Judge rules against TennCare

TennCare must hold hearings for Tennesseans who have waited months to learn whether they qualify for Medicaid coverage because of delays in processing applications, a federal judge has ruled.

U.S. District Judge Todd Campbell also granted class-action status to the lawsuit, meaning hundreds, potentially thousands, of Tennesseans could also become plaintiffs in the case. Campbell issued the orders at 3 p.m. Tuesday.

"It is clear that irreparable harm has occurred and will continue to occur without the issuance of injunctive relief," Campbell said in the order. "The plaintiff class members are economically impoverished and, without TennCare benefits, have forgone or are forgoing vital medical treatments, services and prescriptions. These injuries cannot be made whole by a retroactive award of money after the litigation process is complete."

The judge specifically stopped TennCare from refusing to provide fair hearings within 45 days after one is requested about a delayed determination. People requesting such a hearing must prove they have gone 45 days without learning the outcome of their application when eligibility is based on income or 90 days when it is based on disability. The injunction became effective immediately.

Michael Kirk, the attorney for TennCare, had blamed the federal insurance exchange for Tennessee's delays, but Chris Coleman, the lawyer for Tennessee Justice Center representing people who got lost in the system, argued the state had created its own problems. His argument was supported by a filing from the U.S. Attorney on behalf of U.S. Secretary of Health and Human Services Sylvia Mathews Burwell.

Campbell ruled that TennCare could not delegate its responsbilities under the Medicaid program to some other entity, "whether that entity is a private party or the federal government."

In the second order granting class-action status, Campbell noted that the "plaintiffs' claims arise from the same acts or refusals to act by the defendants."

"We are jubilant that the vulnerable Tennesseans will now get the care upon which their lives and futures depend," said Michele Johnson, executive director of The Tennessee Justice Center. "We look forward to working with state officials to develop a process that protects the health of Tennesseans and the infrastructure upon which we all rely."

The Tennessee Justice Center teamed with the Southern Poverty Law Center and the National Health Law Program in filing the suit on behalf of Tennesseans awaiting a decision on their Medicaid applications.

The legal dispute centers on TennCare's decision to stop staffing state offices with personnel who helped people fill out Medicaid applications that went directly to the state agency and, instead, require everybody to apply through Healthcare.gov, the federal health exchange.

Reach Tom Wilemon at 615-726-5961 and on Twitter @TomWilemon.