A Medicaid block grant agreement brokered with the Trump Administration rolled through the House Friday on a party line vote.
The measure passed 68-22, as the House joined the Senate in approving a Medicaid waiver program designed to enable the state’s TennCare program to take advantage of savings garnered over decades of work.
Rep. Bryan Terry, chairman of the House Health Committee, argued that the program is a shared savings program that will enable the state to put accumulated money into new services for the 1.5 million people on TennCare.
“This is not a block grant. They are not approving the block grant financing the state described in its application,” said Terry, a Murfreesboro Republican.
Terry pointed out a letter from the federal government said the program is not a “block grant” and won’t be sent in a lump sum but instead will match state expenses and set a cap on spending but with safeguards to cover extra costs.
Despite uncertainty looming over the program, state officials say services, TennCare recipients and payments to providers will not be cut under this agreement, which will be the first of its kind in the nation.
The Trump Administration reached an agreement with the state just a week ago, and the Legislature pushed it to passage this week, even though the first few days of the session are usually intended only for organization.
Under the federal agreement, Tennessee will receive about $8.3 billion for the $12.7 billion program instead of an amount based on the number of people on the rolls of TennCare, which serves mainly pregnant women with children, the state’s elderly, disabled and most needy residents.
Democrats oppose the bill mainly because of the unknown and the likelihood the incoming administration of President-elect Joe Biden will rescind the agreement. Democrats also continue to push Medicaid expansion under the Affordable Care Act, a deal 38 states and Washington, D.C. have accepted since it took effect under the Obama Administration.
Tennessee is one of a handful of states still denying Medicaid to its working uninsured. . . (The block grant) is a political gimmick that jeopardizes access to healthcare for hundreds of thousands of Tennesseans by creating a state budget booby trap. – Michele Johnson, Tennessee Justice Center
State Rep. Gloria Johnson, a Knoxville Democrat, opposed the measure Friday, saying medical experts have told her only Congress has authority to waive sections of Medicaid law, not the Trump Administration or director of the Centers for Medicare and Medicaid Services.
TennCare Director Stephen Smith told lawmakers in briefings this week the state will take savings from the same efficient operations it’s used for years and, instead of sending the money back to the federal government, use it for new services such as maternal infant care, rural healthcare and possibly the addition of some of the state’s disabled residents to the program.
Smith, however, admitted he had not spoken with the incoming Biden Administration about the waiver and whether it would be rescinded. Biden favors Medicaid expansion under the Affordable Care Act.
Consequently, critics of the program accused Republicans of rushing the deal through the Legislature without ample time for the healthcare industry or advocates to comment.
“Most of us can’t answer detailed questions about what’s in this,” Rep. G.A. Hardaway, a Memphis Democrat, said during Friday’s debate.
Hardaway also argued that TennCare can’t quantify the exact changes to be made in the program, causing confusion among enrollees statewide. He added that many people in his urban district already lack adequate healthcare.
Likewise, state Rep. John Ray Clemmons, a Nashville Democrat, argued that $6 billion held out to the state as a “savings account” for TennCare overruns is nothing but a “carrot” at the end of a stick.
The state could receive a 90/10 share of federal funds, rather than a 63/35 split, by simply expanding Medicaid to about 300,000 uninsured and underinsured Tennesseans and avoid “blowing up” TennCare, Clemmons said.
Yet Republican lawmakers said TennCare operations have been discussed for more than two decades, and they noted the Legislature voted two years ago to have Gov. Bill Lee’s Administration seek the block grant deal.
“I’m confident we’re going to have millions of dollars flexibly spent by us,” said Rep. David Hawk, a Greeneville Republican.
A new group called Tennesseans for Better Healthcare Choices touted the move Friday.
“This meaningful healthcare reform will increase funding and lead to new, better care options through TennCare. It is clear that states know best how to serve their population, and that is a great move in the direction of more state control,” said Chris Walker, an advisor to the group who previously served as Gov. Lee’s press secretary.
The Tennessee Justice Center criticized the agreement immediately after federal officials announced a deal last week.
“Tennessee is one of a handful of states still denying Medicaid to its working uninsured, and the block grant is just another example of putting politics ahead of healthcare during this pandemic. It’s a political gimmick that jeopardizes access to healthcare for hundreds of thousands of Tennesseans by creating a state budget booby trap,” said Michele Johnson, executive director of Tennessee Justice Center, a nonprofit organization that advocates for healthcare services for the state’s neediest residents.
Johnson added, “It is tragic that, in the middle of a deadly pandemic, our legislators have rushed to adopt this crass political gimmick. It distracts from their continued refusal to to let 300,000 working Tennesseans receive the federally funded health coverage that former Gov. (Bill) Haslam’s plan would provide.”