Gov. Bill Lee on Medicaid block grant waiver critics: 'If their concern is valid, we can improve it'

Staff photo by C.B. Schmelter / Gov. Bill Lee speaks during a groundbreaking ceremony for the McMinn Higher Education Center on Friday, Sept. 27, 2019 in Athens, Tenn. The new facility will include the Tennessee College of Applied Technology-Athens, Cleveland State Community College, and the McMinn County UT Extension Institute of Agriculture.

MEMPHIS - Tennessee Gov. Bill Lee said today that although he still believes many of the overwhelmingly negative public comments about his Medicaid block grant proposal are based on "misinformation," he will wade through all 2,200 pages while keeping an open mind on possible changes.

"I want to review those comments and look at them and read them," the Republican governor told reporters after speaking to attendees at the American Conservative Union Foundation conference here. "Many of them are misinformed. But that's what public comment periods are for, they provide feedback, whether you expected it or liked it."

Quickly adding he is "glad to get feedback," Lee said "I wanted public comment. That's why we have it, even if it's disagreeing with what we're doing. I want to evaluate those comments and make sure that either they are misinformed or, if their concern is valid, we can improve the submission as a result of those comments. That's exactly what we're going to do."

At the direction of fellow Republicans in the state legislature, Lee is asking the U.S. Department of Health and Human Services for authority to convert $7.9 billion in federal funding for TennCare, the state's $12.1 billion Medicaid health insurance program for 1.42 million low-income Tennesseans, into a lump sum "block grant" with fewer strings and greater flexibility for the state.

It's generated concerns among enrollees -- a good number of whom would be impacted -- as well as advocates for the poor, hospitals, physicians and national drug manufacturers.

During required community hearings, only one supporter of the plan testified during five public hearings. That was from a Middle Tennessee man who has a health care business who showed up at the last hearing in Chattanooga.

Providers made their concerns public during a legislative hearing last week.

The Lee administration last week said it is already agreeing to make several changes to address some provider concerns.

With his plan, the governor is testing how far the Trump administration, which wants to use block grants to save the federal government money, is actually willing to go.

With Tennessee's managed care Medicaid program already saving the feds an estimated $2 billion annually over a traditional Medicaid fee-for-service program, Lee is asking for a 50/50 split of the savings. If he gets what he wants, it could inject upwards of $1 billion more into TennCare.

Lee sees the additional money and less red tape as being able to improve and expand services to existing enrollees and possibly extend health coverage to some in a state where GOP lawmakers rejected former Republican Gov. Bill Haslam's proposed Medicaid expansion to some 300,000 uninsured working age adults under the federal Affordable Care Act.

The clock is now ticking on Tennessee submitting its formal waiver of Medicaid rules to HHS's Centers for Medicare and Medicaid Services. Lee has until Nov. 20 to submit it.

But the public won't be able to see the revised waiver with its changes until it's filed with CMS.

Lee defended that today, saying "that's how the process works. You put out a proposal, then you give a period of public comment. You receive those public comments. You make changes prior to submission and then the federal government will actually have a public comment period also."

Once a revised waiver is submitted, the public, including enrollees, advocates and providers, will have 30 days to have their say.

Asked if there's anything stopping him from making the changes public once they've been decided by his administration, Lee said "just the process and the time it takes to do it."

The governor also intends to speak with federal officials prior to submitting the waiver.

Asked what he hopes to accomplish, Lee said "we just want to let them know ahead of time where this is headed, what the public comments are, what the concerns are, what we believe is the best approach for them.

"It's part of the negotiating process to make sure we don't surprise the federal government with our plan and they can help us craft it in a way that will allow us to negotiate a successful agreement," the governor added.

During his speech to attendees of the CPAC conference, Lee, who took office earlier this year, touted his achievements during this year's legislative including a controversial private school voucher program that wound up being restricted in the end to only Shelby and Davidson counties, the state's two largest school districts.

Also speaking today at the CPAC conference was Republican U.S. Senate candidate Bill Hagerty, who recently stepped down as President Donald Trump's ambassador to Japan.

Hagerty, a former state economic development commissioner who previously ran venture capital firms, praised Trump in areas ranging from tax cuts to foreign affairs. He charged that U.S. House Democrats, who this week are turning their impeachment inquiry into a full-fledged impeachment process, "would like to come in and tear it all down."

"Their goal has been to undo the results of the 2016 election since the beginning," Hagerty said.

Scheduled to speak later this afternoon is Dr. Manny Sethi of Nashville, Hagerty's main GOP rival in the 2020 Republican Senate primary.

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