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Lawsuit: State Depriving Residents Of TennCare Coverage

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Lawsuit: State Depriving Residents Of TennCare Coverage

CREATED Jul 23, 2014
NASHVILLE, Tenn. – A class action lawsuit was filed Wednesday against the state of Tennessee for allegedly failing to provide certain services as required by the federal health care law.

The three nonprofit legal firms representing the plaintiffs -- the Southern Poverty Law Center, the Tennessee Justice Center, and the National Health Law Program-- said their clients have been denied coverage because the website HealthCare.gov cannot determine eligibility for individuals falling within certain categories.

According to the lawsuit, the state has failed to let people know within 45 days if they're eligible for Medicaid and doesn't provide a hearing if there's a delay in the eligibility decision.

The lawyers claim Tennessee is the worst state in the nation for fulfilling its Medicaid obligations.

The suit follows a letter from the Centers for Medicare and Medicaid Services that was sent to state officials last month, accusing them of failing to meet six of seven critical success factors required by the health care law. Two of those includes the "ability to accept a single, streamlined application for healthcare," and the ability to verify a person's eligibility for coverage based on electronic data sources.

TennCare director Darin Gordon sent a response, blaming those issues on HealthCare.gov.

The lawsuit states that Tennessee began depriving the plaintiffs of coverage when they ended in-person assistance for those applying for TennCare in the fall of 2013. Since then, all applicants must apply for TennCare through the federal Health Insurance Marketplace website. 

The lawyers claim the state has also terminated coverage for newborns once they leave the hospital, which they claim is a violation of regulations of the state child health plan, "CoverKids."

Governor Bill Haslam's office issued a response via email Wednesday afternoon, saying "Due to the pending litigation, it'd be inappropriate to comment at this time."

Plaintiffs' Stories

One of the plaintiffs is mother of three April Reynolds, who owes more than $20,000 in medical bills after being in critical care at the hospital for three days in March, following a high blood pressure episode that nearly caused a heart attack. She had applied for TennCare coverage in February, and now cannot afford to go to monthly checkups with doctors.

Mounting medical bills forced another family to apply for TennCare coverage after a baby, identified in the suit as S.P., was diagnosed with a severed bacterial infection. Since then, the family has been waiting to find out if they receive coverage. 

Since February, Melissa Wilson, who is the caretaker of three young grandchildren and suffers from kidney failure, has called TennCare every two weeks to inquire on the status of her application. Each time, she has been told the status of her application is unknown. She requires regular blood transfusions and is supposed to take 17 medications daily but can only afford three of them.

Without coverage, Wilson has only been able to see a doctor at a health clinic.

Another plaintiff is a baby identified as “S.G.,” who was born two months premature. He was born into CoverKids coverage, but Tennessee revoked it the moment he left the hospital. S.G. has not had coverage since leaving the hospital.

As a premature child, he is at high risk of contracting the potentially fatal respiratory and airway virus known as RSV. He requires monthly shots – at $3,000 each – to prevent this illness. His parents can’t afford the treatment.

(The Associated Press Contributed To This Report.)