This week, a federal judge in Tennessee found that an algorithmic system similar to the one in Texas and designed by the same company illegally denied Medicaid benefits to thousands of Medicaid-eligible individuals. The TennCare Connect system, developed by Deloitte, failed to accurately determine eligibility, leading to wrongful terminations of coverage (decision below).
“Poor, disabled, and otherwise disadvantaged … should not require luck, perseverance, or zealous lawyering”
Judge Waverly Crenshaw Jr. started his opinion by writing “Poor, disabled, and otherwise disadvantaged Tennesseans should not require luck, perseverance, or zealous lawyering to receive healthcare benefits they are entitled to under the law… Plaintiffs allege that TennCare’s policies and practices caused thousands of Tennesseans to lose their healthcare coverage.”
The judge’s ruling highlights the potential vulnerabilities in similar systems, such as Texas’s TIERS (Texas Integrated Eligibility Redesign System), developed by Deloitte and under scrutiny due to an ongoing FTC complaint.
FTC complaint filed against Deloitte system in Texas
The FTC complaint, filed last January by the National Health Law Program (NHeLP), Electronic Privacy Information Center (EPIC), and Upturn, Inc., outlines how Deloitte’s system in Texas has caused widespread harm by wrongfully denying Medicaid benefits to hundreds of thousands of residents. These issues echoed in Tennessee, underscore the systemic problems within Deloitte’s automated eligibility systems across multiple states.
In Texas, the TIERS system has been criticized for its failure to conduct accurate ex parte redeterminations, leading to the wrongful denial of benefits for vulnerable populations, including newborns, pregnant women, and non-citizens. The system’s errors have resulted in significant delays and loss of coverage, mirroring the issues identified in Tennessee. The Tennessee ruling may bolster efforts to hold Deloitte accountable and prompt Texas to reassess its reliance on automated systems for Medicaid eligibility determinations.
The ongoing FTC complaint further illustrates the widespread nature of these issues, as it calls for an investigation into Deloitte’s practices and seeks to prevent further harm to Medicaid enrollees.
Frew v. Hawkins 2?
With the Tennessee ruling setting a precedent, Texas HHS needs to fully address the flaws in its Medicaid eligibility system to avoid similar embarrassing legal challenges eerily reminiscent of the Frew v. Hawkins case. This lawsuit was filed “to compel Texas officials to fulfill their obligations under the Medicaid Act to provide indigent children with medical screening and treatment services” and was enforced by the Supreme Court in 2004.
Cynicism about collusion to reduce Medicaid coverage
One of the media reporting on the ruling is the tech news blog Gizmodo and the comments left by readers entertain a fair degree of cynicism about the nature of Deloitte’s system’s flaws.
“That’s not a bug, that’s a feature.”
“I bet the algorithm worked exactly as designed.”
“This is probably what the local Tennessee and Texas governments wanted. But I sincerely hope Deloitte fixes this problem and an investigation weeds out the true problem.”
“My money’s on: a few million will be paid back to Tennessee, no admission of guilt will be made, people who needed and qualified for Medicaid will still be screwed, Deloitte partners’ annual bonuses will be just fine, wash-rinse-repeat.”
“I worked for Deloitte back in 2014-2015 working on Pennsylvania’s social services website and it was an absolute disaster. 12-16 hour days for months, with provided breakfasts and dinners included in their budget, because they knew it would end up like this. They’ve been sued by multiple states for their software dumpster fires. A more efficient, dedicated team of people could have WITHOUT DOUBT built this system for less than one-tenth of that budget.”
Yes, with over 900,000 children dropped from Medicaid in Texas due to technicalities rather than ineligibility, one can get cynical.