Policy Recommendations for the Next Governor
Family Support Program
This program is a model of successful disability policy that was
created by the General Assembly in 1992. It provides a hand-up to
thousands of Tennessee families who are struggling each year to care
for loved ones at home who otherwise might be forced into a nursing
home at much greater expense to the state.
Family Support is crafted so that administrative expenses are limited
to no more than 15% of the program to ensure that the bulk of funding
goes directly into the hands of Tennessee families. On average a
family receives a modest $1,500 each year to cover expenses such as
respite care, home modification, personal assistance, medical devices
and more. This modest support is a valuable lifeline that has kept
many families together since Family Support’s creation.
Unfortunately, the latest state budget eliminated practically all
recurring funds for the $7.2 million program and replaced those dollars
with one-time federal stimulus money. This means the program is headed
toward elimination during the 2010-2011 fiscal year.
Long-Term Care Reform
For generations Tennessee has lagged every state in the union when it comes to the provision of more cost-effective home- and community-based services (HCBS) that permit seniors and persons with disabilities to avoid life in an institution. Not long ago, the state was spending about 2% of its long-term care budget on HCBS while dedicating 98% of its long-term care budget to costly institutions like nursing homes
The state took a solid first-step last year to reversing its “institution first” mentality with passage of the Long-Term Care Community Choices Act of 2008. This legislation fundamentally changes the long-term care landscape in Tennessee by creating a system that fosters development of more robust HCBS options while gradually shifting valuable state dollars from high-cost institutions such as nursing homes to more cost-effective HCBS.
It will take three years or more to implement the new long-term care system and several more years to work out the kinks. This provides an excellent chance for the next Governor to put their stamp on an invaluable effort to increase options for and support independence of seniors and persons with disabilities.
However, those reforms focused on seniors and adults with physical disabilities. As a result they left out one population in Tennessee that is long overdue to see a similar transformation in care delivery – persons with a developmental disability such as mental retardation. This population has been poorly served by the state in recent years as Tennessee continues to pump tens of millions into the building of new institutions for this population while ignoring the greater need for HCBS services that can be provided at a fraction of the cost.
Medicaid Spend Down – TennCare’s Missing Link
The state has promised for several years to re-open the Medicaid Spend Down category for TennCare, but no substantive action has taken place. This is unfortunate because re-opening this eligibility category is critical to helping families who live on the edge of financial ruin due to overwhelming medical bills.
Spend Down works by permitting an individual to qualify for Medicaid despite making too much money if the person spends so much on medical care that it drives their remaining income below the thresholds to qualify for TennCare. For example, let’s say that John Doe can’t get health coverage through his employer and has recently been diagnosed with a serious medical condition. Let’s also assume that John makes $5,000 more than permitted for Medicaid, but it looking at $20,000 in health care bills. In states that have “Medicaid Spend Down” programs John could subtract that $20,000 in health care bills from his income and then qualify temporarily for Medicaid.
This permits John to stay in the work force, deal with a serious, but temporary medical emergency and avoid becoming permanently reliant upon Medicaid. Approximately 33 states have a Medicaid Spend Down category.
