With Gov. Bill Haslam's efforts to expand Medicaid dead for now, questions are now being raised about how long Tennessee will be able to rely on a $750 million federal funding pool that hospitals depend onto help treat uninsured patients.
The Low Income Pool payments Tennessee receives -- approximately $500 million before the state's $250 million match -- are set to expire Dec. 31, said TennCare spokeswoman Sarah Tanksley.
That's why the state is closely monitoring the situation in Florida, where Low Income Pool payments are scheduled to expire June 30 and where legislators are debating Medicaid expansion. Federal officials said last week that Florida's decision about Medicaid would count in the decision whether they would extend those funding pools would past their deadlines.
Last week, Tennessee officials received a phone call from the U.S. Centers for Medicare and Medicaid (CMS) broaching the same topic, a federal official confirmed.
"We've been in contact with those states that have uncompensated care pools and reiterated that we look forward to an ongoing dialogue to develop a solution that works for patients, hospitals and the taxpayer," Ben Wakana, spokesman for the U.S. Department of Health & Human Services, said Wednesday.
"We told states that our letter to Florida articulates key principles CMS will use in considering proposals regarding uncompensated care pool programs in their states, but that discussions with each state will also take into account state-specific circumstances."
Joan Alker, executive director of Georgetown University's Center for Children and Families, said such conversations over the fate of the funding program "are important for Tennessee legislators to consider."
"CMS has articulated a policy saying, 'We're not going to give you uncompensated care costs as a Band-Aid when you refuse to expand Medicaid,'" Alker said. "I don't see this as hardball. They are trying to be stewards of taxpayer money."
Expanding Medicaid would insure an estimated 280,000 Tennesseans, who could then get more preventive and regular care instead of showing up in hospital emergency rooms and adding to the burden of uncompensated care, Alker explained.
Senate panels twice killed Haslam's proposal, once in a special session before the regular General Assembly and again recently in a Senate committee.
On Wednesday, TennCare spokeswoman Kelly Gunderson said the bureau was monitoring interactions between CMS and other states, but stressed that "just because a change is being discussed in one state does not mean it will apply to all states."
"I wouldn't say Tennessee is 'concerned' at this juncture, but that may change as the discussions continue," said Gunderson. "As of right now, none of the Tennessee's pool funds are 'at risk.'"
Because Haslam has made good-faith efforts to expand Medicaid, Alker said, the state is in a "much more constructive place" than other states. But, she added, added that it was a matter "the state would be smart to start negotiating about far ahead of the deadline."
Other states CMS contacted about expiring pools were Texas, California, Massachusetts, Arizona, Hawaii, Kansas and New Mexico, a CMS official said.
Contact staff writer Kate Belz at kbelz@timesfreepress.com or 423-757-6673.