A federal judge has delivered a significant ruling against Tennessee's Medicaid program, known as TennCare, finding that it has improperly terminated health insurance benefits for thousands of residents since 2019. The decision, issued on August 26, 2024, marks a crucial development in a class action lawsuit that has been ongoing for several years.
Chief U.S. District Judge Waverly Crenshaw issued a 116-page opinion following a non-jury trial last autumn. The judge determined that TennCare had violated multiple legal and constitutional provisions, including the federal Medicaid law, the U.S. Constitution's due process clause, and the Americans with Disabilities Act (ADA).
The ruling highlights systemic issues within TennCare's redetermination process, which is required by federal law to occur at least once every 12 months. Plaintiffs in the case alleged that the program's procedures routinely terminated benefits for eligible individuals without proper recourse.
Michele Johnson, executive director of the Tennessee Justice Center representing the plaintiffs, hailed the decision as a "tremendous win" for TennCare members who lost vital health coverage due to unlawful practices.
Judge Crenshaw's opinion cited specific examples of beneficiaries losing coverage due to administrative failures. In one instance, a woman and her five children lost benefits in 2019 when TennCare sent information requests to an incorrect address. Another case from 2023 involved a mother unable to submit documentation for her autistic son due to technical issues with TennCare's online portal and phone system.
The lawsuit, filed in 2020, sought no monetary damages. Instead, plaintiffs requested a court order to reinstate wrongly terminated individuals and prevent future improper terminations. Judge Crenshaw indicated that an "appropriate order" would be forthcoming.
It's worth noting that Tennessee is among only ten states that have not expanded Medicaid eligibility under the Affordable Care Act (ACA), which was enacted in 2010. This expansion would have made additional federal funds available to cover more low-income individuals.
The case underscores the ongoing challenges in administering Medicaid, which covers approximately 80 million Americans as of 2024, making it the largest source of health coverage in the United States. Established in 1965 as part of President Lyndon B. Johnson's Great Society program, Medicaid has been a crucial safety net for low-income and disabled individuals.
The COVID-19 pandemic added complexity to Medicaid administration, with a federal emergency order pausing disenrollments nationwide in 2020. These redeterminations resumed in 2023, bringing renewed attention to the processes involved in maintaining or terminating benefits.
This ruling serves as a reminder of the importance of proper administrative procedures in ensuring access to healthcare for vulnerable populations. As the legal proceedings continue, the focus will be on implementing reforms to prevent future wrongful terminations and reinstate those who have been improperly disenrolled from this vital program.
"Poor, disabled, and otherwise disadvantaged Tennesseans should not require luck, perseverance or zealous lawyering to receive healthcare benefits they are entitled to under the law."
The case, known as A.M.C. et al v. Smith, was heard in the U.S. District Court for the Middle District of Tennessee, an institution established in 1839. It involved legal representation from various organizations, including the Tennessee Justice Center (founded in 1996), the National Health Law Program (established in 1969), and the National Center for Law and Economic Justice (founded in 1965).
As this legal battle continues to unfold, it serves as a critical examination of the intersection between bureaucratic processes and the fundamental right to healthcare access for some of society's most vulnerable members.