Judges orders TennCare recipients reinstated
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If the ruling stands, it could cost the state $300 million between now and the end of the fiscal year on June 30, Gov. Don Sundquist said. The budget is based on 159,000 recipients being cut from the rolls by Jan. 1.
“This has pushed TennCare reform and the implementation of the new waiver back to square one and will lead to serious financial challenges,” said Gov.-elect Phil Bredesen, who takes office next month.
TennCare is the state’s $5.9 billion federal-state health care program for 1.4 million Tennesseans who are Medicaid eligible, uninsurable due to medical conditions or are uninsured children. The federal government pays two-thirds of the cost.
For the last six months, the state has aggressively tried to reverify the eligibility of 577,000 TennCare enrollees who were not on the program as Medicaid eligibles. To date, about 200,000 people have been eliminated from the program, and two more groups are still in the reverification process, according to TennCare chief John Tighe.
“People are always telling us we should run the state like a business,” said state Rep. Charles Curtiss. “But how many businesses do you know that lay off people and have a judge come in behind them and tell them they have to be rehired.”
“So really we can’t ever run the state like a business,” continued Curtiss. “This has happened every time we’ve tried to make structural changes to TennCare.”
It was not clear how long it might take to get those people back on the program, or what the procedure for doing so might be. Tighe said the court order gives the state 10 business days to reinstate all those who have been taken off. He said the state definitely plans to appeal the ruling.
As for what state lawmakers will do to remedy the problem of providing health insurance for thousands of people not included in the state budget, Curtiss said it will be up to legislators to roll up their sleeves and get back to work when the General Assembly starts back in session Jan. 14.
“There have been some blunders,” said Curtiss. “There were some people who were purged off TennCare who probably shouldn’t have been taken off.”
Sundquist vowed Thursday that his administration will do everything possible to fight the order issued Wednesday by U.S. District Judge William J. Haynes Jr.
“The court concludes that the state’s new reverification procedures for July 1, 2002, to present has resulted in the termination of TennCare coverage for a substantial number of TennCare enrollees without adequate notice and opportunity to appeal, as guaranteed by applicable Medicaid regulations,” Haynes wrote.
He also said the state has failed to “make reasonable accommodations” for mentally and physically disabled TennCare enrollees.
“I think a lot of people will have a more peaceful Christmas,” said Michele Johnson, a staff attorney for the Tennessee Justice Center, which filed the lawsuit on behalf of TennCare enrollees.
She agreed that TennCare needs to purge its rolls of people who are not eligible but said the process in place since July was fatally flawed.
“We’ve gotten call after call from people who have gone through the process, filled out all these documents, sat down for face-to-face interviews, and the next week they get a letter saying they’ve been terminated for failure to respond to their reverification notice,” Johnson said.
“Over and over we’ve seen people who are eligible, who have followed all of the rules, lose their health insurance. And for many it means the difference between life and death. The gist of the ruling is, when people’s lives are at stake, a coin flip is not sufficient. You’ve got to give them a fair shake.”
The court decision halts implementation of the TennCare reforms approved earlier this year by the federal government and state lawmakers.
Sundquist said that if Haynes’ order remains in effect, “TennCare as we know it may cease to exist, putting some 500,000 Tennesseans at risk of losing their health care coverage.”