TennCare officials appeal judge's ruling requiring hearings on delayed TennCare applications


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NASHVILLE, Tennessee — Tennessee is asking a federal appeals court to overturn a ruling that the state's Medicaid program must provide applicants with a fair hearing if it cannot process their requests on time.

States that participate in Medicaid programs are required to determine eligibility within 45 days in most cases. If the state does not meet that deadline, the applicants are entitled to a hearing.

Applicants for TennCare — Tennessee's version of Medicaid — filed suit earlier this year complaining that their applications had been pending for months, and the state had refused to provide hearings.

The state has blamed the delays on the federal government.

According to court records, the new federal health care program, known as the Affordable Care Act, requires states to use a new formula for calculating income. Because the computer program that Tennessee planned to use for implementing the new calculation was not ready by Oct. 1, 2013, as required, the state received permission to have the federal health insurance marketplace process TennCare applications on an interim basis.

As of Aug. 14, however, TennCare Director Darin Gordon could not say when the state's computer system would be fully operational.

In a Sept. 2 ruling, U.S. District Judge Todd Campbell said Tennessee cannot pass off its responsibilities.

"If a state decides to participate in the Medicaid program, it is required to ensure that applications are adjudicated reasonably promptly and that hearings on delayed adjudications are held reasonably promptly," Campbell wrote.

Attorneys for the state filed a notice of appeal on Friday, asking the 6th U.S. Circuit Court of Appeals to overturn Campbell's order requiring it to provide hearings.

In a separate order, Campbell agreed to make the case a class-action lawsuit — meaning that anyone who applied for TennCare on or after Oct. 1, 2013, and who did not receive a determination of eligibility in a timely manner and was not given the opportunity for a fair hearing, is a potential plaintiff.

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