Federal Judge Approves Class Action Status in TennCare Lawsuit

Sep 03, 2014 at 10:42 am by Staff

Published September 2, 2014 by Emily Kubis, NashvillePost The federal lawsuit filed against TennCare by three legal advocacy groups is now a class action, based on an order filed Tuesday afternoon by Judge Todd Campbell.

Filed in July by the Southern Poverty Law Center, the Tennessee Justice Center and the National Health Law program, the suit alleges that Tennessee's Medicaid agency, TennCare, has failed to comply with federal requirements.

Specifically, the suit centers on the requirement that applications for TennCare must be processed within 45 days. If that deadline cannot be met, a hearing must be held. The advocacy groups allege that several plaintiffs in the case had their applications pending for more than 200 days.

Last Friday, counsel for the plaintiffs argued in favor of two motions they filed — that the court order TennCare to process backlogged claims, and open the case up to all Tennesseans whose applications have been pending longer than 45 days.

Michael Kirk, counsel for TennCare, argued that because Tennessee directs TennCare applications to the federal exchange in lieu of its own system, the state agency was not to blame for still-pending applications. Furthermore, he argued, the federal government now holds the eligibility information and the state cannot adjudicate claims without it.

In Campbell's order, he wrote that the court was unpersuaded that the state could delegate its responsibilities under the Medicaid program to another entity.

Additionally, the state's argument was "undermined" by a deal it made with the plaintiffs and several other Tennesseans to fast-track their unprocessed applications. Kirk argued that since the deal was made, all 11 plaintiffs had been enrolled in TennCare, and that the case should therefore be dismissed.

"The state was able to act on the applicants of several plaintiffs whose names were brought to their attention," Campbell wrote, in opposition to TennCare's argument that it did not have and could not obtain eligibility information from the federal government.

"There is no legal or factual barrier preventing the state from obtaining information … from the federal exchange," Campbell wrote in his order, which enjoins the state from continuing to refuse to provide fair hearings on delayed determinations.

Class certification has been granted for all individuals who applied for TennCare on or after Oct. 1, 2013, have not received a final eligibility determination and have not been given the opportunity for a hearing.

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