Judge to rule next week on TennCare lawsuit

Aug. 30--NASHVILLE -- A federal judge plans to rule next week in a lawsuit seeking class-action status for would-be TennCare enrollees who charge Tennessee officials delayed processing their Medicaid applications for months despite requirements of the federal health care law.

U.S. District Court Judge Todd Campbell of Nashville made the announcement Friday following three hours of sometimes heated arguments by attorneys for the would-be enrollees and the state.

Campbell will rule on the request for class-action status as well as plaintiffs' request for an injunction.

The injunction would force the state's Tenn-Care Bureau to follow the 45-day limit on processing applications in order to get people signed up more quickly for health coverage. It accuses the state of relying solely on the federal government's online health care exchange to enroll applicants and doing virtually nothing to help Tennesseans who encounter problems enrolling.

In Tennessee, the Medicaid health coverage program for low-income mothers, their children and some disabled people is operated as TennCare.

The suit was filed on behalf of 11 named plaintiffs and other unnamed individuals by the Southern Poverty Law Center, the Tennessee Justice Center and the National Health Law Program.

All of the named plaintiffs say their cases lingered for at least 140 days and others are said to have waited 200 or more days.

Tennessee officials concede their planned $35.7 million system designed to handle applications in conjunction with the federal heath insurance exchange system has been a bust.

Under the best-case scenario, the system is more than three months away from being operational. The state may have to switch contractors to get the job done. At this point they've hired a consultant to see how big a problem Tennessee has on its hands.

"The one option the state does not have is to throw up their hands and do nothing," attorney Christopher Coleman with the Tennessee Justice Center told Campbell.

But state officials are seeking to lay problems at the feet of the Obama administration, saying they can't get full access to the U.S. Department of Health and Human Services' system.

Defense attorney Michael Kirk argued federal officials indeed deserve the lion's share of the blame because Tennessee can't access their system's full files for qualification appeals.

"The state cannot supervise the federal government," Kirk said.

He also told Campbell he should deny the request for class-action status, arguing that it fails to meet any part of a seven-point test. He cited a 2011 U.S. Supreme Court decision in a case in which female employees at Wal-Mart alleged gender discrimination.

The state worked with the advocacy groups to process applications for the 11 named plaintiffs and a number of others. Because of that, Kirk argued, the named plaintiffs' problems no longer exist and thus the request for class-action status should be denied.

Meanwhile, Kirk lashed out at the U.S. attorney's filing of a "statement of interest" filed shortly before Friday's hearing.

The filing points a finger at Tennessee, saying, "it is the state Medicaid agency, in this case TennCare, that at all times retains the ultimate responsibility to ensure that a reasonably prompt decision is made on applications, including ones that have been submitted in the first instance to the federally facilitated Exchange in the State."

In a sharply worded June 27 letter to Republican Gov. Bill Haslam, the Centers for Medicare and Medicaid Services' deputy director, Cindy Mann, said the agency had been voicing concerns for nine months to the state about its problems.

Plaintiff's attorneys and a national expert say Tennessee is the only state in the country that is relying solely on the federal government's healthcare.gov application website.

Among those watching the proceedings Friday was 25-year-old Terri Lynn Casola. The working mother with a 3-year-old son said after the hearing she applied in March and is still waiting for health coverage.

She said she has kidney stones and infections in both kidneys. That's forced her to go to a hospital emergency room. But with $6,000 in bills and no doctor, Casola said she can't afford that route again.

"As a single mom, it's definitely impacted me," she said. "I'm concerned for my health ... and also for my son. He's my major concern."

TennCare Bureau Director Darin Gordon said later that "we're focused on helping people come into the program and continue to do so."

Contact staff writer Andy Sher at [email protected] or 615-255-0550.

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