Not everything on Gov. Bill Lee’s wish list made it into the state budget this year, but lawmakers did sign off on his plan to invest in access to health care for rural Tennesseans.
It puts about $200 million into that system over the next five years. That might have been an easier sell, given the money isn’t coming from state coffers.
Every state is struggling to maintain a rural health workforce. Lee’s solution includes creating more apprenticeships, skills training and other programs to keep workers in these small towns. It will also go to expanding telehealth and specialty care.
That money comes from a unique agreement Tennessee has with the federal government as part of the Medicaid program, TennCare.
Medicaid uses state and federal money to give low-income people mostly free health insurance. It’s been around since the 1960s, and every state runs their own version of it. There’s a lot of variety across the country.
Part of that is because states can ask the federal government for permission to create their own policies. The permission comes in the form of a waiver.
A few years ago, TennCare secured a waiver to change how the federal money comes into the state.
Basically, the feds put a cap on how much the state can spend on TennCare. If the state stays under budget, they get to keep half the leftovers. Over the past two years, Tennessee has gotten to hold onto about $600 million.
Supporters — like Lee — say this rewards Tennessee for keeping costs down and managing TennCare well. They also note: Under this program, more of that money stays in Tennessee instead of going back into the federal pot.
Critics say the program incentivizes cutbacks that could harm members — for example, refusing to cover more expensive medications or making it easier for people to lose eligibility.
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