TennCare is fielding nothing but pushback to its block grant proposal, which it plans to submit to the federal government next month. The state’s Medicaid program is holding public hearings this week, and the kickoff in Nashville resulted in a unified chorus of resistance.
This block grant would be a first in the U.S. and would transform Tennessee’s Medicaid program, giving it far more flexibility in how federal money is spent and the opportunity to keep as much as half the savings it achieves.
But health care providers fear reduced reimbursement rates. Mental health advocates are suspicious of efforts to cut drug spending by reducing the number of covered medications. And many speakers on Tuesday noted a lack of details in the 25-page block grant proposal, despite its overhauling a health care program that covers 1.4 million Tennesseans.
"The first part of it says it's not designed to cut care or to cut benefits," said Michele Johnson, executive director of the Tennessee Justice Center. "And then if you just turn the pages you get to page 20 and guess what it says? We're going to ask for permission to cut benefits."
A handful of TennCare patients and their relatives spoke up on Tuesday, expressing sweeping distrust in an agency that has had difficulty explaining a dramatic drop in its enrollment.
Former state worker Arlene Martin-Norman of Nashville says a block grant would be such a massive change, sick people would inevitably get lost in the shuffle.
"Anytime you start something new, there’s going to be growing pains, there’s startup pains," she says. "And in this instance, those pains affect real people."
Many opponents, including Nashville Congressman Jim Cooper, point out the state is pursuing an untested strategy supported by the Trump administration while rejecting federal money for Medicaid expansion, which appears to improve the health of states that have gone through with it.
"This is a radical, Trump-inspired plan, to treat Tennesseans like guinea pigs," Cooper said. "This waiver request not only doesn't help. It actually goes backwards."