State Rep. Timothy Hill: Medicaid Block Grants Are the Conservative Way to Expand TennCare Coverage

NASHVILLE, Tennessee – State Representative Timothy Hill is sponsoring HB 1280, which is the first step in the process of requesting Medicaid block grants for the funding of TennCare.

The main reason Representative T. Hill is bringing the legislation, he told The Tennessee Star, is that block grants are the conservative way to expand the coverage that TennCare provides.

Senator Paul Bailey (R-Sparta) is sponsoring the companion bill SB 1428 in the State Senate, where the measure already has 22 Republican co-sponsors, including Lt. Governor McNally, of the potential 25 Republican State Senators.

Representative T. Hill explained that, in doing research, “we found the block grant concept is not new – President Reagan tried it in 1981, Newt Gingrich in the 90’s and was almost successful, and now President Trump has expressed interest for this concept.”

“So, Senator Bailey and I feel like it’s the right time to try it again and to try it from the State’s perspective,” continued Hill.

Hill doesn’t know how many other states are attempting to take the block grant approach, which is “a fundamental shift in how you pay for the program,” as he put it. Hill said that with Tennessee being a very well run state from a fiscal perspective, “if there’s any state that can lead on how to make the block grant work, it’s Tennessee.”

“At the end of the day,” Hill told The Star, “the money that is in Washington, D.C. is Tennessee taxpayer dollars that belong in Tennessee. We can make better decisions for Tennesseans in Tennessee, as opposed to Washington, D.C.”

Hill believes about nine percent of Tennesseans are without health care and that “fundamentally changing the way TennCare is funded will reduce, if not eliminate, the cost of compliance with the Federal government that has an actual real overhead administrative cost associated with it, so there will be more dollars to take care of more people.”

“The second half of it,” as Hill explained, “which is what is going on in the TennCare Committee and the Oversight Committee now, is looking at TennCare through the lens of how to make it the most efficient, cutting out any waste, fraud and abuse that we can get a hold of.”

“The end result will be using existing resources to serve more people.” The end goal, according to Hill, is to be able to serve the nine percent of Tennesseans who don’t currently have health insurance.

“The two efforts combined create a genuine conservative solution to actually help people in need. The mindset that Republicans don’t care is not true. It’s more of how can we make it work, and it’s got to make sense for the State and ultimately, and more importantly, it’s got to make sense for constituents and part of that is making sure it’s sustainable.”

Hill’s bill directs the Governor, through the Commissioner of Finance and Administration, to submit a request for waiver to the Centers for Medicare and Medicaid Services (CMS) that would provide TennCare funding through a block grant that would be indexed for inflation and population growth.

It is “kind of fuzzy,” as Hill put it, as to whether the Governor could make the request of CMS without the General Assembly passing legislation directing it. He added regarding the purpose of the bill, “We want to be clear, and we want the governor to know that the legislature is in full support of him when he makes this request.”

Hill approximated last year’s Federal funding of TennCare at $7.8 billion, providing 65 percent of the funding with the State providing the remaining 35 percent. He has heard estimates that the program represents as high as 35 percent of the overall State budget.

“Obamacare is not going to expand in Tennessee,” Hill told The Star, pointing out that a bill has been brought forward nearly every year since the expansion opportunity was given and has not passed. The choice, Hill said, is to be resigned to the nine percent of Tennesseans without health insurance or to fundamentally change the way TennCare is funded to take care of more people.

Hill said for those that are concerned about the various “pieces and parts” of the requirements, “That’s not what this bill does. What this bill does is initiate the process and demonstrates that the legislature is in support.”

The bill has been assigned to the House TennCare Subcommittee. While Hill hasn’t begun to work on co-sponsorships, he did say Speaker Casada is in full support and will sign on to the bill shortly.

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Laura Baigert is a senior reporter with The Tennessee Star.