Rosen v. Tennessee Commissioner of Finance & Administration

288 F.3d 918
CourtCourt of Appeals for the Sixth Circuit
DecidedMay 6, 2002
DocketNos. 01-6324, 01-6325 and 01-6521
StatusPublished
Cited by3 cases

This text of 288 F.3d 918 (Rosen v. Tennessee Commissioner of Finance & Administration) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rosen v. Tennessee Commissioner of Finance & Administration, 288 F.3d 918 (6th Cir. 2002).

Opinion

OPINION

BOGGS, Circuit Judge.

The Tennessee Commissioner of Finance and Administration (“the state” or “Tennessee”) appeals from two orders of the district court issued as part of an ongoing suit challenging the administration of Tennessee’s TennCare program. The first order, issued on September 14, 2001 (“the September order”), required the state to take various steps to comply with [921]*921an earlier agreed order issued by the court. In the second order, issued on October 25, 2001 (“the October order”), the district court entered a preliminary injunction enjoining the state from implementing an amendment to the TennCare program relating to eligibility, requiring the state to undertake an expedited reverification process to remove from the TennCare rolls individuals- no longer eligible for participation, and appointing a special master to ensure state compliance with the court’s order. The state brought these challenges as three separate appeals, which this court has consolidated for the purpose of decision. For the reasons that follow, we affirm the district court’s September order but vacate its October order.'

I

The TennCare program is a demonstration project under which the federal Center for Medicare and Medicaid Services (“CMS”) (formerly the Health Care Financing Administration, or “HCFA”) waived certain sections of the Social Security Act and the state, effective January 1, 1994, replaced its traditional Medicaid program with one that serves expanded classes of individuals. As authorized by CMS, TennCare served: (1) individuals who would have qualified to participate in Tennessee’s traditional Medicaid program; (2) individuals who are “uninsured,” or those without government or employer-sponsored insurance;1 and (3) “uninsura-ble” individuals, ie., those suffering from pre-existing conditions that preclude them from getting private health- insurance. Those who would be eligible for traditional Medicaid are enrolled in TennCare free of charge, while uninsured and uninsurable individuals pay a monthly premium based on family income.

A. Case Background

The suit forming the basis for the court’s orders was filed in July 1998 by ten current and former enrollees in TennCare, representing a class consisting of “present and future TennCare applicants and beneficiaries who are eligible for TennCare coverage under the federal waiver, rather than under traditional Medicaid eligibility rules” (uninsured and uninsurable individuals), who alleged that the notice and hearing procedures used by the state in making TennCare eligibility determinations failed to comply with due process of law. Rather than litigate the issues, the state entered into negotiation with the plaintiffs; this has resulted in the district court entering several agreed orders.

Early on in the litigation, the plaintiffs applied for, and the district court granted, a preliminary injunction ordering the state to reinstate all members of the plaintiff class who had been denied TennCare coverage without receiving due process of law. The state sought to comply with that injunction and in an agreed order entered on September 13, 1999, the court approved the procedures for a reinstatement scheme agreed to by the parties. The state agreed to identify all uninsureds and unin-surables who had been terminated and send them notices offering re-enrollment to those who replied. Those who did not respond were to receive a second notice.

In April 2000, the plaintiffs filed a renewed motion for injunctive relief, again arguing that the state’s procedures for terminating individuals from TennCare did not comply with due process requirements. The district court entered a temporary restraining order prohibiting the state from terminating the coverage of any member of the plaintiff class without first providing notice and a hearing. The tem[922]*922porary restraining order was extended several times by agreed order while the parties negotiated. The court held a hearing in October 2000 on motions for contempt and imposition of sanctions filed by the plaintiffs against the state; however, the parties asked the court to withhold its ruling on these matters as negotiations continued.

The parties finally reached a settlement agreement, which came to be embodied in an agreed order entered by the district court on March 12, 2001 (the “agreed order”). The agreed order provides that the state is to follow the Medicaid notice and hearing procedures set out in 42 C.F.R. Part 431, Subpart E when terminating or denying applications for enrollment in TennCare. Further, the state agreed to offer an opportunity to reapply or appeal for reinstatement in TennCare2 to class members whose coverage was terminated on or after July 11, 1998. The class members were to be given 60 days to reapply or appeal their termination after receiving notice of their right to do so. In exchange, the plaintiffs withdrew their still-pending motions for contempt and sanctions.

B. The September Order

In July 2001, the plaintiffs filed a motion to enforce the agreed order, arguing that the state was violating it in two respects. First, the plaintiffs argued that the state was violating the agreed order by applying a TennCare rule providing that individuals who were terminated for failure to pay their premiums must pay all past due premiums in full before they can be reinstated. Second, the plaintiffs alleged that the state continued to deny due process to members of the plaintiff class who were uninsurable by virtue of being severely and persistently mentally ill (SPMI) adults or severely emotionally disturbed (SED) children by failing to ensure that local mental health facilities were able to provide guidance to these individuals on how to apply for TennCare and by utilizing applications and denial letters that provided inadequate notice of TennCare coverage for the mentally ill and the reasons for denial.

After an evidentiary hearing, the district court entered an order awarding the plaintiffs relief on both of these grounds. In its order dated September 14, 2001, the court required the state (a) to permit members of the plaintiff class to re-enroll in Tenn-Care without paying past due premiums in advance, and (b) to devise proper notices and ensure that local mental health centers are able to provide guidance on how to apply to TennCare. In the first of the appeals before us, the state argues that neither of these actions are required by the parties’ agreed order, and that the court’s order requiring them therefore erroneously expands the agreed order.

C. The October Order

At a chambers conference on September 27, 2001, the state informed the court and counsel for the plaintiffs that the next day it would issue a rule making changes in the TennCare program that would take effect October 1, 2001 (the “October 1 rule”).

The state had requested and received from CMS an amendment to the federal waiver controlling the TennCare program that would permit the state to close Tenn-Care to adult uninsurables.3 The amend[923]*923ment would not affect those adult unin-surables who were either enrolled in TennCare or had submitted applications for enrollment prior to October 1, 2001.

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Related

Maria Pena Alvarez v. John D. Ashcroft
78 F. App'x 551 (Eighth Circuit, 2003)
Rosen v. Tennessee Commissioner of Finance & Administration
280 F. Supp. 2d 743 (M.D. Tennessee, 2002)

Cite This Page — Counsel Stack

Bluebook (online)
288 F.3d 918, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rosen-v-tennessee-commissioner-of-finance-administration-ca6-2002.