A timeline of Tennessee’s path to become the first state to receive a Medicaid block grant – The Tennessean
A timeline of Tennessee’s path to become the first state to receive a Medicaid block grant The Tennessean
Tennessee is seeking a block grant from the federal government for the state’s Medicaid program, a change Gov. Bill Lee and TennCare officials say could …
Tennessee is seeking a block grant from the federal government for the state’s Medicaid program, a change Gov. Bill Lee and TennCare officials say could present a cost savings and, potentially one day, allow the state to expand coverage.
Critics of the scenario say block grants could result in services eventually being cut back to deal with a limited pool of money, despite decreased federal restrictions.
Here’s a timeline of how the block grant process began in Tennessee and where it will go from here.
Summer 2018: On the gubernatorial campaign trail, then-candidate Bill Lee touts block grants as a health care solution in Tennessee. Meanwhile, Sen. Paul Bailey, R-Sparta, says he and others in Senate leadership have begun talking about how to potentially bring a block grant program to Tennessee.
January 2019: Bailey and Rep. Timothy Hill, R-Blountville, discuss sponsoring legislation to begin the process of seeking a block grant for Medicaid. Lee is sworn in as governor and soon after speaks with Seema Verma, Centers for Medicare and Medicaid Services administrator, about Tennessee pursuing the option.
February 2019: Bailey and Hill file legislation that would require Lee to negotiate with the federal government for a block grant program for TennCare.
May 2019: After undergoing back-and-forth debates between chambers to tweak the bill and the requirements for Lee’s negotiations with the Centers for Medicare and Medicaid Services, the bill passes in the legislature and is signed by the governor.
Summer 2019: Officials with TennCare, including director Gabe Roberts and the department’s chief financial officer, chief of staff, policy director and other staff members, work on crafting a draft waiver to submit to CMS.
Sept. 17, 2009: The Lee administration unveils the waiver it plans to submit to the federal government. The waiver includes details on how the state plans on achieving savings and the flexibility it hopes to receive from the federal government, among other details.
Oct 1, 2 and 3: Tennessee must allow a 30-day public comment period. Public hearings are scheduled for each of the state’s three Grand Divisions to allow for the public to provide comments. They will take place Oct. 1 in Nashville, Oct. 2 in Knoxville and Oct. 3 in Jackson. Stakeholders, such as those in the medical industry and advocacy groups, will also provide feedback to TennCare and the public can mail or email comments.
Late-October 2019: The public comment period ends Oct. 18. Based on feedback, the state could make tweaks to the waiver, though it’s unlikely the final submitted version will differ drastically from the draft released a month earlier.
Early to mid-November 2019: Roberts said he intends for the state to submit the waiver to CMS ahead of the due date, with a target for turning it in during the first or second week of November.
Nov. 20, 2019: The date the legislature requires the governor to submit the waiver application to CMS, which is 180 days after the law was enacted.
December 2019: After CMS formally accepts the submitted waiver, which is usually a couple of days after submission, it holds it for 30 days to receive any additional public comments.
January 2020: After the monthlong holding period for more public input, CMS will reach out to TennCare staff to set up the first of what will likely become a series of phone calls for negotiations. After this, the timeline becomes uncertain, as neither Roberts nor Lee knows exactly how long the deliberations would last.
Negotiations are expected to take place for months.
For perspective, once TennCare submitted its waiver renewal application, as required every five years, in June 2016, it wasn’t until November 2017 that the state heard back with approval from CMS.
Roberts said he anticipates the block grant approval process probably won’t take nearly as long.
2020-2022: At the end of the negotiations, CMS will return with either a “yes” or “no” on the block grant agreement. If there is an agreement from CMS, Tennessee has 30 days to respond, including the legislature approving the finalized waiver.
That could be tricky if the General Assembly is out of session. Lee said he has not yet considered whether he would call the legislature back for a special session to approve a block grant agreement.
The state and federal government could then begin working to shift to the block grant program.
Lawsuits challenging the program would likely be filed at that time.
Reach Natalie Allison at nallison@tennessean.com. Follow her on Twitter at @natalie_allison.
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Published 1:27 PM EDT Sep 17, 2019
