Tennessee’s Medicaid program has to provide applicants with a fair hearing if it cannot process their requests on time, under an order that’s been upheld by a federal appeals court.
Applications for most forms of Medicaid should be processed within 45 days, by law. Applications based on disability are allowed 90 days.
Applicants for TennCare — Tennessee’s version of Medicaid — sued in July 2014, complaining that their applications had been pending for months, and the state had refused to provide hearings.
A federal judge in Nashville issued a preliminary injunction in September 2014 requiring hearings for those whose applications were not timely processed. The injunction is a temporary ruling in effect while the case works its way through the courts. The judge also granted the lawsuit class-action status, meaning anyone in a similar situation to the original plaintiffs could be considered a plaintiff.
The state appealed, asking the 6th U.S. Circuit Court of Appeals to dismiss the lawsuit on technical grounds.
On Monday, a 6th Circuit panel ruled 2-1 in favor of the TennCare applicants.
The TennCare application process went awry with the rollout of the Affordable Care Act in October 2013. Tennessee was supposed to have a new computer system in place, but it fell behind schedule.
In the meantime, the federal government agreed to temporarily process TennCare applications through the federal health care exchange. In cases where Internal Revenue Service records did not match up with the financial information provided by TennCare applicants, the federal government was unable to process the applications.
After the lawsuit was filed, Tennessee began coordinating with the federal Centers for Medicare and Medicaid Services to resolve the problem applications.
The plaintiffs’ attorney said it’s not clear how many people are still facing the delays.
Chris Coleman is an attorney with the Tennessee Justice Center, one of the organizations representing the TennCare applicants. He said plaintiffs’ attorneys haven’t been able to get current information from the state about how many applications are not being processed on time.
He noted that the 6th Circuit opinion says Tennessee is required by law to have a system in place to accept applications directly. Because it still does not, the state is in ongoing violation of federal law, Coleman said.
In an email Tuesday, TennCare spokeswoman Kelly Gunderson said, “We believe the mitigation plan approved by the federal government is working well and has solved the problem that gave rise to the lawsuit.”