TJC: Too early to speculate on legality of TennCare block grant proposal

Zach Vance • May 7, 2019 at 6:42 PM

The Republican-controlled Tennessee legislature’s desire to become the first state in the nation to seek block grant funding for its Medicaid program is expected to produce legal challenges along the way, but for now, one of the state’s leading patient advocacy groups is idly waiting to see what the proposal contains before committing to filing a lawsuit. 

Tennessee Justice Center Staff Attorney Gordon Bonnyman told reporters during a Tuesday call that it’s “premature” to speculate since lawmakers have been extremely vague with their objective in obtaining a lump sum from the federal government to pay for TennCare costs. 

“It’s premature, at this point, I think to assess the legality of any particular block grant (proposal). We’d have to see what’s in it,” Bonnyman said.  

“There’s already a lot of flexibility under current law, and we haven’t heard anybody articulate a case in the legislature about what particular flexibility they want that they don’t already have. There’s enormous flexibility already. So before we trade in open-ended federal funding, which we have right now, and take the financial risk, we would say, ‘What is it you want to weigh? What is it you want to do that you don’t think you can?’

“Only then, after the state has figured that out, I think, it makes sense to talk about ‘Is it even legal?’”

Nonetheless, representatives of the Council on Aging of Middle Tennessee, the Rural Health Association of Tennessee and the Tennessee Association of Alcohol, Drug & Other Addiction Services expressed concerns about how a block grant could do away with federal protections, such as safety and quality standards. 

Sponsored by state Rep. Timothy Hill, R-Blountville, the bill passed on the last day of the legislative session and directs Gov. Bill Lee submit a block grant proposal within 180 days.

Lee has indicated he will sign the bill and told reporters in Nashville Thursday that he won’t accept a “bad” deal when it comes to negotiating the block grant. 

"We would never negotiate a deal with the federal government that would be bad for Tennessee," Lee said, according to the Chattanooga Times Free Press. "This will allow us the ability to negotiate, to pursue a, really a correction to a system that's broken.

"It does not work well and we want to create a system that does in our state and that lowers the cost of health care for Tennesseans."

Under the current system, the federal government pays roughly two-thirds, or $7.5 billion, of TennCare’s $12.1 billion cost to cover 1.3 million low-income, elderly and disabled residents. 

Grace Smith, from the Council on Aging of Middle Tennessee, told reporters Tuesday that 61 percent of nursing home care in Tennessee is paid for by TennCare. 

“So any caps or cuts to Medicaid really pose a significant threat to the heath coverage of Tennessee’s nursing home residents. And to their family caregivers, who cannot afford to shoulder the financial burden of long-term care,” Smith said. 

Rebecca Jolley, with the Rural Health Association of Tennessee, said her organization appreciates the governor’s commitment to ensuring every Tennessean has access to high-qualify, affordable health care. 

“We really need to have a holistic view of all the options that we can use to address health care challenges in our rural areas. We would encourage that going down a road toward a block grant discussion, we may be closing some doors to other opportunities to innovate rural health care delivery,” Jolley said. 

“Limiting Medicaid funding is really not going to help with the innovation we need, and we are concerned a block grant might do that.” 



Johnson City Press Videos