Gov. Bill Lee speaks to local media at the front of McConnell Elementary School on Wednesday, Aug. 11, 2021, in Hixson, Tenn. (Troy Stolt/Chattanooga Times Free Press)

NASHVILLE — Tennessee Gov. Bill Lee and legislative leaders are weighing using $100 million in federal funds to boost medical staff at dozens of nearly overwhelmed acute care hospitals now under assault by one of the nation's steepest rises in COVID-19 infection rates and resulting hospitalizations stressing the state's intensive care units.

It's one of several options officials are considering for an estimated $3.88 billion in federal aid expected to flow into state coffers across many functions of state government under the American Rescue Plan passed by Democratic members of Congress with no Republican support and signed by President Joe Biden.

Other proposals target education, transportation, infrastructure and agriculture among state government functions.

Officials from the health department and other state offices have been thinking big, not only on grappling with the current coronavirus pandemic crisis, according to presentations top officials made this week to Lee's Fiscal Stimulus Accountability Group.

Health officials presented a number of costly programs targeting health needs of rural Tennesseans, a top priority for Lee, a Republican.

The proposed hospital staffing assistance program, however, is intended to ensure the capacity of Tennessee's acute care hospitals, including those in major cities such as Chattanooga, as they strain to deal with the state's coronavirus crisis. It's actually a continuation of a similar effort initially funded through June under the prior presidential administration's Coronavirus Relief Fund legislation.

It lays out three options for Lee and lawmakers to consider:

— Under a $52 million option, the state could continue its limited program under which aid can be provided with facilities that have 90% floor-bed utilization and where 25% or more of patients have COVID-19.

Thirty-five hospitals currently qualify for it. And that's more than double the figure from two weeks ago as students return to school. It also comes as Lee has overridden local school systems in their effort to enact district-wide mask mandates at schools. Lee had mandated that parents have the ability to opt their children out of any such mandate.

The governor also has prohibited entire school systems from switching to virtual learning as a way to stop the spread of the virus, preferring that schools either meet in person or take a learning-free "stockpile day," usually reserved for inclement weather. Individual schools and classes can apply for a waiver to switch to virtual learning.

— A second option for the funds would be beefed-up financing from a prior surge that began last October. If adopted, it would apply to hospitals that have 75% of their floor beds utilized in which more than 10% of those patients have COVID-19. It also would allow additional reimbursements to hospitals with more than 70% of their ICU beds in use and with more than 30% of the patients having COVID-19. Officials say 71 hospitals would qualify for additional funding under the two scenarios. The program would cost $20 million through September and $80 million to go from there through December.

— The third option is a hybrid plan. It calls for maintaining the current stringent criteria through this year at a cost of $52 million while dedicating $50 million for special needs facilities, rehabilitation hospitals and long-term care facilities, such as nursing homes and other provider staffing aid. Total cost: $102 million.

In addition to Lee, the Fiscal Stimulus Accountability Group is comprised of state Finance Commissioner Butch Eley, both the Senate and House speakers and top lawmakers, including Senate Finance Committee Chair Bo Watson, R-Hixson, and House Finance Committee member Patsy Hazlewood, R-Signal Mountain.

Deputy Health Commissioner Margaret McDonald said in response to questions that the hospital-focused criteria is "much better to really target to the highest need."

That sparked debate during Thursday's Fiscal Stimulus Accountability Group meeting with House Speaker Cameron Sexton, R-Crossville, saying nursing homes serve as a safety valve for overburdened hospitals and need additional funding.

Hazlewood told the group local hospital staffs are under strain. She said she "gets calls regularly from our safety net hospital," an apparent reference to the publicly owned Erlanger Health System.

"The last conversation I had with someone there, they had 50 or 60 people in the ER that they could have placed in the hospital" but had not because a "large part of that was the staffing issue."

State health officials are also pitching setting aside $177.8 million, part of which would assess the health needs of Tennesseans living in rural areas, as well as developing and carrying out plans to help provide rural residents the care.

One $113 million health proposal targets recruitment and retention of rural health care providers such as physicians and dentists, by beefing up their salaries and loan repayment incentives and education stipends for allied health professionals, such as X-ray technicians and dental hygienists working in rural areas.

Other initiatives target education, transportation, infrastructure and agriculture.

For example, Education Commissioner Penny Schwinn and her department chiefs have proposed a $250 million plan aimed at creating "secondary workforce pathways" along with a "redesign" of middle schools with an eye toward modernizing and expanding the state's future workforce. The goal is ensuring both adult learners and high school students have access to more opportunities using shared services to be better prepared for post-secondary education.

Each high school would receive an average of $250,000 to replace aging equipment with new equipment. The equipment must be aligned to current and future workforce needs and must also be a Tennessee College of Applied Technology or local industry partner. Another $37.5 million would go for competitive grants. And $25 million would support facility improvements at publicly funded, privately run charter schools to deal with pandemic-related issues.

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