Tennessee Medicaid block grant plan heads for federal review

The TennCare block grant plan was amended to say the state “would not be permitted to use this authority to make reductions to its benefits package,” and would be “limited to benefit changes that are additive in nature.” (Image: MGN)

Tennessee officials committed not to halt or limit coverages under a revised plan submitted to the federal government Wednesday requesting to become the first state to receive funding in a lump sum for its Medicaid program, TennCare.

The TennCare block grant plan was amended to say the state “would not be permitted to use this authority to make reductions to its benefits package,” and would be “limited to benefit changes that are additive in nature.”

The first draft of the proposal faced a deluge of criticism during public meetings and submitted comments, with advocates, health care groups and others worrying that the plan could compromise care for the state’s most vulnerable low-income and disabled citizens. Republican Gov. Bill Lee long contended patients wouldn't risk losing benefits or eligibility under the plan, and the original draft included less explicit assurances.

“Some of the concerns we got were that if we get this flexibility, then we could just unilaterally decide to stop covering things or limit certain things that we cover,” TennCare Director Gabe Roberts said in a conference call with reporters Wednesday. “And we want to be clear that that wasn’t our intent and we are committing ourselves not to do that.”

Read more: Tennessee mom concerned her family will go bankrupt if proposed TennCare revisions pass

The plan also spells out what Lee has hinted at previously — that possible savings could go toward adding a yet-to-be-determined number of people for coverage on the TennCare rolls. Lee has batted away suggestions to expand Medicaid under former President Barack Obama’s health care law, saying that would expand a broken system. His predecessor, Republican former Gov. Bill Haslam, failed to convince GOP lawmakers to pass a Medicaid expansion plan.

Lee argued that his plan could expand coverage in “not a way that comes at great risk to our state.”

“It’s a good, innovative, creative way to provide more coverage,” Lee said in the conference call.

The federal government will now consider the $7.9 billion plan, still a far shot from being put into practice. Another public comment period will be underway. And if the state and federal government negotiate an agreement, Tennessee lawmakers get a final vote. Legal challenges likely will follow.

President Donald Trump’s administration has encouraged states to submit block grant proposals like Tennessee’s, which would cover core medical services for the disabled and blind, children, adults and elderly — or about 1.2 million Tennesseans. This means administrative costs, prescription drugs, uncompensated hospital payments and individuals dually eligible for Medicaid and Medicare would not be part of the block grant plan, which would cover a much smaller segment of TennCare.

The federal government would increase Tennessee's block grant funding if enrollment grows beyond the original calculation.

Roberts, the TennCare director, has described the plan as a "hybrid" approach to block grants because the state has designed its proposal to allow Tennessee to keep 50% of any unspent block grant funds.

In addition to possibly expanding enrollment, the plan also spells out using possible savings to extend post-partum coverage from two to 12 months, provide pre-natal and post-partum dental coverage, expand eligibility, clear the waiting list of 5,000 people with intellectual or developmental disabilities, and address health crises ranging from the opioid epidemic to maternal and infant mortality rates.

The new version of the plan doesn’t change a controversial component that could limit some prescriptions for those on TennCare to one drug covered per therapeutic class. But it does adjust to include an exceptions process to cover other drugs and would not limit use of off-label drugs for children under age 21.

State lawmakers passed legislation earlier this year requiring the plan to be filed by Wednesday.

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