Medicaid

Lee says block grant critics are ‘misinformed’

Gov. Bill Lee speaks at the state Capitol on Sept. 16, 2019. (Erik Schelzig, Tennessee Journal)

Gov. Bill Lee says the largely critical response to his Medicaid block grant proposal in public hearings around the state is coming from people who have either been misinformed or haven’t taken the time to understand the proposal, the AP’s Kimberlee Kruesi reports.

From the AP report:

“I do think that a lot of the folks who are concerned about this have been either misinformed or have not taken the time to really understand it. And there’s legitimate concern about that. We want people to understand this,” Lee, a Republican, told reporters.

The public comment period is required under federal rules for seeking Medicaid waivers. Public hearings were scheduled for Nashville, Knoxville, and Jackson this week. Lee has said he will add stops in Chattanooga and Memphis.

Lee’s Medicaid block grant proposal deemed ‘illegal’ by House chairman

Gov. Bill Lee speaks at the state Capitol on Sept. 16, 2019. (Erik Schelzig, Tennessee Journal)

Gov. Bill Lee’s application for a Medicaid block grant is drawing fire from a power chairman in the U.S. House, the Chattanooga Times Free Press reports.

“This is illegal and the Trump Administration does not have the authority to do this,” House Energy and Commerce Chairman Frank Pallone (D-N.J.) wrote on Twitter.

“I wrote to [Health Secretary Alex] Azar this summer reminding him HHS does not have legal authority to implement a block grant or per capita cap on the Medicaid program,” Pallone said. “While Secretary Azar has yet to respond to me, ignoring oversight letters from Congress doesn’t change the fact that block granting Medicaid is illegal.”

The Tennessee proposal has drawn praise from Republican Tennessee Sens. Lamar Alexander and Marsha Blackburn.

The details of Lee’s block grant application were unveiled this week, launching a 30-comment period before it is submitted to the federal government. Supporters say it can be approved without congressional oversight.

“Gov. Lee has reiterated that point throughout this process and it will be up to [the Centers for Medicare & Medicaid Services] to communicate what they are willing to accept during the negotiations,” said Laine Arnold, a spokeswoman for the governor.

Lee’s block grant proposal: What they’re saying

Gov. Bill Lee’s administration on Tuesday unveiled its Medicaid block grant proposal, kicking off a 30-day public comment period. Here’s a sample of how Tennessee news outlets are covering the news.

Tennessean:

Currently, the federal government provides about $7.5 billion to $8 billion annually to pay for TennCare. This funding increases or decrease as the need grows or shrinks, and the money is theoretically limitless if the state continues to operate TennCare in accordance with federal guidelines.

As proposed, Gov. Bill Lee’s administration’s plan would convert that funding into a “modified block grant,” giving the state government more authority over how this money is spent. Block grants are generally finite, raising concerns this money might run out, but the governor’s proposal asks the federal government to commit to providing more money if it is needed by the state in the future.

Chattanooga Times Free Press:

Lee’s proposals have already come under fire even before he made full details public.

“I think the issue is that when they say that they’ve created all these ‘savings’ for the federal government, that includes like the 220,000 children that were cut off even though tens of thousands of them were eligible,” said Michele Johnson, executive director of the Tennessee Justice Center, in an early September interview.

“Here’s the bottom line,” Johnson said. “The Trump administration has said they’re going to cut over a trillion dollars out of the [national] Medicaid program through block grants. The Lee administration says we’re going to be able to get all this money, an expansion of health care? The math doesn’t work out.”

_ The Daily Memphian:

Initially, the governor avoided answering how much the state could net through the block grant proposal. But after TennCare Director Gabe Roberts acknowledged the state’s “budget neutrality” figure is $2 billion, the governor conceded Tennessee could land $1 billion if the feds agree to the state’s entire proposal.

Lee couched that comment by noting the amount will depend on whether the feds place new service requirements on TennCare, which typically receives about $8 billion from CMS and about $4 billion from the state.

_ WPLN-FM:

Primarily, the additional money comes from a plan to split savings TennCare already generates with the federal government. Under its current waiver, Tennessee’s Medicaid program costs the federal government billions of dollars less than if it were just the open-ended federal benefit. Tennessee now wants to share those savings 50/50, which is expected to be a key sticking point in negotiations.

The block grant also envisions saving money by cutting red tape, like the periodic reapprovals of Tennessee’s waiver. Even when very few changes are made, the process takes nearly a year. Tennessee is asking for its new block grant proposal to be considered permanent.

TennCare wants to change a few rules that would ensure it’s the “payer of last resort,” particularly in cases where a patient also qualifies for Medicare.

_ The Associated Press:

The plan’s likelihood of ever being implemented, however, remains largely unknown. To date, no state has been given permission to rely solely on block grants to cover Medicaid expenses. The idea has been floated by Republicans for decades but never implemented, due to possible legal challenges and concerns that doing so would result in large spending cuts to the states’ most vulnerable populations.

Yet Lee remains hopeful, noting that support is growing under President Donald Trump’s administration and asserting that no services to the state’s indigent population will be cut. Tennessee’s GOP U.S. Sens. Lamar Alexander and Marsha Blackburn have also expressed interest in the plan, an endorsement that some say could help push the idea further along.

The Nashville Business Journal:

The 50/50 split Lee is pitching, as well as other aspects of the proposal, are subject to changes and negotiation once Tennessee submits a formal proposal to the federal Centers for Medicare and Medicaid Services.

“We think we have crafted a waiver that is going to really mitigate the risk that Tennesseans have and actually give us an opportunity to benefit from the efficiencies and the way that we run our program,” Lee said. “That benefit will give us an opportunity to provide enhanced services to our TennCare population … and eventually, for the same money, provide additional services to more people.”

While health systems have yet to comment publicly on Lee’s plan, Republicans in Congress had pitched a similar proposal in 2017 as their effort to repeal and replace the federal Affordable Care Act. At the time, more than 20 organizations, including the American Hospital Organization and the American Medical Association, came out against the proposal, which ultimately failed.

_ The Washington Post:

Tennessee is setting up the nation’s first test case of how far the Trump administration is willing to go to allow a state the “flexibility” that has become a watchword of the administration’s health-care policies.

If TennCare, as that state calls its Medicaid program, wins federal approval for its plan, it could embolden other Republican-led states to follow suit. It also almost certainly would ignite litigation over the legality of such a profound change to the country’s largest public insurance program without approval by Congress.

The Wall Street Journal:

If block grants catch on, the Trump administration could be successful in achieving the Medicaid changes congressional Republicans were unable to in their failed 2017 repeal of the ACA, also known as Obamacare. Tennessee’s proposal released Tuesday would be submitted to the Trump administration in November following a public comment period.

Under Tennessee’s draft proposal, the state would get a lump sum based on projected Medicaid costs. The grant would be adjusted each year for inflation. The federal government would increase its funding on a per capita basis when Medicaid enrollment eclipses the number used to calculate the state’s initial grant amount.