TJC files complaint against State of Tennessee for
denying effective appeals to people with severe disabilities

On September 11, 2009, TJC submitted a complaint to the federal Department of Health and Human Services (HHS) on behalf of TennCare beneficiaries with severe disabilities. The complaint charges that the State of Tennessee is refusing to afford them a meaningful opportunity to appeal when the State or its HMO contractors wrongfully terminate their health care coverage or refuse to provide prescribed medical care.  

When a TennCare beneficiary has to appeal to get needed medical care, it is usually essential that she participate in person at the hearing. This is especially true if the person has serious disabilities. The severity of a person’s illness or of her functional limitations often decide the outcome of appeals where eligibility or the medical need is in dispute. In such cases, affording the individual the opportunity to interact with, and be observed by, the hearing officer can make a crucial difference. This is particularly important where the individual’s disabilities limit her ability to effectively convey the facts of her case.

Federal regulations recognize these realities by requiring states to take all reasonable steps to afford in-person hearings to individuals with disabilities. These include providing paratransit services needed to enable the person to travel to the hearing site, or holding the hearing in or close to the person’s home. Hearing officers in Tennessee typically travel long distances to conduct hearings at state office buildings, and going to the person’s home would involve little or no additional burden or expense. Tennessee nonetheless refuses to provide such accommodation. The state that those who are physically unable to come to the hearing site must either participate by telephone (which leaves them unable to effectively present their case) or abandon their appeals.

TJC has submitted a complaint to the HHS Office for Civil Rights and the Centers for Medicare and Medicaid Services, requesting that those agencies enforce the federal regulations. The complaint cites the examples of people whose experiences illustrate the injustice of the state’s policy:

• Brandon Byrd lives in rural Tipton County. He is a 29 year old father of two small boys. Mr. Byrd has quadriplegia as a result of a spinal cord injury, and he requires continuous care. The state recently tried to terminate his care, and he appealed, supported by his doctors and family members. At stake is not only his health, but his ability to remain outside of an institution and parent his children. The state refused to relocate the hearing from Memphis, so that Brandon could participate. 

• Julie Williamson also has quadriplegia as a result of a traumatic injury. She is a 39 year old mother of three who lives in Jackson. Ms. Williamson has a tracheostomy and must depend upon a ventilator. The TennCare HMO recently reduced her care, despite the objections of her doctors. When her mother appealed and asked for the hearing to be held in her home so that Julie could participate, the state refused.

• Ernest Hubbard is a 74 year old resident of McMinnville. He lives with his wife of 54 years, Martha Hubbard, who is his primary caregiver. Mr. Hubbard has quadriplegia due to a degenerative neurological disease. He is ventilator-dependent, is fed and medicated by tube, and is bedfast. His TennCare HMO recently gave notice it was disregarding his doctor’s orders and reducing his care. When Ms. Hubbard appealed, she explained his circumstances and asked for an in-home hearing. She explained that her husband cannot leave his home except by ambulance and that he cannot participate effectively in a telephone hearing due to his severe disabilities. Mr. Hubbard is unable to speak audibly, and he communicates by having his wife read his lips and relay the message. The state insisted that he would either have to participate by phone or not participate at all.