Update on the Appellate Court's ruling

You may have heard about a recent ruling over TJC’s lawsuit to improve TennCare services for children. The story has been featured in the Tennessean and in other local media. In case you hadn’t heard, the State had appealed to the 6th Circuit Court of Appeals, asking them to set aside the Consent Decree that TJC negotiated to ensure that TennCare complies with federal law and provides low-income and medically fragile children with the health care they need. A consent decree is an agreement made by both sides of the case to take steps that the court will oversee. The State also asked that the case be reassigned to a new lower court judge for future proceedings.

TJC argued against both setting aside the Consent Decree and reassigning the case. Ultimately, the court did rule that a new judge should be assigned to the case. In 2006, the federal court had asked the State what its plan was for complying with the law that promises children the health care they need. The State said there was no need for a plan because it was already in compliance. Since then, TJC has been monitoring the State’s compliance to its obligations to Tennessee’s children under the Consent Decree. The monitoring and discovery process has been very contentious, delaying a trial on the merits of the case. The Appeals Court noted the “strategy of contention” that the State has pursued has dragged the case out, but it ultimately ruled to reassign the case to a new judge.

The Appeals Court did not, however, relieve the State from its obligations under the Consent Decree. It refused to lift the State’s obligation to provide services to low-income and medically-fragile children in Tennessee. TJC remains committed to holding the State accountable to its most vulnerable citizens. Though the immediate future of this case remains unclear, what is certain is that TJC will continue to stand with Tennessee children when their HMOs deny them the services their doctors say they need.

We are hoping that these new developments will give the State a chance to reconsider its tactics and shift its focus to fulfilling its obligations to children. Legal wars of attrition are not in the interest of taxpayers who have to pay out-of-state lawyers’ huge legal fees. More importantly, focusing on these fights instead of children’s health is costly to the state for generations to come. Our case has never been about TJC’s lawyers scoring points in the courtroom – it is about ensuring that TennCare enrollees get the services they are promised by the law. These are services that taxpayers have already paid HMOs to provide, but the State must hold its contactors more accountable. As long as the State and its HMOs continue to deny children medically necessary services, we will continue to challenge the State’s failures and work to make things right.