NASHVILLE, Tenn. (AP) — Changes are coming to Tennessee’sproposal to become the first state to receive funding in a lump sum for itsMedicaid program, TennCare, health officials said Thursday.
TennCare Director Gabe Roberts told state lawmakers that theproposal will be amended to say changes won’t be made to the Early and PeriodicScreening, Diagnostic and Treatment benefit for children under 21. He saidanother change will say the plan won’t limit off-label drugs for pediatricpatients.
Roberts said TennCare wasn’t planning to change either, butwants to provide clarification.
The edits come as TennCare sorts through written and verbalpublic comments on the $7.9 billion block grant proposal. Gov. Bill Lee’sadministration released the proposal last month under a new state law callingfor a block grant plan, which Trump has encouraged states to submit. The agencydrew a slew of concerns during five public hearings on the issue about whetherthe proposal could compromise care for the most vulnerable citizens.
More changes are expected based on the feedback, Robertssaid.
At the first hearing , for instance, one speaker pointed outthat concerns in the room came from many quarters including trade associations,disability groups, specialty and primary care groups, physicians,pediatricians, senior citizens, charitable clinics, mental health and addictionexperts, parents and others.
During Thursday’s state House committee meeting, TennCareheard from groups that represent doctors, hospitals, people with disabilitiesand the pharmaceutical industry, with each still concerned about the proposal.
Each group, for instance, worried about one proposed changethat could limit some prescriptions for those on TennCare to one drug coveredper therapeutic class. The pharmaceutical representative even contended thatthe idea would violate an agreement under a Medicaid rebate law.
“A closed formulary would severely restrict aphysician’s ability to prescribe the most effective medicine for a patient andcould lead to more costly treatments, such as emergency department visits,hospitalizations and added procedures,” said Jack Fosbinder, state counselfor Pharmaceutical Research and Manufacturers of America.
TennCare has sought to assure that TennCare patientswouldn’t be at risk of losing benefits or being taken off eligibility rolls.The waiver proposal said the only new flexibilities sought in eligibility orbenefits would be “common-sense measures consistent with the larger blockgrant framework of improving program efficiency, and which are intended to makethe TennCare program stronger and more effective.”
Lee has touted it as a chance to be innovative anddemonstrate efficiencies in delivering the same services.
“We’ve written it in the waiver and we’ve said itrepeatedly and the governor has too: this model is not contingent upon anytypes of cuts to service or cuts to eligibility,” Roberts told reporters.
Tennessee must file the proposal with federal officials byNov. 20. If federal approval is granted, state lawmakers would get to vote onthe final product.
The block grant would cover core medical services for thedisabled and blind, children, adults and elderly — or about 1.2 millionTennesseans. This means administrative costs, prescription drugs, uncompensatedhospital payments and individuals dually eligible for Medicaid and Medicarewould not be part of the block grant plan, which would cover a much smallersegment of TennCare.
The federal government would increase Tennessee’s blockgrant funding if enrollment grows beyond the original calculation.
Roberts, the TennCare director, has described the plan as a“hybrid” approach to block grants because the state has designed itsproposal to allow Tennessee to keep 50% of any unspent block grant funds.
