The Sixth Circuit rules that Tennessee's procedures for disenrolling more than 300,000 TennCare (Tennesee's Medicaid program) recipients do not violate federal regulations or the due process clause. Rosen v. Goetz (6th Circuit U.S. Ct. of App., Nos. 05-5633, 05-5779, May 27, 2005).
In March 2001, the state of Tennessee entered into a consent decree with the beneficiaries of TennCare. The consent decree prohibited the state from terminating TennCare coverage without providing a hearing in accordance with federal regulations (42 C.F.R. Part 431, Subpart E). In January 2005, budget shortfalls caused Tennessee's governor to announce that the state would be eliminating several TennCare eligibility categories and disenrolling 323,000 beneficiaries from the program. The Centers for Medicare and Medicaid Services (CMS) approved Tennessee's procedures for disenrollment, which allowed recipients who received notice of disenrollment to get a hearing if there was a valid factual dispute.
The district court determined that the consent decree barred disenrollment, and the state appealed. The U.S. Court of Appeals for the Sixth Circuit remanded the case, ruling that the district court had authority to determine whether the state's procedures for disenrolling TennCare beneficiaries complied with Medicaid regulations.
On remand, the district court ruled that the state's proposed termination plan violated federal regulations and the Due Process Clause of the Fourteenth Amendment. The court held that an administrative law judge must hear all appeals regardless of whether there was a valid factual dispute. The state appealed. CMS filed a brief on behalf of the state's disenrollment procedures (see CMS Files Brief in TennCare Case).
The U.S. Court of Appeals for the Sixth Circuit reverses, holding the state's procedures comply with Medicaid regulations and the due process clause. The court states that the court owes deference to CMS, which had authored the regulations and approved Tennessee's procedures. In addition, the court finds that the procedures do not violate the due process clause because they are "carefully structured" to determine who receives a hearing.
To download the full text of this decision in PDF format, go to: https://www.ca6.uscourts.gov/opinions.pdf/05a0233p-06.pdf.
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