One State Is Being Sued Over Obamacare Politics

A lawsuit filed Wednesday accuses Tennessee of denying coverage to low-income patients.

SAN FRANCISCO, CA - SEPTEMBER 21: Protestors carry signs as they demonstrate against proposed cuts to Medical and Medicare outside San Francisco city hall on September 21, 2011 in San Francisco, California. Dozens of disabled people staged a protest against proposed cuts to Medical, Medicare and Medicaid programs.
National Journal
Sophie Novack
July 23, 2014, 10:49 a.m.

Ten­ness­ee is be­ing sued for de­priving eli­gible res­id­ents of Medi­caid cov­er­age.

The changes to the state’s Medi­caid pro­gram, Ten­nCare, fol­low­ing the im­ple­ment­a­tion of the Af­ford­able Care Act have res­ul­ted in thou­sands of in­di­vidu­als be­ing blocked from cov­er­age they are en­titled to, ac­cord­ing to a law­suit filed Wed­nes­day in the U.S. Dis­trict Court for the Middle Dis­trict of Ten­ness­ee in Nashville. And the firms in­volved ar­gue it’s be­cause of polit­ics re­lated to the health care law.

“Ten­ness­ee of­fi­cials are sac­ri­fi­cing the health of the state’s most vul­ner­able cit­izens just to score polit­ic­al points,” said Sam Brooke, staff at­tor­ney for the South­ern Poverty Law Cen­ter, which is fil­ing the law­suit along with the Ten­ness­ee Justice Cen­ter and Na­tion­al Health Law Pro­gram. “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.”

Medi­caid law re­quires ap­plic­a­tions to be ad­ju­dic­ated with­in 45 days, yet many res­id­ents in Ten­ness­ee have not re­ceived any re­sponse from Ten­nCare in as long as three times that peri­od, the law­suit says. Fur­ther­more, the state is not al­low­ing hear­ings in the event of a deni­al or no de­term­in­a­tion, leav­ing ap­plic­ants in limbo with no re­course to get cov­er­age.

The or­gan­iz­a­tions fil­ing the suit say these delays are a res­ult of changes to Ten­nCare that were put in­to place fol­low­ing the Obama­care rol­lout. On Jan. 1, the state stopped ac­cept­ing dir­ect ap­plic­a­tions for cov­er­age, in­stead re­quir­ing con­sumers to ap­ply through Health­Care.gov — something they say the fed­er­al mar­ket­place was nev­er meant to handle alone.

If there are de­term­in­a­tion is­sues between the fed­er­al sys­tem and the state of­fice, ap­plic­ants are out of luck, be­cause the state also ended in-per­son as­sist­ance last fall.

Ten­ness­ee is the only state without in-per­son guid­ance or an en­roll­ment sys­tem of its own.

Ten­nCare, however, places the blame on the fed­er­al gov­ern­ment for any prob­lems that have aris­en.

“The state has not only shouldered its own re­spons­ib­il­it­ies, but also has de­voted sub­stan­tial re­sources to mit­ig­at­ing prob­lems arising from the fed­er­al mar­ket­place flaws,” Ten­nCare Dir­ect­or Dar­in Gor­don wrote in a let­ter to the Cen­ters for Medi­care and Medi­caid Ser­vices earli­er this month. “A small per­cent­age of ap­plic­ants have had dif­fi­culty com­plet­ing the en­roll­ment pro­cess, but al­most all of those prob­lems have been the res­ult of flaws in the fed­er­al gov­ern­ment’s Health­Care.gov web­site.”

The re­marks were a re­sponse to a re­quest from CMS at the end of last month for a plan of how Ten­nCare will meet Medi­caid re­quire­ments. Sim­il­ar let­ters were sent to five oth­er states with large back­logs of Medi­caid ap­plic­a­tions: Alaska, Cali­for­nia, Kan­sas, Michigan, and Mis­souri.

Yet while the oth­er states have taken meas­ures to ad­dress the prob­lem and re­duce their back­logs, the suit’s filers say, Ten­ness­ee has taken steps back­ward. CMS’s only re­course aside from a slap on the wrist is to re­voke Medi­caid fund­ing from the state — a last re­sort the suit’s filers say no one wants, and one they hope to avoid through court in­ter­ven­tion.

Like most red states, Ten­ness­ee has de­clined to par­ti­cip­ate in Medi­caid ex­pan­sion, but it is the first state in the coun­try to face lit­ig­a­tion over its Medi­caid prac­tices since the ACA went in­to ef­fect.

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