Tennessee wasn’t one of the 26 states that expanded Medicaid coverage under the Affordable Care Act when it went into effect in January. But the state did change how it evaluates applicants for its existing program: It eliminated positions for caseworkers who used to handle the applications by hand. Instead it outsourced most of the task to the federal healthcare.gov website, which was already bedeviled by glitches.
Five other states—Idaho, New Jersey, Pennsylvania, Texas, and Wisconsin—also decided to send applicants for public health insurance programs for low-income people to the new federal website. Tennessee is the only one that shut down its own system at the same time. As of Jan. 1, a state bulletin announced, residents “can’t apply for TennCare Medicaid anymore at your local Department of Human Services (DHS) office.” Instead they were directed to apply online. The department promised to make computers available for applicants who lacked Internet access. Tennessee’s approach seems to have been driven in part by antipathy to Obamacare on the part of the Republican-led state legislature. Its members had unsuccessfully pushed Tennessee’s attorney general to join a multistate challenge to the law.
Civil rights lawyers say the state’s reliance on healthcare.gov has been disastrous for thousands of people, especially pregnant women and newborns. A lawsuit filed on July 23 in U.S. District Court in Nashville by the Southern Poverty Law Center, the Alabama-based civil rights organization, and the Tennessee Justice Center blames a combination of “unlawful policy and administrative dysfunction” for preventing 11 plaintiffs, including children, who are eligible for TennCare from enrolling. They’re asking the court to force Tennessee to speed up the enrollment process and seeking class-action status.
“Tennessee has worked and continues to work tirelessly to develop workarounds to compensate for these flaws in the federal process, including developing a new workaround that may help all of the children named in this suit,” says Sarah Tanksley, a spokeswoman for TennCare. The plaintiffs remain unenrolled, says Tennessee Justice Center lawyer Gordon Bonnyman Jr.
The suit comes on the heels of a June 27 letter to Tennessee officials from the federal Centers for Medicare & Medicaid Services (CMS) reprimanding them for the delays. Using healthcare.gov for Medicaid enrollment “was approved as a short-term measure, not a long-term solution,” the agency wrote. In 2012, Tennessee awarded Northrop Grumman a $35.7 million contract to build a state system by Oct. 1, 2013, for determining Medicaid eligibility. The system has not yet launched. In his reply to the CMS, TennCare director Darin Gordon gave no date for when it would work. “We will not go live with a system that has not been adequately tested,” he wrote. Gordon said only a “small percentage” of applicants couldn’t enroll and blamed “flaws in the federal government’s healthcare.gov website.”
State officials say more than 125,000 people have joined the program in 2014. But the lawyers bringing the suit say eligible applicants are still stuck without coverage. Their lead plaintiff, 45-year-old Melissa Wilson, has lupus, renal failure, osteoporosis, high blood pressure, and a platelet disorder. She says she lost her TennCare insurance in November without knowing why and tried to reapply in February, filling out a paper application while at a hospital for a blood transfusion. She says she’s since called state and federal authorities 30 times to find out whether she’s been approved. “They told me that the application was in limbo,” Wilson says. She can’t afford doctor’s visits or some of her medications—so she’s skipping them.
Another family that makes just $1,600 a month, identified in the suit only by initials for privacy reasons, incurred $17,000 in medical bills when a newborn wound up in intensive care with E. coli. They haven’t been approved for Medicaid coverage despite applying shortly after the baby was born in January. “The family cannot afford to pay these bills,” the suit says.
In March, Republican Governor Bill Haslam suggested using federal funds to expand Medicaid to poor Tennesseans through private managed-care plans. Indiana and a handful of other states are pursuing that approach, which needs a special exemption from the CMS. Hospitals that have had to absorb the cost of caring for such uninsured patients want as many Medicaid-eligible Tennesseans enrolled as possible, and fast, says Craig Becker, president of the Tennessee Hospital Association. “It would be a whole lot simpler if we could have all the computers talking to each other.”