TennCare culling illegal, judge rules; 150,000 reinstated (BANKRUPTING the state)

The Commercial Appeal ^ | 12/20/02 | Paula Wade

[GailA]

TennCare culling illegal, judge rules; 150,000 reinstated

By Paula Wade wade@gomemphis.com December 20, 2002

NASHVILLE - A federal judge Thursday reinstated TennCare coverage to all 150,000 Tennesseans who've been culled from the troubled health program since July 1.

The state's massive TennCare reverification process violates federal law, the judge ruled.

Gov. Don Sundquist vowed to appeal, estimating that if upheld, the ruling could cost the state $300 million - money the state doesn't have - and could force the state to abandon TennCare altogether.

That course would leave more than 500,000 Tennesseans without health coverage.

The ruling means the state has 10 days to reinstate all those who have been removed from TennCare through the controversial reverification effort. It also bars the state from removing anyone else until the system complies with federal law.

U.S. Dist. Judge William J. Haynes ruled that the state's reverification process has failed to provide adequate help to the mentally ill and other TennCare enrollees, failed to give them adequate notice of procedures and appeal rights, and cut off Tennesseans without fully reviewing their eligibility.

Haynes also found that TennCare's new federal waiver was adopted illegally.

"(Federal law) requires federally funded Medicaid programs to be administered 'in the best interests of the program's recipients,' " Haynes wrote. "The denial or termination of coverage to eligible enrollees, without proper notice or right to appeal, particularly for eligible children and adults with severe mental illness, is not in the best interest of TennCare."

Haynes concluded in the 183-page ruling that the state has not adequately staffed its local Department of Human Services offices to handle the reverification process.

He found that the combination of inadequate staffing, poor worker training, a complex system and badly written notification letters makes the system nearly impossible for many elderly, mentally ill, medically fragile or impaired TennCare recipients to navigate.

Since 1996, TennCare has identified 190,000 people as seriously mentally ill. But even after completing the Medicaid eligibility process with DHS, many enrollees were dropped because they weren't able to complete - or in some cases weren't told about - a second medical eligibility process to enroll in TennCare as an uninsurable person.

State officials contend the reverification was needed to weed out those with access to private insurance or who no longer qualified for the health program.

"It doesn't matter - whether you just didn't show up to reverify, you're in prison, you had access to other insurance, or had insurance through an employer - it doesn't matter: We have to put you back on," said Deputy Finance Commissioner John Tighe, who heads TennCare.

Tighe said the ruling also bars the state from dividing TennCare into two programs - one for the Medicaid-eligible and an HMO-style program for those qualifying as uninsurable.

"But we still have to determine who is eligible and who is ineligible, because those who are ineligible - but who we can't now cut off - we have to pay for them with all state funds."

The state has 10 working days to file for a stay and appeal the case. Tighe said that will happen as soon as possible and that the state will ask for an expedited appeal.

"If this is upheld, the legislature will have to appropriate $300 million more this fiscal year, or we take it from somewhere else, or we have to vacate the (TennCare) waiver altogether," Tighe said. "We're not left with a lot of choices."

Gov.-elect Phil Bredesen called the ruling "a significant setback" and said the state should move as quickly as possible to make sure the reverification process is fixed.

"I have said previously that I thought the reverification process was flawed, but I would have preferred another appeal option, to let people come back on if they could show they were eligible," said Bredesen.

TennCare advocate Gordon Bonnyman, the lawyer who brought the federal case in 1998, said Thursday that too many Tennesseans' lives are at stake to let the reverification go on.

"This ruling will save lives," said Bonnyman, citing a UT Health Science Center study calculating the likely additional deaths that would result if the state stripped 160,000 people from their health coverage. That study concluded that there would be 3,311 additional deaths over a 10-year period.

"The reverification process is such that 260,000 people were likely to lose their health coverage, not because they were ineligible, but because DHS has fallen and can't get up," Bonnyman said.

Contact Nashville Bureau reporter Paula Wade at (615) 242-2018.

[GailA]

This is a slick willie judge.

Eual funding for small schools ruling put the State in a real bind. This one will BANKRUPT it. We were already on the edge of BANKRUPTCY because of TennCare. This will be the straw that broke the camel's back.

weasel phil bredesen the gov elect will now have his excuse for an INCOME TAX.

There are only 6 months left in this fiscal year. $300M for just 6 months..equates to $600M for a full year. Tennessee doesn't have that much spare money, not when it will need $300M for the equal funding for the schools verdict.

[Vigilanteman]

Interesting, isn't it, how a single unaccountable judge, can override the decisions of elected representatives? Judicial dictatorship at it finest.

[oyez]

MLG&W will give away $8 Mil in utilities this year. When will this all stop?

[xzins]

It seems the best avenue is to abandon TennCare altogether. I'm not sure why states need separate health programs in addition to federal programs anyway. They certainly are under no obligation to have them. It's simply another way to take tax money and use it to build a constituency.

It's obvious that this is a pro-income tax judge.

How'd the elections go in Tenn? Did the people put in anti-income tax legislators?

[tomball]

"He found that the combination of inadequate staffing, poor worker training, a complex system and badly written notification letters makes the system nearly impossible for many elderly, mentally ill, medically fragile or impaired TennCare recipients to navigate."


As far as this comment is concerned, I am surprised that TennCare is singled out. Seems no one else bothered to notice that every other health insurer has the same inadequate staffing (due to rising health care costs), poor worker training (due to the same rising health care costs), a complex system (due to the federal and state reporting mandates - which helped increase health care costs), and badly written notification letters (because it is hard for any employer to find someone qualified - out of college or high school - who can read and comprehend a letter, let alone know how to write one.)

TennCare is a fine example of why governments should have nothing to do with the health care "business". Governments know nothing about businesses, except how to break them. They know even less about health care, except how exploit those who can't afford it.

It would be interesting to learn how much of the $300 million is for actual "health care" costs, and how much of that money is designed to fund the bureaucracy that maintains it.

[Teacher317]

If those 150,000 can't have it, then the other 500,000 won't either? Now THERE'S a mature decision, your honor.

Of course, the best thing for Tennessee to do would be to drop TennCare altogether... which, of course, means that they will keep it, expand it, and start collecting taxes based on income to boot.

Ain't Socialism grand?

[Blood of Tyrants]

The judge didn't order that the 150,000 be re-screened to make sure that they weren't dropped from the rolls because of mental illness or incompetency or other reasons not related to eligibility requirements. That would make sense. No, he orders that all 150,000 be RE-ENROLLED regardless if they are ineligible, out of the state, dead, have private insurance, or were defrauding the state.

This jusde is an idiot.

[Blood of Tyrants]

"This ruling will save lives," said Bonnyman, ... if the state stripped 160,000 people from their health coverage... there would be 3,311 additional deaths over a 10-year period.

Then he won't mind throwing in a few hundred million every year then, will he?

[JDGreen123]

We did o.k. in the Legislature but dropped the ball on the Governor. We removed all but about 15 legislators who voted for an income tax last summer. Problem is that the ones who survived are in leadership roles. Many of the ones defeated are joining the Bredesen administration in various positions.

Bredesen has a long history of tax-and-spend true to his New York & Massachusetts roots. He did promise no income tax in his first 4 years but the rulings give him ample opportunity to change his mind. He has already gone on record as saying that TennCare is in worse shape than he imagined. I hate to be a pessimist but I doubt that we will be able to hold off a State Income tax much longer.

I believe Medi-Cal is one of the big items that has California in that $35 billion hole. Talk host Neal Boortz has said that we out to just give up the fight against socialized medicine and concentrate on battles that we still can win. He may be correct.

[BlueMondaySkipper]

"(Federal law) requires federally funded Medicaid programs to be administered 'in the best interests of the program's recipients,' " Haynes wrote. "The denial or termination of coverage to eligible enrollees, without proper notice or right to appeal, particularly for eligible children and adults with severe mental illness, is not in the best interest of TennCare."

Did it ever occur to this judge that having the entire system collapse may not be in the best interest of the program's recipients? Or maybe that the people that were removed were no longer recipients and therefore not eligable to have thier interests considered?

[GailA]

My electric bill for this month was DOUBLE last months.

[GailA]

We bounced 4 pro-taxers in the General Assembly BUT the leftist out did us for gov..the weasel RAT got that. Now he gets this mess along with the equal teacher pay mess to deal with. That's about $900M, what the tax increase was. He'll be screaming for the IT in no time at all.

[xzins]

Yep. You're right.

Don't give up.

[oyez]

My electric bill for this month was DOUBLE last months.

Well,They have to make up the differnce some way.