Volunteer State is First in Nation to Face Litigation Due to its Medicaid Practices; Eligible Tennesseans Suffer While State Plays Politics
NASHVILLE, Tenn.—The state of Tennessee has broken a decades-old promise to its most vulnerable residents by adopting policies that deprive thousands of people of health care coverage even though they are eligible for TennCare, the state’s Medicaid program, according to a federal class action lawsuit filed today by three advocacy groups.
The lawsuit was filed in the U.S. District Court for the Middle District of Tennessee in Nashville by the Southern Poverty Law Center (SPLC), the Tennessee Justice Center (TJC) and the National Health Law Program (NHeLP). It comes on the heels of a scathing letter the Centers for Medicare and Medicaid Services (CMS) sent state officials for failing to meet six of seven critical success factors required by federal health care law, easily making Tennessee the worst state in the nation for fulfilling its Medicaid obligations.
“Each day that Tennessee fails to follow the law, the health and lives of more Tennesseans are put at risk,” said Jane Perkins, NHeLP legal director. “We are monitoring enrollment in other states, and at this point, Tennessee is among the worst, if not the worst, offenders. The state is doing the least to help its residents obtain health insurance coverage they are qualified for and need.”
Tennessee makes it harder than any other state to enroll in its Medicaid program. According to the lawsuit, the state forces applicants to apply for TennCare through the federal Health Insurance Marketplace website, which was not designed for this purpose, causing many residents – including those with serious medical conditions – to go needlessly without health care. To make matters worse, the state has discontinued accepting TennCare applications in person.
“Tennessee officials are sacrificing the health of the state’s most vulnerable citizens just to score political points,” said Sam Brooke, SPLC staff attorney. “They’re throwing a monkey wrench into their own Medicaid program so they can demonize the federal government. People in dire need of medical care are being sacrificed.”
Under federal law, an application for Medicaid must be processed in 45 days. The decisions Tennessee has made have resulted in many applicants – including all the plaintiffs in this case – being forced to wait over two or three times the maximum period, with dire consequences.
The state also is arbitrarily terminating coverage for newborns after they are carried out the hospital door – a direct violation of regulations governing its state child health plan, “CoverKids.” Many newborns are now left without medical coverage during one of the most critical periods of their lives.
“It is disgraceful to see our state fall so far short of its legal obligations to provide basic health care to our most vulnerable citizens, including babies who are days old,” said Michele Johnson, TJC co-founder and executive director. “Tennessee is turning its back on its own citizens, and our healthcare infrastructure, once the pride of our state, is becoming dismantled as a result of politics. This situation means that millions of dollars in federal Medicaid money are not flowing to Tennessee hospitals – many of which, particularly in rural communities, are already in financial trouble.”
The changes that have deprived Tennesseans of coverage began in the fall of 2013 when the state ended in-person assistance for residents applying for TennCare, removing an important service that helped them navigate the application process. The state decided instead to make the federal Health Insurance Marketplace website the only means for applying for TennCare, leaving many residents without coverage because the site cannot determine eligibility for individuals falling within certain categories.
Plaintiffs’ Stories
The plaintiffs in the case include April Reynolds, a mother of three, who applied for coverage in February. The next month she suffered a high blood pressure episode that nearly resulted in a heart attack. Doctors told her that if she had waited any longer to go to the hospital, she may have died. She was hospitalized in critical care for three days.
Reynolds now owes more than $20,000 for her medical care and was told by doctors that she needs to receive monthly checkups. Because she’s afraid to accrue more debt, Reynolds has seen a doctor only once since the incident.
The lawsuit also describes how the family of a baby identified as “S.P.” incurred more than $17,000 in medical bills after the child was diagnosed with a severe bacterial infection. Despite applying for TennCare, the family has struggled to receive information about the status of their application. They have yet to receive coverage.
Plaintiff Melissa Wilson, a caretaker of three young grandchildren, has been stuck without care since February. Wilson has kidney failure and requires regular blood transfusions to live. She is supposed to take 17 medications daily but can only afford three of them.
She has called TennCare every two weeks since February, but every time, she has been told the status of her application is not known. Wilson needs to see specialists in order to stay healthy, but without health care coverage she has been able to see a doctor only at a health clinic. She can’t even afford to see her own primary care doctor.
Another plaintiff is a baby identified as “S.G.,” who was born two months premature. He was born into CoverKids coverage, but Tennessee revoked it the moment he left the hospital. S.G. has not had coverage since leaving the hospital.
As a premature child, he is at high risk of contracting the potentially fatal respiratory and airway virus known as RSV. He requires monthly shots – at $3,000 each – to prevent this illness. His parents can’t afford the treatment.
“These stories are real and they are heart wrenching,” said Brooke. “Despite countless appeals and stern notices from CMS, Tennessee has recklessly and obstinately refused to address the problem. We had no choice but to act to try and prevent further suffering.”
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