NASHVILLE — Amid concerns raised by powerful health provider groups and others, Tennessee Gov. Bill Lee's administration intends to make some changes to its proposal to convert most federal funding for the state's TennCare Medicaid program into a lump sum with fewer strings.
TennCare Director Gabe Roberts sought to assure a House panel Thursday the administration will clarify some aspects of the proposed waiver the state will submit to the Trump administration by Nov. 20.
"I think that as we go through that process and we hammer out some of these details that address some of the concerns that you heard, they will be clearly articulated," Roberts told members of the TennCare Subcommittee.
His comments came after groups representing doctors, hospitals, national pharmaceutical manufacturers as well as an advocacy group for disabled Tennesseans said that although there were aspects of the plan they liked, other aspects were concerning.
At the direction of fellow Republicans in the General Assembly, Lee is seeking the waiver to convert $7.9 billion in federal funding for the 1.4 million-enrollee TennCare program into a hybrid block grant.
The administration's public comment period ended last week.
Lee and administration officials have stressed no enrollees would lose coverage if the waiver is approved by the federal Centers for Medicare and Medicaid Services. In fact, officials say they would like to expand services for beneficiaries and also possibly provide new coverage in a state where GOP lawmakers have refused to expand Medicaid under the federal Affordable Care Act.
A primary goal of the state's plan is a proposal to get a share of money the state says TennCare is saving the federal government annually through its managed care approach. Tennessee is angling for half the savings, which could generate upwards of $1 billion.
But there's still major concerns among enrollees, providers and advocates.
During Thursday's legislative hearing, Tennessee Hospital Association President Wendy Long, a former TennCare director, said hospitals' "position is we are cautiously optimistic" and believe the mode could "bring substantial new dollars" to the program.
Shared savings could help hospitals, she noted. TennCare costs are driven by eligibility, benefits and provider payments, Long said.
"The waiver speaks very clearly to a commitment not to change eligibility and benefits," Long said. She added that while hospitals have "received verbal assurances that there's not an intention to reduce provider rates, we'd love to see that side by side with those two other commitments in the waiver."
Ben Simpson, The Tennessee Medical Association's assistant general counsel, said doctors "really like" proposals to invest more money in public health measures and preventative care.
Still, Simpson said, doctors have issues if the state seeks to renew efforts to expand the Episodes of Care payment model. In an episode of care, providers can receive financial rewards if the services a patient received meet certain quality measures that are also cost effective. The previous Haslam administration last year halted efforts to expand that.
"This is the effort we stopped two years ago," Simpson added.
On another front, TennCare's Roberts said the proposal will be amended so there won't be changes to the Early and Periodic Screening, Diagnostic and Treatment benefit for children under 21. And under another change, the waiver won't limit off-label drugs for pediatric patients.
The administration's public comment period ended last week following five public meetings, including a final hearing in Chattanooga. The only person to praise the governor's plan was a Middle Tennessee man who came to Chattanooga.
Contact Andy Sher at email@example.com or 615-255-0550. Follow him on Twitter @AndySher1.
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