Dozens of Memphis-area residents spurned Tennessee's planned "experiment" with a new funding model for its low-income healthcare program, TennCare.
At a public forum Tuesday hosted by TennCare officials, opponents scrutinized Gov. Bill Lee's proposal to pay for healthcare through a so-called block grant, rather than through federal reimbursements.
Tennessee is one of 14 predominately Republican-controlled states that have not adopted Medicaid expansion as a rebuke to the Affordable Care Act -- a decision that has so far prevented 380,000 adults from receiving health benefits they would otherwise have, according to the Commonwealth Fund.
Instead, Gov. Lee wants a federal block grant of about $7.6 billion annually to adminster his own program. He says the block grant would give Tennessee autonomy to improve the program and save money without compromising users’ benefits.
The state would have built-in incentive to cut costs: unspent funding would be split between the federal government and the state. The state says it would direct money back into TennCare services.
But until this week, TennCare officials have avoided discussing Gov. Lee's plan in Shelby County, the state's largest urban area with the most number of TennCare recipients.
Several speakers pointed out that the finite resources of a block grant mean the state will have to scale back programs if the money runs out.
“The most likely place for those cuts to come would be on services that are already being provided,” says Katy Ramsey, the director of a low-income medical-legal clinic at the University of Memphis School of Law. “That includes medication, that includes preventive healthcare.”
She says low-income children would be the most vulnerable to downsizing.
“We [already] see, every week, multiple children whose TennCare benefits have been terminated or are being reduced for reasons that are framed around cost savings for the state,” Ramsey says.
She cites examples such as a reduction in the number of home nursing hours covered for disabled children and changes in prescription drug coverage.
Emily Vergho worries block grant funding could jeopardize her 31-year-old autistic son’s Medicaid benefits. She’s also has experienced cuts in the past.
“Periodically, they have cut his hours for different services, or I’ve had to appeal to get those hours reinstated,” she says.
Many at Tuesday’s event were frustrated that lawmakers hadn't opted for the traditional Medicaid expansion model under the ACA.
Ramsey also questions the rationale of allowing Tennessee to operate its Medicaid program with less federal oversight.
“There would be no checks on how they would be able to implement the coverage that they’re currently required to provide by the federal government,” she says.
Previously this year, Tennessee lawmakers hoped to cut TennCare enrollment by creating work requirements for recipients, which has been challenged in courts. Such a program would cost millions of dollars to manage, which the state would have to pay for under its current Medicaid arrangement with the federal government. But it could be funded through a block grant.
Public comment on the proposal is open until October 18. Comments can be emailed to public.notice.tenncare@tn.gov.