By: Sarah Grusin and Elizabeth Edwards
Executive Summary
On August 26, 2024, a federal court handed down a major victory for Medicaid enrollees in Tennessee, including people with disabilities, in the case A.M.C. v. Smith. The case was brought by the Tennessee Justice Center, National Health Law Program, National Center for Law and Economic Justice, and pro bono firm Selendy Gay, PLLC.
The detailed decision describes pervasive flaws in Tennessee’s Medicaid program, called TennCare, that harm access to health care for low-income Tennesseans. These flaws included significant issues with the State’s Deloitte-operated automated eligibility system (Tennessee Eligibility Determination System or TEDS), the notices it generates, and barriers to legally required hearings for people wrongfully terminated. As the federal court explained, “when an enrollee is entitled to state-administered Medicaid, it should not require luck, perseverance, and zealous lawyering for him or her to receive that healthcare coverage.” But that is exactly what Medicaid enrollees in Tennessee have needed to maintain access to vital health coverage.
This case explainer highlights key aspects of the 116-page decision and describes the next steps.
