'I don't trust them to do the right thing.' Lee's TennCare block grant proposal not well received in Memphis
Corinne S KennedyGov. Bill Lee’s proposal to change how Tennessee’s Medicaid program, TennCare, is funded was roundly denounced Tuesday in Memphis, with Shelby County residents, officials and healthcare advocates criticizing the plan as an immoral prioritization of cost savings over vulnerable citizens.
During a two-hour meeting at the University of Memphis campus, 32 people spoke or asked questions about Tennessee's proposal to receive a block grant from the federal government to pay to fund TennCare. No one who spoke at the meeting expressed support for the plan, and a majority of speakers said the state should expand Medicaid rather than pursue a block grant funding mechanism.
While several people simply asked questions about the block grant plan, the vast majority of speakers, including doctors, attorneys, caretakers and TennCare recipients, castigated the proposal and criticized TennCare’s current management, the governor and the federal government.
Under the proposal, the state would receive a $7.9 billion block grant to use on some of its Medicaid services, rather than receiving an unspecific but unlimited amount of funding based on claims filed.
Aaron Butler, director of policy for TennCare, said the proposal could result in a "significant increase" in funding for TennCare.
“After the first year, the block grant would be increased each year to adjust for inflation,” he said.
Butler said the requested figure was based on average enrollment over the past several years and said the block grant amount given out by the federal government would increase if enrollment exceeds the average. He also said the block grant proposal would give the state “flexibility” to administer its Medicaid program without federal red tape, which he said creates more work for TennCare without adding benefit for program recipients.
Many who spoke Tuesday said they thought TennCare needed more federal supervision, not less.
Memphis resident Michael Heinrich, who said he was previously a TennCare recipient, said he was concerned that without federal oversight, the agency would pursue the goal of cost savings by cutting coverage for vulnerable populations.
“I don’t think, in my opinion, that the powers that be have earned my trust to be free from these requirements. My experience has been that these folks who make the decisions have been drug into court by their ankles to live up to the responsibilities they have,” he said of TennCare. “I don’t trust them to do the right thing.”
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Craig Sander, director of neonatology at Baptist Women’s and Children’s Hospital, said that in the long run, the block grant proposal would decrease the number of people on TennCare and funding for the program.
“This is exactly the opposite direction that our state should take in order to provide adequate healthcare for Tennesseans,” he said. “The rejection of the expansion of TennCare by our legislature, despite the efforts of Governor Haslam, has had deleterious effects to the health of our people.”
Numerous people also criticized TennCare for not initially scheduling a public hearing on the block grant proposal in Shelby County, which has more TennCare recipients than any other county in Tennessee.
University of Memphis law student Eliza Jones said it was “inappropriate” that Memphis was not a “top priority” when scheduling public meetings about the block grant.
“Shelby County has more than 250,000 people enrolled in TennCare. That number represents 26% of our county’s total population and 17.6% of TennCare enrollees, the highest concentration of TennCare enrollees of any county in Tennessee, by almost double,” she said. “Shelby County is undoubtedly the most significant TennCare stakeholder of all Tennessee counties and this city should have been the starting place for any TennCare hearing concerning an issue of this magnitude."
Several elected officials representing Memphis and Shelby County in Nashville also took the meeting as an opportunity to both thank residents for sharing concerns and sharply criticize the proposal. State Sen. Katrina Robinson said it should be noted that no one who spoke at the meeting voiced support for the block grant.
“Make no mistake that this block grant is an effort to basically concert states across this country to dismantle federal entitlement programs,” she said. “This is just one tiny piece of the puzzle and what we are doing is diverting money from our healthcare system.”
Rep. Antonio Parkinson said Tennessee had close to $1 billion in reserves and could afford to provide medical insurance for citizens. Parkinson said he believed the block grant proposal was “built around racism.”
If implemented, the proposal would result in the billions the federal government provides the state annually to administer TennCare being provided in one grant. Supporters of the proposal say it would give the state more control over how those Medicaid dollars are spent, resulting in a more efficiently run program. Opponents have raised concerns that TennCare recipients could suffer if the program runs out of money — either due to mismanagement or an enrollment spike — and that the pursuit of cost savings could lead TennCare to cut services offered or eligible recipients.
Tennesseans who want to comment on the block grant proposal have until the end of the day Friday to submit comments via email or in writing to the agency. TennCare will then review the comments before sending the block grant proposal to the federal government. If it is approved by the federal government, it will come back to the state legislature for further debate and a final vote.
Corinne Kennedy is a reporter for The Commercial Appeal. She can be reached via email or at Corinne.Kennedy@CommercialAppeal.com or on Twitter @CorinneSKennedy.