What we learned at Tennessee’s public hearings on the state’s Medicaid block grant proposal – The Tennessean
For three days last week, in community rooms across the state, nearly 70 people stepped up to a microphone to voice concerns about Tennessee’s pursuit of block grant funding for a portion of the state’s Medicaid program.
If granted by the federal government, the arrangement would be unprecedented.
Tennessee could become the first state in the nation to fund its Medicaid program, called TennCare, through a federal block grant, which would involve the state receiving a fixed sum of money to run the program with increased flexibility and fewer restrictions.
President Donald Trump has made pushing block grant funding for state Medicaid programs a priority of his administration in an effort to cut costs.
Tennessee is asking to receive a $7.9 billion block grant to use on some of its Medicaid services, rather than receiving an unspecified amount of funding based on claims filed, and to have the amount increase on a per capita basis for each new member enrolled. It also is requesting the amount be adjusted annually for inflation.
The state is also proposing that if TennCare spending comes in under projections by the Centers for Medicare and Medicaid Services (CMS) — which has been the case in recent years — it will split those savings in half with the federal government to use on other health care initiatives.
While the state argues that the increased flexibility and savings would allow Tennessee to expand TennCare coverage to some of the hundreds of thousands of residents who currently do not qualify for state insurance, opponents say the plan could result in cuts in benefits for those currently enrolled.
Here is what we learned about what people are thinking as they consider the state’s proposal.
A Medicaid block grant isn’t popular among speakers at listening sessions
More than 250 people showed up at three listening sessions TennCare scheduled last week to receive feedback on the proposal before the state submits it to CMS.
Of those gathered, 70 came forward to offer comments. While eight of those comments could be construed as neutral, the remainder were all squarely negative.
Not a single person has shown up to the public hearings to support the plan.
But that’s to be expected, TennCare says, and is consistent with previous public hearings it has held on proposed Medicaid waiver changes. Those who are in favor would have no reason to come and offer feedback, TennCare spokeswoman Sarah Tanksley said.
“While the comments are extremely important to us, it is illogical for anyone to make the conclusion that, because no one showed up to voice support for the block grant in recent hearings, no one supports it,” Tanksley said.
The department also stands by Gov. Bill Lee’s assessment Thursday that people oppose the plan because they are “misinformed or have not taken the time to really understand it.”
“It is alarming that folks are describing the proposal in terms that could not be further from the truth,” Tanksley said.
TennCare representatives declined to answer questions about the plan at the public forums last week.
People are worried a block grant will result in service cuts
Among the chief concerns of those speaking out against a block grant for the state’s Medicaid program is that such a funding model incentivizes the state to cut services as a way to save money.
At the third hearing last week, Craig Fitzhugh, a former West Tennessee state representative and candidate in the 2018 Democratic gubernatorial race, declared the state could only save money by making cuts to TennCare members.
“There are only two ways to save money,” said Fitzhugh, who served as House minority leader and was a vocal proponent of expanding Medicaid under the Affordable Care Act. “One is to reduce services and two is to reduce the people you serve.”
Others, like Jessica Fox, who attended the Knoxville hearing and has a 5-year-old daughter who needs substantial care for her disabilities, expressed fear that therapy and nursing services patients currently receive will be cut back.
TennCare firmly insists none of this will be the case.
“Any characterization that this proposal will lead to a cut in benefits or eligibility, or both, is false,” Tanksley said.
In the the plan the state has released, the document states that the “proposal does not rely on reductions to eligibility or benefits in order to achieve savings, and indeed, does not request any significant changes in those areas” and lists a generic set of principles it will implement in order to “deliver healthcare to its currently membership more effectively.”
Concern abounds about losing access to necessary medications
At the public hearings, people around the state expressed similar fears that the block grant system will allow the state to deny TennCare members access to certain drugs they depend on.
If TennCare is granted the arrangement requested in the initial proposal, the program could cover fewer medicines than it does now in order to negotiate lower prices with drug companies.
“The proposal does not specify any appeals process” for obtaining certain drugs, said Michelle Gross, of Jonesborough, who brought her 6-year-old daughter Asher to the Knoxville hearing. “Which means my child may not be able to access the medication she needs to help her breathe.”
Dawn Schneider, who also spoke at the Knoxville meeting, charged that limiting the list of drugs covered “will kill people.”
Tanksley said said that such a concern is “unfounded” and that “members will continue to receive access to all drugs they need to treat their medical condition.”
The department says that for medical conditions that can be addressed by multiple drugs, TennCare is seeking to be able to only cover “the most clinically effective drug rather than be required to cover every one of the drugs that do the same thing,” Tanksley wrote in a statement.
Such an arrangement, TennCare contends, will allow the department to negotiate better prices on drugs.
Tanksley said that the department will provide access to a specific drug if someone has a medical need for it even if it is not covered for the majority of members. TennCare also will maintain access to new drugs being developed for patients with “complex or rare conditions,” she explained, but is asking for the ability to pursue alternative payment arrangements to cover a blockbuster drug that potentially costs $1 million.
She said a drug appeals process is not addressed in the waiver application because TennCare is not asking to change its current appeals process in any way and will continue to allow members to use the department’s regular and emergency appeals processes.
A Medicaid block grant does not help the 300K uninsured Tennesseans, speakers argue
In every city, critics of the proposal repeatedly uttered the same line: Tennessee should expand Medicaid.
The Republican-controlled state legislature has refused to expand eligibility for Medicaid as allowed under the ACA.
Such a change would extend coverage to an estimated 300,000 Tennesseans who currently are ineligible for TennCare but who can’t afford health insurance.
While former Gov. Bill Haslam unsuccessfully in 2015 tried to push his Insure Tennessee, a version of Medicaid expansion, Lee has been firmly opposed to doing so. Proponents of expanding Medicaid describe Tennessee Republicans’ failure to do so largely as a political decision to avoid associating with an initiative tied to Obamacare.
“Don’t forget that since 2010, we have been offered almost a billion dollars a year in health assistance by the federal government,” said U.S. Rep. Jim Cooper, D-Nashville, who was the first speaker at the hearing held in his hometown. “Perhaps if it had been offered by the Gates Foundation, we would have accepted it.
“Since 2010, we have made the cruel decision to reject federal money for ideological reasons.”
At the Nashville session Tuesday, roughly half of the speakers called for the state to expand Medicaid.
Rep. Gloria Johnson, D-Knoxville, spoke at the session Wednesday in her hometown.
“Block grants don’t commit to add a single person to the rolls,” Johnson said. “Just vaguely state that somewhere down the road we might be able to add some more people.”
Tanksley said that expanding the state’s Medicaid population “was not the charge of the legislation,” referring to the mandate passed by the General Assembly this spring that requires the Lee administration to negotiate with CMS for a Medicaid block grant.
“But it is not true to characterize the proposal as one that does not contemplate covering additional Tennesseans,” Tanksley said in a statement.
The state has proposed using money saved to fund other services for current members, listing in the proposal the example of offering optional dental coverage for pregnant women. Currently, a dental benefit is only offered to children.
Lee has vaguely suggested that in the future the state may be able to expand eligibility for TennCare with any significant savings realized through the block grant. But neither he nor his administration have emphasized such an outcome as one of their top goals in implementing the plan.
Two more public hearings are set to be held before Oct. 18, the final day to submit comments to the state before it reviews the feedback and considers whether to make any revisions to the proposal.
A hearing is set for 2 p.m. Oct. 16 at the downtown branch of the Chattanooga Public Library. The date and time of a Memphis public hearing has not yet been set, but TennCare and Lee have confirmed it will take place.
Reach Natalie Allison at nallison@tennessean.com. Follow her on Twitter at @natalie_allison.
Comments by mail and email
- Send by mail to Mr. Gabe Roberts, Director, Division of TennCare, 310 Great Circle Road, Nashville, TN 37243
- Email comments to public.notice.tenncare@tn.gov
Want to read more stories like this? A subscription to one of our Tennessee publications gets you unlimited access to all the latest politics news, podcasts like Grand Divisions, plus newsletters, a personalized mobile experience and the ability to tap into stories, photos and videos from throughout the USA TODAY Network’s 109 local sites.
Published 8:00 AM EDT Oct 6, 2019
