Tennessee Supreme Court strikes TennCare cap on emergency room payments

Published by the Tennessee Lookout, Reporter Anita Wadhwani – June 6, 2023

For more than a decade, Tennessee’s Medicaid program set a $50 cap on its payments to emergency room doctors treating low-income patients who show up at hospitals without experiencing a genuine medical emergency.

The Tennessee Supreme Court has now ruled that TennCare failed to follow the rules in setting the cap, a decision that potentially opens up taxpayers to years of back claims from the state’s hospitals and doctors over being underpaid for patient care since 2011.

The cap is now void. It was originally set as part of a broad cost-cutting measures as TennCare — the state’s publicly-funded health insurer for low-income and disabled residents —was facing a $100 million shortfall.