TennCare

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.

TennCare director Wendy Long leaving for Nashville post

TennCare Director Wendy Long is leaving her position with the state to become director of health for the Metropolitan Board of Health of Nashville and Davidson County.

Here’s the full release from Gov. Bill Haslam’s office:

NASHVILLE – Tennessee Gov. Bill Haslam today announced TennCare Director Dr. Wendy Long will leave state service in January. The Metropolitan Board of Health of Nashville and Davidson County has selected Dr. Long as the new director of health, pending contract approval by the Metropolitan Council.  

Haslam appointed Dr. Long in June 2016 as the director of TennCare after she previously served in other executive positions within the agency including deputy director and chief medical officer. Dr. Long has 14 years of service to TennCare and more than 30 years to Tennessee State Government. Dr. Long’s state service includes working as assistant commissioner at the Tennessee Department of Health where she oversaw a wide variety of programs and services including maternal and child health, communicable disease control, and the operation of local and regional health departments throughout the state. 

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Tennessee’s uninsured rate up by 10% over 2017

Tennessee uninsured rate increased by 10% over last year, according to a new study released by the University of Tennessee.

An estimated 452,000 Tennesseans are uninsured in 2018, or 6.7% of the state’s total population. That compares with the 408,000 people, or 6.1%, who were uninsured in 2017. That followed a low of 5.6% in 2016. That state’s uninsured rate hovered near the 10% mark between 2006 and 2013, before the Affordable Care Act went into effect.

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TennCare moves to implement new TN ‘defund Planned Parenthood’ law

In compliance with a law approved earlier this year by the state legislature, TennCare officials last week applied to the federal government for a waiver that could block clinics that provide abortions from being paid for other health care services, reports the Johnson City Press. An ETSU professor says there may be unintended consequences including more abortions; a legislator disagrees.

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TennCare backs off initiative aimed at making doctors more cost conscious

After months of resisting pressure from doctors, Tennessee’s Medicaid program, known as TennCare, is slowing down an initiative meant to make physicians more cost conscious, reports WPLN. The Tennessee Medical Association has complained about the so-called “episodes of care” payment model since its inception, though doctors initially cooperated with state officials in designing the program.

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Bill requiring some to work for TennCare coverage gets final legislative approval

The Republican-led Tennessee Legislature on Thursday passed a controversial bill aimed at imposing work requirements on people receiving Medicaid benefits through the TennCare system, reports the Associated Press. Gov. Bill Haslam has backed the measure.

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GOP legislators spurned renewed Haslam pitch for Medicaid expansion in private meeting

Gov.  Bill Haslam asked Republican legislative leaders earlier this month if they would reconsider Medicaid expansion legislation, which was rejected when he initially proposed the idea three years ago, reports The Tennessean. House Speaker Beth Harwell and Senate Speaker Randy McNally were open to discussing the idea but others were not and the notion was dropped.

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Late-night calls deemed ‘outrageous’ by legislator, a timing error by sponsor

State Sen. Kerry Roberts and Lt. Gov. Randy McNally (R-Oak Ridge) are calling for multiple investigations after robocalls from the Tennessee Justice Center criticizing Roberts’ TennCare work requirements legislation went out in the middle of the night Thursday, reports the Nashville Post.

“These robocalls are outrageous and the information disseminated is false and misleading,” said Roberts (R-Springfield). “They were conducted in the middle of night with the call back number, for those who thought that it might be a dire emergency due to the late hour, going to my legislative office which is completely deceptive.”

However, the TJC — a nonprofit that assists state families with TennCare, Medicaid and Medicare eligibility and appeals — insists the error was not malicious.

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McNally blocks Senate vote on Harwell’s work-for-Medicaid bill

House Speaker Beth Harwell was caught “completely off guard” Thursday when Senate Speaker Randy McNally stopped a scheduled floor vote on her House-approved bill that imposes work requirements on some able-bodied adult Medicaid enrollees, reports the Times Free Press.

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House votes (along party lines) to require work for some on TennCare

The state House voted 72-23 Monday night to direct the Haslam administration to seek a waiver of federal Medicaid rules to develop a plan imposing a work requirement on some able-bodied TennCare enrollees, reports the Times Free Press.

The vote on HB1551) sponsored by House Speaker Beth Harwell and presented by Rep. Dan Howell (R-Georgetown)  was along party lines – Republicans yes and Democrats no (with the exception of Rep. John Mark Windle of Livingston). There was spirited debate.

The measure now awaits a Senate floor vote.  Gov. Bill Haslam has said he sign the bill when it reaches his desk.

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