Governor Bill Lee's administration has released a draft of Amendment 42 outlining the state’s proposal to convert federal funding for Medicaid (TennCare) into a “block grant.” The draft, an executive summary and overview of the amendment is online at:
https://www.tn.gov/tenncare/policy-guidelines/waiver-and-state-plan-public-notices.html
The block grant proposes to change the way Medicaid (TennCare) is funded:
- Currently, the federal government funds part of each state’s Medicaid program based on population and the needs of each state.
- Using the current funding mechanism, the federal government funds 2/3 TennCare costs
- The block grant would cap federal funds, with certain exceptions and adjustments for inflation
- The proposed block grant funding mechanism will make it hard to expand Medicaid services or serve additional Tennesseans
There are a few parts of TennCare that were not included in the block grant and will continue to be funded the traditional way:
- The Department of Intellectual and Developmental Disabilities 1915c waiver programs are not included in the block grant.
- All of the Bureau of TennCare’s administrative costs
- Uncompensated care payments to hospitals
- Costs of outpatient pharmacy services
- Case management services provided to children in state custody
How could the block grant impact Tennesseans with disabilities:
- The CHOICES long-term supports and services for adults with disabilities and seniors who do not have access to Medicare are included in the block grant. Block grant funding will make it hard to expand services or serve additional people.
- The Employment and Community First CHOICES long-term supports and services program is included in the block grant. Block grant funding will make it hard to expand services or serve additional people.
- New programs, including the Katie Beckett Program, will not be included in the block grant for their first three years of operation. At that time, the funding that the program has needed for operations (whether or not enrollment is at full capacity) will be the funding allotted for the future of the program through the block grant. Block grant funding will make it hard to expand services or serve additional children.
- Tennessee is asking to be exempt from future federal Medicaid mandates. This means, for example, that if the federal government mandated that states cover a particular medication or provide a new type of service, Tennessee would be exempt from that rule and not have to do so.
- Tennessee is currently required to cover all prescription medications included in the federal Medicaid drug rebate program. The state is asking to adopt a commercial-style closed prescription drug formulary. This could limit prescriptions covered, in particular specialty medications needed by a small group of people, like those of us with disabilities.
- The federal Medicaidid comparability requirement means that covered benefits must be the same for all covered populations. Tennessee is asking to waive this requirement, which would allow TennCare to vary the types of benefits that are available to different types of patients. This could prevent an individual beneficiary from accessing the types of services he or she needs.
- Tennessee is asking to never have to reapply or have TennCare re-evaluated by the federal government. This would remove oversight of the program. Federal oversight has traditionally been critical to protecting people with disabilities.
- Tennessee is asking to be able to make changes to the benefits it provides, TennCare enrollment processes and service delivery systems without federal government approval or oversight. Federal oversight has traditionally been critical to protecting people with disabilities.