Algorithmic Medicaid Denial System Found Illegally Depriving Thousands of Benefits Worth $400 Million by Judge's Decision
Hundreds of Tennesseans Unfairly Denied Medicaid Due to Flawed System
Thousands of Tennesseans have been unfairly denied Medicaid and other benefits due to errors in an algorithmic system, according to a recent court ruling. The US District Court judge, Waverly Crenshaw Jr., determined that the TennCare Connect system, which costs over $400 million, often fails to properly load data, assigns beneficiaries to the wrong households, and makes incorrect eligibility determinations.
Designed to analyze income and health information to automatically determine eligibility for benefits program applicants, this system built by Deloitte and other contractors has left many Tennesseans struggling to receive the healthcare coverage they are entitled to. In his opinion, Judge Crenshaw wrote, "When an enrollee is entitled to state-administered Medicaid, it should not require luck, perseverance, and zealous lawyering for him or her to receive that healthcare coverage."
The decision came as a result of a class action lawsuit filed in 2020, representing 35 adults and children who were initially denied benefits. Michele Johnson, executive director of the Tennessee Justice Center, commented, "We are proud to have stood with the courageous families that brought the case in order to protect the health coverage of many thousands of their neighbors across the state."
Launched in 2019, TennCare Connect was a part of the state's years-long effort to modernize its Medicaid system and adhere to new eligibility criteria and streamlined enrollment requirements mandated by the Affordable Care Act. Under the new rules, states were supposed to provide a single application process that would collect residents' information and determine which of the many complex health and disability benefits programs they were eligible for. However, Judge Crenshaw found that TennCare Connect did not consider whether applicants were eligible for all available programs before it terminated their coverage.
Deloitte, a major beneficiary of the nationwide modernization effort, has won contracts to build automated eligibility systems in more than 20 states, including Tennessee and Texas. Advocacy groups have raised concerns and asked the Federal Trade Commission to investigate Deloitte's practices in Texas, where they claim thousands of residents are similarly being inappropriately denied life-saving benefits by the company's faulty systems.
While there is no current information about active investigations into Deloitte's practices, the company has faced criticism for administrative waste and inefficiency in Georgia, where they received significant taxpayer funds for building software related to Medicaid work requirements[2]. If you're looking for more detailed information on ongoing investigations or cases involving Deloitte and Medicaid eligibility systems in Tennessee or Texas, consult state-level press releases or legal filings for a more precise understanding[3].
- The flawed TennCare Connect system, a tech solution developed by Deloitte and other contractors, has been found to incorrectly deny Medicaid to hundreds of Tennesseans, as per a court ruling by Judge Waverly Crenshaw Jr.
- The system, designed to streamline Medicaid enrollment and determine eligibility for benefits, has failed to consider all available programs before terminating coverage, according to Judge Crenshaw's opinion.
- Advocacy groups have raised concerns about Deloitte's practices in other states like Texas, where they claim similar issues of incorrect benefit denials are taking place due to faulty systems.
- If interested in detailed information on ongoing investigations or cases involving Deloitte and Medicaid eligibility systems in Tennessee or Texas, one should consult state-level press releases or legal filings for a more precise understanding.
