Plaintiffs await class-action decision in TennCare suit

The attorney for TennCare blamed the federal insurance exchange for Tennessee's delays processing Medicaid applications, but lawyers representing people who got lost in the system said during court testimony Friday that the state created its own problems.

After listening to almost three hours of arguments, U.S. District Judge Todd Campbell said he expects to make a decision next week on three important motions that will largely determine whether a federal lawsuit against TennCare moves forward. The 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.

But a behind-schedule $35.7 million state computer system that can't process income information and other data sent from the federal exchange is causing months-long delays for people seeking coverage like Terri Lynn Casola. She applied for Medicaid for herself and her 3-year-old son in March and is still waiting to learn their eligibility status.

"Since that time I've been to the ER with some serious kidney issues that I've not been able to get resolved or see a doctor," she said, noting that bill collectors are calling about $6,000 in medical debts.

State lists issues

She is not one of the 11 plaintiffs named in the suit but could be if Campbell grants it class-action status. That's just one of the motions before the judge. The plaintiffs are also asking him to force TennCare to set up a work-around system for determining eligibility of applicants who have been waiting 45 days or longer. But the defendants contend that the lawsuit should be dismissed because all 11 original plaintiffs have now received Medicaid coverage.

Michael Kirk, a lawyer based in Washington, D.C., who is representing TennCare, listed a litany of problems the state encountered when trying to gather information from the federal files to get those plaintiffs' applications processed. He said state officials had "worked their tails" off to get this done and help up to 100 applicants the Tennessee Justice Center had notified them about.

RELATED:TennCare blames feds for application delays

TennCare agreed to prioritize up to 100 people waiting on eligibility status if the Tennessee Justice Center, one of the organizations suing TennCare, would provide the agency with details and assist in that effort. Both sides tried to use this agreement to their legal advantage. Kirk said the process showed how badly flawed the federal system was, while Chris Coleman with the Tennessee Justice Center argued these cases proved the state could serve its citizens better by setting up a work-around system.

Kirk spoke for an hour and 49 minutes, outlining seven reasons that the judge should deny an injunction that would force the state to set up a work-around system and also deny class-action status.

Coleman gave a shorter response.

"The law here is clear," he said. "Responsibility for this problem lies with the Bureau of TennCare. Now, the situation in which they find themselves is entirely of their determination."

He said Tennessee was the only state that sent all of its Medicaid applications to the federal exchange. His point was underscored by a letter from the U.S. attorney's office on the day of the hearing. In a court filing on behalf of Secretary of Health and Human Services Sylvia Mathews Burwell, Assistant U.S. Attorney Mark Wildasin wrote that the burden for processing Medicaid applications and determining eligibility lies with the state.

Derrick Simpson watched all the legal arguments from a court bench and then, after the hearing, told how he would just like to take his Christmas tree down at his home in Paris. It's been up since he went to live with his parents at their Charlotte home. The family has been trying since February to get home-care assistance.

"They are spending all this money on computer systems. ... That's money that could be well spent on people," Simpson said. "I mean hundreds and hundreds of people, especially the elderly."

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