Melissa Wilson, et al. v. Darin Gordon, et al.
The SPLC filed a federal class action lawsuit against Tennessee for Medicaid practices that deprived thousands of people of health care coverage despite eligibility. These policies resulted in some residents – including those with serious medical conditions – going needlessly without health care.
According to the lawsuit, the state violated federal law by discontinuing in-person help for applicants to its Medicaid program, TennCare. Instead, Tennessee forced applicants to apply for TennCare through the federal Health Insurance Marketplace website, which was not designed for this purpose, causing some residents – including those with serious medical conditions — to go needlessly without health care.
The lawsuit came on the heels of a scathing letter the Centers for Medicare and Medicaid Services (CMS) sent to state officials for failing to meet six of seven critical success factors required by federal health care law – easily making Tennessee the worst state in the nation for fulfilling its Medicaid obligations.
Under federal law, an application for Medicaid must be processed in 45 days. The decisions Tennessee made resulted in many applicants – including all the plaintiffs in this case – being forced to wait more than two or three times the maximum period, with dire consequences.
Plaintiff April Reynolds had attempted to get TennCare while putting off seeking medical treatment. She ended up in the hospital following a high blood pressure episode. A doctor later told the mother of three that she could have died if she had waited any longer to seek medical treatment.
The state also arbitrarily terminated coverage for newborns after they are carried out the hospital door – a direct violation of regulations governing its state child health plan, “CoverKids.” Many newborns were left without medical coverage during one of the most critical periods of their lives.
Another plaintiff, a baby identified as “S.G.,” was born two months premature. He was born into CoverKids coverage, but Tennessee revoked it the moment he left the hospital.
Shortly after the lawsuit was filed in 2014, a federal judge granted a preliminary injunction requiring the state to hold a fair hearing within 45 days for people whose Medicaid applications were unreasonably delayed, which created a critical method for those facing intolerable delays to finally get a decision.
The case went to trial in 2018, resulting in the judge finding the number of delayed applications had decreased and the state had committed to continue following the new procedures even if the case was closed. The court therefore vacated the preliminary injunction and closed the case.
Co-counsel included the Tennessee Justice Center and the National Health Law Program.