Nearly 87,000 adult TennCare enrollees could be affected under work requirement plan

NASHVILLE - As many as 86,400 able-bodied adult enrollees on Tennessee's Medicaid program could be affected by a bill that seeks to require they work, attend school, volunteer or face losing their health benefits, according to a legislative analysis.

The bill, estimated to cost the state $18.7 million annually, cleared the Republican-controlled House Health Subcommittee on a voice vote. The two Democrats on the panel, including Rep. JoAnne Favors, D-Chattanooga, voted no.

Sponsored by Republican House Speaker Beth Harwell of Nashville and state Rep. Dan Howell, R-Georgetown, the bill orders the Haslam administration to seek a federal waiver to impose Medicaid work requirements under the new policy issued last month by the Trump administration.

"My intent in this bill is to try to ease them into the workforce, try to make them productive citizens," Howell, who is carrying the bill, told the panel.

Rep. John Ray Clemmons, D-Nashville, said "the data is clear" with proponents' "ultimate" goal being "to kick people off" of TennCare, the state's Medicaid program.

Citing estimates by the Beacon Center, a nonprofit, free-market think tank, Howell estimated the bill would impact about 58,000 able-bodied adults who don't work or have children under the age of 6.

Those affected would be required to spend 20 hours a week working, volunteering or in education programs.

TennCare covers an estimated 1.2 million low-income families and children, pregnant women, the elderly and people with disabilities.

GOP lawmakers as well as officials with Beacon Impact, the political and lobbying arm of a conservative think tank, sharply questioned estimates made by TennCare officials working in Republican Gov. Bill Haslam's administration.

The administration has put a "fiscal flag" on the legislation, meaning it is concerned about its costs. But Ashley Reed, TennCare's director of legislation, said the department is officially neutral and has "deferred" to the General Assembly.

An irritated Rep. Cameron Sexton, R-Crossville, chairman of the full Health Committee, told TennCare officials he was frustrated because "if we didn't ask you to do it, we wouldn't be talking about" legislative Republicans "taking the lead."

Harwell, who is running to succeed the term-limited Haslam, announced the legislation back in January.

In the fiscal note prepared by the Legislature's Fiscal Review Committee, analysts estimated the total annual cost includes an additional $22.3 million in expenditures for case management costs and $3.7 million in state savings from disenrollments based on the program starting in 2020.

The federal government would bear an additional $15.3 million in costs. Republicans objected, saying based on a waiver approved for Kentucky by the federal Centers for Medicaid and Medicare Services (CMS), it should be budget neutral.

They questioned one estimate that TennCare officials would need to spend $100 per enrollee annually for case management, including helping impacted enrollees find work, volunteer work or education to meet the requirement.

They argued TennCare could simply use existing work, education and community involvement requirements set out for those on welfare, known as the Temporary Assistance for Needy Families (TANF) program, or food stamps, called the Supplemental Nutrition Assistant Program (SNAP).

Favors said she hoped "we will be very cautious" in implementing the work requirement, saying she feared "part of the problem" is moving "so quickly to get rid of people" on TennCare.

Replied Howell: "This is a simple bill. It's simply a request to ask for a waiver. Right now, I feel like it's a good step forward."

Contact staff writer Andy Sher at or 615-255-0550. Follow him on Twitter @AndySher1.

Contact Andy Sher at or 615-255-0550. Follow him on Twitter @AndySher1.

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