Digitalization: $400 million medical system illegally denied benefits to thousands instead of simplifying enrollment

The digitization efforts in Tennessee, USA, appear to have gone awry: many individuals were unlawfully denied access to the Medicaid program and other benefits due to errors in the automated system.

The state utilizes the TennCare Connect system to determine the eligibility of low-income residents and those with disabilities for discounts. This is detailed in a mandate from a district court, which resulted from a class-action lawsuit filed in 2020 on behalf of 35 adults and children who were denied benefits.

The TennCare Connect system, developed by Deloitte and other contractors, cost $400 million. The algorithm analyzes information regarding income and health status to automatically determine the eligibility of applicants for the benefits program. However, in practice, the system often fails to load the pertinent data, assigns benefits incorrectly, and draws erroneous conclusions.

"When a participant qualifies for the Medicaid program, they shouldn't require luck, perseverance, and determined lawyers to obtain that healthcare coverage," notes Judge Crenshaw.

The launch of the system in 2019 was the culmination of years of efforts by the state to modernize Medicaid service delivery and simplify registration requirements as mandated by the Affordable Care Act. According to the law, states must provide a unified application process and collect information about residents to determine their eligibility for various comprehensive health and disability assistance programs. The court found that TennCare Connect did not consider whether applicants were eligible for all available programs before terminating their benefits.

Deloitte was one of the key players in these changes, having secured contracts to develop automated systems in over 20 states. Advocacy groups have appealed to the Federal Trade Commission to investigate Deloitte's actions in Texas, where they claim thousands of residents were similarly wrongfully denied medical benefits due to errors in the program.

Source: Gizmodo