TennCare automated system accused of illegally denying Medicaid

A US District Court judge ruled that TennCare's automated Eligibility Determination System (TEDS) wrongfully terminated Medicaid coverage for thousands of Tennessee residents. D eveloped by Deloitte, the USD 400 million system was implemented in 2019 to streamline eligibility determinations but was plagued with systemic errors, including a failure to consistently load relevant eligibility data, allocating incorrect assignment of enrollees to households, sending renewal notices to wrong addresses, and causing difficulties for users, especially those with disabilities, in updating information through the online portal. The problems with the system resulted in the loss of TennCare participants' Medicaid and disability benefits, leaving many without access to necessary medical care; financial hardship, especially for low-income families and those with disabilities, and emotional and psychological damage. The ruling came from a class action lawsuit filed in 2020 on behalf of 35 children and adults denied benefits , with t he judge fin ding that TennCare violated the Medicaid Act, the Fourteenth Amendment, and the Americans with Disabilities Act . TennCare was aware of these issues but was slow to address them, leading to wrongful terminations of coverage, particularly for disabled individuals. Similar issues had been reported with Deloitte-developed systems in other states, including Texas, leading to calls for broader investigations into automated eligibility systems. TennCare TennCare is the state Medicaid program in the U.S. state of Tennessee . TennCare was established in 1994 under a federal waiver that authorized deviations from the standard Medicaid rules. Source: Wikipedia 🔗 System 🤖 TennCare Eligibility Determination System 🔗 Documents 📃 Deloitte. TennCare: Life in the Cloud (pdf) Operator: TennCare Developer: Deloitte Con sulting LLP Country: USA Sector: Govt - welfare Purpose: Assess insurance coverage applications Technology: Anomaly Detection; Computer vision; Optical Character Recognition; Machine learning Issue: Accuracy/reliability; Human/civil rights; Robustness Regulation ⚖️ Americans with Disabilities Act Legal, regulatory 👩🏼‍⚖️ A.M.C., by her next friend, C.D.C., et al., Plaintiffs, v. STEPHEN SMITH, in his official capacity as Deputy Commissioner of Finance and Administration and Director of the Division of TennCare (pdf) Complaint and Request for Investigation, Injunction, and Other Relief Submitted by National Health Law Program (NHeLP), Electronic Privacy Information Center (EPIC), and Upturn, Inc. (pdf)

Date it happened

2024-08-01

Organisation involved

TennCare

Product, system or model

Eligibility Determination System

This is a record of what was reported, not a finding that anyone broke the law. If it names your organisation and you believe it is wrong, the corrections process is free and open to everyone.