On August 26, 2024, the A.M.C. v. Smith court ruling shed light on the unjust practices of Tennessee’s Medicaid system, TennCare, which provides essential healthcare coverage to approximately 1.5 million individuals. The Tennessee Supreme Court ruled that TennCare unlawfully terminated tens of thousands of economically disadvantaged families by violating Medicaid law, the Americans with Disabilities Act, and the Due Process Clause of the U.S. Constitution.
This lawsuit emerged in 2020 after numerous recipients of TennCare reported that their coverage was terminated without proper notice of the reasons why. This case highlights several systemic flaws in the system. First, TennCare failed to adequately notify individuals about their termination by not specifying what regulation was broken and not notifying recipients of their right to seek reconsideration within 90 days. Additionally, the state committed errors in its eligibility determinations as TennCare failed to check for other categories of qualification when a person was being terminated. Furthermore, beneficiaries who lost coverage were not provided the right to a fair hearing to challenge TennCare’s decision, even if they offered valid reasons for not meeting deadlines or not submitting necessary documentation.
TennCare also discriminated against disabled recipients by consciously utilizing a flawed system that was not accurately determining eligibility. Although aware of these problems, TennCare delayed fixing any error, forcing disabled individuals to lose coverage. Ultimately, Tenncare failed to provide accessible support or proper accommodations that people with disabilities needed to navigate the complex and misleading state system.
Shockingly, these unlawful practices still persisted even after the lawsuit was filed. For example, in 2023, a mother lost benefits for her autistic son when the TennCare online portal repeatedly logged her out of the system, preventing her from submitting necessary documents. Imagine a single mother trying to pay for medication her son so desperately needs but is suddenly terminated from TennCare, left without any support or resources. Countless other stories echo this experience, showcasing how the system was almost designed to deny people the coverage they rightfully deserve.
The parties have been ordered to discuss potential remedies that will bring justice for the innocent families harmed by TennCare’s unfair policies. The judge has ordered the State and the plaintiffs to reach a mutual agreement that will resolve the case. A justified course of action would include retroactive coverage for the plaintiffs, backdating their benefits to the day they lost coverage. Individuals who were unable to pay for healthcare after being terminated deserve to be refunded for their out-of-pocket expenses, helping mitigate the significant financial burdens they were subject to.
A.M.C. v. Smith provides a glimpse into Tennessee’s conservative approach to healthcare accessibility. This case is a direct reflection of the political landscape of the Tennessee legislature that regards Medicaid as a financial burden rather than a lifesaving program for struggling and vulnerable families. The judge’s ruling is a monumental step in the right direction as it forces us to question the current policies of the state legislature and encourages other states to analyze the effectiveness and ethical standards of their Medicaid systems.
Although this ruling was a major victory for Tennessee, the refusal to expand Medicaid under the Affordable Care Act is detrimental to thousands of individuals who could significantly improve their well-being with coverage. As one of the ten states without expansion, Tennessee’s stance on Medicaid is entrenched in political beliefs that overshadow the urgent priorities of its residents. As there is no financial or moral reason not to expand Medicaid, Obama’s connection to Medicaid expansion appears to be the only reason the legislature rejects this initiative. In fact, a Vanderbilt poll in 2014 revealed that 56% of registered voters in Tennessee were in favor of Medicaid expansion to provide care to low-income residents. Healthcare is a fundamental human right, and it’s time for the state government to shift its priorities from partisan politics to fulfilling the essential needs of its people. Tennessee state legislators must overcome their aversion towards Obamacare and recognize that healthcare is not a privilege but rather a necessity. With the expansion, Medicaid would insure an additional 300,000 individuals in Tennessee who, without coverage, may not receive life-saving healthcare that could cost them their lives.
This case highlights the devastating consequences of prioritizing bureaucratic efficiency over the basic rights of the most vulnerable Tennesseans, marking the court decision as a significant triumph for many families. Chief U.S. District Judge Waverly Crenshaw captured this sentiment stating, “poor, disabled, and otherwise disadvantaged Tennesseans should not require luck, perseverance, or zealous lawyering to receive healthcare benefits they are entitled to under the law.” This ruling should serve as a wake-up call to the Tennessee legislature, prompting them to alter their healthcare policy approach and promote the welfare and dignity of residents over political optics.
