As Trump administration opens door, Beth Harwell pushes TennCare work requirements

House Speaker Beth Harwell, R-Nashville, presides over the House on the opening day of the legislative session Tuesday, Jan. 9, 2018, in Nashville, Tenn. (AP Photo/Mark Humphrey)
House Speaker Beth Harwell, R-Nashville, presides over the House on the opening day of the legislative session Tuesday, Jan. 9, 2018, in Nashville, Tenn. (AP Photo/Mark Humphrey)

NASHVILLE - The Trump administration's just-announced policy to let states pursue work requirements for able-bodied Medicaid enrollees without young children quickly entered Tennessee's political debate Thursday.

Republican House Speaker Beth Harwell announced she has legislation, co-sponsored by Rep. Dan Howell, R-Georgetown, directing the Haslam administration to seek and then implement a federal waiver to do just that.

It would impose what Harwell calls "reasonable work requirements" on able-bodied working-age adult enrollees who are caretakers for children over the age of 5.

"This is exactly the type of flexibility states have been asking for the last several years, and I appreciate the Trump Administration handing that power back to the states," said Harwell, who is running for governor.

She also said in her statement that "this legislation is about lifting people out of poverty, while still providing the support needed for Tennesseans to be successful and prosperous."

Howell will carry the bill which would impact an unknown number of adult enrollees on TennCare, the state's version of Medicaid.

TennCare has an estimated 1.3 million low-income children, pregnant mothers, parents, caretakers and Medicare-certified disabled enrollees.

TennCare spokeswoman Sarah Tanksley said in an email the state is analyzing the federal Centers for Medicare and Medicaid Services' (CMS) guidance "within the context of TennCare's population and our own system limitations, but we do not yet have an accurate estimate of the number of individuals on the program for which such a requirement would apply."

The CMS' guidance, Tanksley said, includes "a number of exemptions and requirements for states to accommodate certain individuals who may have difficulty in meeting community engagement requirements, such as individuals with disabilities, those with substance-use disorder, and those who have been certified by a medical professional as having a medical condition that would prevent them from meeting the requirement."

Meanwhile, Kaiser Family Foundation figures for Tennessee in 2016 indicate a majority of non-elderly or Social Security-designated disabled adults on TennCare already work. When elderly or disabled people are separated out, 77 percent of enrollees live in a family in which someone works, while 57 percent themselves worked.

Earlier Thursday, U.S. Rep. Diane Black, R-Tenn., another GOP candidate for governor, announced that if elected she would pursue a waiver of federal Medicaid rules to implement work requirements.

Harwell spokeswoman Kara Owen said the speaker's plans were well underway before Black's announcement, noting the speaker deliberately chose Howell to carry the bill because of the Bradley County lawmaker's interest in welfare reform and related issues.

According to the General Assembly's website, no Senate companion bill has been filed yet. The Harwell and Howell measure is House Bill 1551.

All this week, House Minority Leader Craig Fitzhugh, D-Ripley, a candidate for Democrats' gubernatorial nomination, and fellow legislative Democrats had called on the GOP-controlled General Assembly to relent and approve an expansion of Tennessee's Medicaid program under the federal Affordable Care Act to some 280,000 low-income adult Tennesseans.

Fitzhugh said earlier Thursday that Democrats were willing to allow Tennessee to impose a work requirement on the expansion population, most of whom he said already work.

Asked about Harwell's announcement, Fitzhugh said he thought it would apply to a "pretty small population because most people are disabled on TennCare except for the children and pregnant women."

But the Democrat said if Harwell wants work requirements, "she should include the expansion population in her bill."

"I truly don't understand why all those on the other side continue to be so dead-set against this expansion," he added.

Fitzhugh said enabling lower income single adults to come onto TennCare would help provide health coverage for treating opioid addiction, which Republicans and Democrats from Haslam and Harwell on down agree is a crisis in Tennessee and a top issue they want to address in the legislative session that began Tuesday.

Without expansion, he said, "where in the world do they think we're going to get money from the state coffers for opioids? Expansion covers drug rehab."

He declined to say whether he thought the speaker's jumping out with the bill may be politically motivated.

Howell, the bill's House sponsor, said, "I appreciate the Trump administration's new guidance and believe Tennessee should take action now. Giving states flexibility allows them to come up with solutions that best fit their needs."

He said TennCare "has always been unique, and implementing these requirements will assist Tennesseans in even greater ways."

Republican majority senators in 2015 twice killed Haslam's proposed Insure Tennessee plan to extend TennCare to the estimated 280,000 adult Tennesseans.

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

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