from receiving healthcare coverage and benefits, a federal district judge determined Aug. 26.

The decision marks a significant moment in a legal battle lasting more than four years between the state and former and current enrollees.

Plaintiffs argued TennCare’s policies caused “thousands” of Tennessee residents to lose healthcare coverage due to the implementation of an electronic eligibility determination system in 2019. Technical design defaults of the system led to “erroneous eligibility determinations,” and TennCare intentionally omitted information applicable to member coverage, the filing reads.

“After years of litigation, plaintiffs have proven TennCare violated their rights under the Medicaid Act, the Due Process Clause of the Fourteenth Amendment, and the Americans with Disabilities Act,” the judge said in the opinion.

These enrollees said TennCare did not provide adequate notice of hearings for members in danger of losing coverage due to procedural reasons. They also said TennCare’s policies and handling of Medicaid redeterminations restricted coverage for members with disabilities, effectively “screening out” individuals that needed additional support. These issues persisted for years without intervention from the program.

“The court has little confidence that TennCare’s system for granting reasonable accommodations is responsive to disabled enrollees,” the judge said, adding that it should not take a combination of “luck, perseverance and zealous lawyering” to receive healthcare coverage.

TennCare has contracted with managed care organizations to administer health benefits for Medicaid members since 1994. It provides insurance to 1.5 million members, many of whom are low-income or individuals with disabilities. TennCare also pays the Medicare premiums and cost-sharing for members dually eligible for Medicare and Medicaid.

“This is a tremendous win for the plaintiffs and all TennCare members who have lost their vital health coverage due to TennCare's unlawful policies and practices,” said Michelle Johnson, executive director of the Tennessee Justice Center. “We are proud to have stood with the courageous families that brought the case in order to protect the health coverage of many thousands of their neighbors across the state”

The lawsuit was brought forward by the Tennessee Justice Center, the National Health Law Program and the National Center for Law and Economic Justice. Plaintiffs and defendants will engage in mediating sessions and an injunction decision is delayed. The state may appeal the court’s ruling.