Home > Cases > Rosen

Rosen v. TN Commissioner of Finance & Administration 3:98-627

Helen and her sons, Colton and Austin. Helen and one of her sons was cut from TennCare. All are Rosen class members. Photo by Abby Whisenant, volunteer photographer

• You are a 78-year-old widow, have lived all of your life in rural Hancock County and have never traveled outside of Tennessee. You are on 11 different medicines. When you go to the drugstore to refill your prescriptions you learn that you lost your TennCare. According to the state computer, you were cut off because you live in Paris, France.

• Your child, Amy, has serious asthma and seizure disorders, and TennCare provides her lifeline to medical care. You receive a notice in the mail to come to the county Department of Human Services office to prove that she is still eligible. You call repeatedly for an appointment as instructed but cannot get through. You make several trips to the DHS office and wait for hours, and finally are able to turn in the medical records, paycheck stubs and other documentation that prove that Amy still qualifies. Weeks later you rush Amy to the emergency room with an asthma attack, only to learn that she no longer has TennCare because DHS records show you never responded to the notice or provided documentation of her eligibility.

• You, your wife, and your four children rely on TennCare. When it is time to be recertified, DHS mistakenly counts your wages of $17,000 per year as $17,000 per month, and the family is found to have too much income. You resubmit documentation of your actual wages, but DHS refuses to consider it.

TJC filed the case of Rosen v. Goetz in 1998 to address these and thousands of cases like them. TJC proved that TennCare and its contractors had routinely failed to credit families’ premium payments, had terminated tens of thousands of eligible families due to computer glitches or defective databases, and had a backlog of several years’ worth of applications that had never been processed.

In 2001, the court approved an agreement between the state and TJC which required that TennCare restore coverage for thousands of families who had been wrongly terminated. Officials promised to obey federal regulations that require the state to give TennCare applicants and participants notice of reasons for the state’s denial of their coverage and a chance to appeal any mistakes. In the agreement, the state promised to improve the program’s management and provide special assistance to applicants with severe disabilities or limited English proficiency.

Carolyn and her son, Lloyd. Lloyd is a "brittle" diabetic who has had portions of his foot removed. Because he is uninsurable, Lloyd was on TennCare Standard and is a Rosen class member. When he was cut from TennCare in 2005, only his mother's persistence enabled him to receive life-saving care. With the support of TJC, Carolyn continues to speak out on behalf of Lloyd and other Tennesseans. Photo by Nicole Eke

Within months, the state was found to have violated the agreement by failing to properly process applications on behalf of people with serious mental illness, and the court ordered the state to comply. In 2002, when the state implemented new eligibility procedures, 50,000 children and 150,000 adults lost their coverage, most of them as a result of systemic breakdowns at DHS. TJC returned to court and won reinstatement for thousands of those affected. In 2003, Governor Phil Bredesen reaffirmed the 2001 agreed order and pledged that the state would obey its terms.

In 2005, the state sought to terminate over 200,000 adults who were protected as members of the Rosen plaintiff class. The orders did not prevent the state from dropping their coverage but required that they be afforded a fair opportunity to demonstrate that they were still eligible in a residual category of Medicaid coverage. The state wanted to severely weaken those rights, and there were extensive trial and appeal proceedings in Rosen throughout the first five months of 2005. TJC’s clients prevailed in the trial court but lost in the Court of Appeals. The Rosen litigation compelled the state to re-screen all of the adults who had been identified as ineligible and scheduled for termination. The state reported that the process, referred to “ex parte review”, had resulted in the restoration of long term eligibility for 15,000 adults who were elderly, disabled or the low-income parents of dependent children.

Since 1998, the Rosen case has restored TennCare coverage for over 100,000 Tennesseans, and it has compelled the state to fix systemic problems that threatened the health coverage of hundreds of thousands of others. Though state officials have complained that Rosen interferes with their administration of the TennCare program, it has only required them to use sound management and obey the Constitution. The Constitution protects all Americans from the loss of liberty or property – in this case, their health coverage – without due process of law, that is, a chance to be heard if the government is wrong. Due process has never been more important than in the Rosen case, where bureaucratic errors and government lawlessness have put lifesaving healthcare at risk.

Rosen v. Tenn. Comm'r of Fin. & Admin., 204 F. Supp. 2d 1061 (M.D. Tenn. 2001), rev'd in part and affirmed in part, 288 F.3d 918 (6th Cir. 2002) Rosen v. Tenn. Comm'r of Fin. & Admin., 280 F. Supp. 2d 743 (2002); Rosen v. Goetz, 410 F.3d 919 (6th Cir. 2005)

Agreed Order [pdf] (3/12/2001)

Rosen Complaint [pdf] (7/8/1998)

Read about other opposition to Tennessee's health care policies.

Click to get involved.