2.16.24 TDC Weekly Public Policy Update

The Tennessee State Capitol building lit up at night and behind a set of ascending stairs

I’ve got sort of a short one for y’all today – our stuff is in a bit of a holding pattern, and everybody at Cordell Hull was seemingly prepping for what some of deemed “the worst week of the year” next week, so it was a bit more quiet than usual (FYI, worst week because President’s Day makes it a short one – thanks Obama). However, just because this week was a bit slow, doesn’t mean we (lookin’ at you GRASSROOTS) should even be thinking about PTO. DDH 2024 – which will be awesome – is coming up fast, it’s getting (perhaps past) time that we get our bills moving and we’ll need to be ready to play defense when some of the uglier legislation starts rolling. So we’ve got stuff to do; check out the update for updates, and prepare yourselves, dear readers, we’re still just getting going. 

 

2024 TDC Priority Bills

  • TennCare for Working Adults – this bill would create an option for working adults with disabilities to pay a premium to access TennCare services (like HCBS), while having income and assets above the current Medicaid eligibility threshold
    • We’re ready to go on this one, just waiting on our wonderful sponsors to feel the same way
      • We also still need our fiscal note 
        • And this, I think, is likely the biggest hurdle to passage (pending any potential fit from TennCare)
    • So we’ll work on helping our friends feel ready to move the bill, helping fiscal review (who determines our fiscal note) get it right, and hopefully get it moving so that you can talk about it at DDH
      • Which (GRASSROOTS), I hope you do
    • Next up:
      • Fiscal review (I hope)
  • Paid Family Caregiving Resolution – this resolution would urge the state (and TennCare) to work with community stakeholders in developing a comprehensive statewide paid family caregiving policy and program
    • I’ve got a date for this one to hit its first committee, and it’s a good one: February 28th, in the Senate Health and Welfare Committee
    • So, if you’re looking for stuff to do on the big day, block off 1 pm and come join us in Senate Hearing Room 1 to flex some disability muscle
    • Next up:
    • HB1939/SB2036 – Parkinson’s Charge – this is the other PFC bill that Representative Antonio Parkinson is working on 
      • Remember, this one very simply prohibits TennCare from denying payment to a family caregiver based on their location of residence
        • It passed Insurance Sub without a “nay” this week – good news!
      • It’s still got a big uphill battle in front of it, and I currently have no idea what the plan is on the Senate side
      • But I do think that more opportunities to talk about the needs of family caregivers the better
        • And so we ought!
          • So if you are somebody who is willing to share your story about how this need impacts your life, let me know!
      • Next up:
  • Right to Repair pt. 2 – this bill would require suppliers of power and manual wheelchairs to offer twice-annual preventative maintenance and to repair malfunctions, and creates a pathway for independent repair persons to do some types of repair. 
    • So, if you’ll recall, last week legal asked us some questions about our draft bill language
    • Thus, all I have for you is vibes
      • But I have good vibes on this one – we have the wheelchair posse (the manufacturers and suppliers) on board, we’ve got a pair of great sponsors, as far as I know TennCare doesn’t care (maybe the Insurance Cabal will?)
        • Plus, if I do say so myself, it’s a VGB, which is always helpful
    • So we’ll hang out here in our holding pattern and hope legal is satisfied with our answers (and that they can help us craft this bill appropriately)
      • And then we can get the ball rolling on this one
    • Next up:
  • TCA Placard Cleanup – this bill would update language related to disability placards found in the Tennessee Code that refers to people who use wheelchairs as “confined to a wheelchair”; this bill would modernize that language
    • Almost there! This one passed the Senate this week (with one “present-not-voting….”), and is set for the House Consent Calendar next week
      • (Consent Calendar means that the bill is considered unobjectionable and has not received a “no” vote along the way – it’s a pretty inexact science)
    • Thus, with pretty strong certainty, I feel pretty good about our prospects here
    • Next up:
  • Tennessee Disability and Aging Act – this bill establishes a new Department of Disability and Aging to serve the state’s population of Tennesseans living with disabilities
    • So it begins next week – this behemoth of a bill has been calendared on the House side
    • Remember, this is a VGB, and the concept has been in the works for a decade-plus
      • But let’s address one big concern that we’re hearing from advocates: that by creating this new department, funding and resources meant for some things will go to others instead (the zero-sum problem)
        • For example, funds for Katie Beckett will go to programs for aging Tennesseans instead
      • But in this case, you need not worry – KB funds are KB funds, Older Americans Act funding are Older American Act funds, etc. and that’s how it goes
      • This is truly (IMO), despite the corporate-speak sounding explanation, the most efficient, streamlined way to help ALL Tennesseans with disabilities get more of what they need
    • And don’t worry, the good guys have spent that last decade-plus working on what this should look like, and the good guys are on the case
      • It may need some fixes along the way, but I firmly believe that this is going to be a very good thing for Tennesseans with disabilities
    • Next up:

 

Other stuff:

  • HB2293/SB2118 – Print Disability Absentee Ballots – this bill would create a process by which a person with a print disability could request and vote via absentee ballot
  • HB2497/SB2146 – IDD Residential CON – this bill would increase the allowable bed limit for a Certificate of Need (CON) for residential facilities that serve individuals with intellectual and developmental disabilities
    • So I’m definitely jumping the gun here, because this is still a caption, but I wanted to put it on your radar
    • But first some background and context (as far as I understand this issue):
      • In order to open most health care or health care-adjacent facilities (from hospitals to MRI centers to residential facilities), you must obtain a Certificate of Need
      • A Certificate of Need demonstrates that the type of facility you want to open is needed in the place you want to put it
        • You only want to open facilities when they are needed for a couple reasons:
          • They (ostensibly) help keep health care costs down by keeping growth manageable
          • They stop unrestrained proliferation of health care facilities, slowing “the Amazon effect” in health care 
            • Think: low price=low quality and the race to the bottom 
          • It slows the financialization of health care by limiting growth and income potential
        • And, to be fair, the debate on the efficacy of Certificates of Need is still raging, and both sides present good arguments about its use (or cost)
      • But, where it is very important to the disability community, is its use in limiting the prevalence of large-scale residential facilities 
        • Another word for “large-scale residential facilities” is “institutions”
      • In Tennessee, to obtain a certificate of need for a facility that serves individuals with disabilities, the facility must have 4 or fewer beds, and be no closer than 500 yards from another facility that serves individuals with disabilities
        • This prevents the establishment of segregated institutions for people with disabilities, which is kind of our thing at TDC
    • So, to get back to it, what we hear about this bill as that it is intended to eliminate the CON requirement for residential facilities that serve folks with disabilities
    • So stay tuned on this one, and sorry if I got your hackles up before there is something to actually yell at
    • Next up: 
      • We’ll see!

 

Federal Update

  • The Medicaid “Unwinding” continues – we’re now down more than 10 million enrollees nationally from peak enrollment
    • Quick reminder, the “unwinding” refers to the eligibility redetermination period for Medicaid, which was a practice that was on pause throughout the public health emergency (PHE) enacted because of Covid-19
      • And further reminder, to be eligible for Medicaid, one must establish (determination), and then every year re-establish income and asset eligibility to their state Medicaid agency (redetermination)
    • In some cases, redetermination is done “ex parte”, where the state automatically establishes eligibility through the use of existing data 
      • (if you’re eligible for other benefits program and have reported for that, they use that data, for example)
    • In others, state Medicaid agencies (like TennCare) send out “redetermination packets”, in which a person must establish that they continue to qualify for Medicaid services
    • TennCare (our state Medicaid agency) had previously published a report on how the PHE unwinding was going, but hasn’t updated since October 
    • TennCare has also been the subject of an ongoing lawsuit asserting that the state’s redetermination process is inherently flawed, violating the rights of enrollees

 

GRASSROOTS UPDATE

  • Hold steady, my GRASSROOTS posse
    • I’m still a bit short on action items for you yet (besides your DDH prep)
    • One thing, but keep in mind that we’re also working on this, is a request for somebody who might want to testify about their experience as a family caregiver
      • This would be in support of Rep. Parkinson’s bill, not our effort
        • Caveat: we’ll need folks to speak to this as well during our Resolution (and subsequent) efforts, so keep your ammo dry if you want to save your testimonials for the TDC effort
    • But otherwise, see all you sickos at DDH in t-minus 12 days!

 

Media Highlights

  • The Atlantic – I’ve got another not-new one for you, but it’s another one that I thought was interesting and important when it came out last year, and thought you might feel at least intrigued at its premise: “I am not sure I want to hide anymore. I’d rather embrace my disability than fear its fallout. But it would be a lie to say I love every part of my body. I am still grappling with the ways I have been made to feel that my body does not belong—and with the conviction that it is easier for everyone that I be a failing normal rather than a normal disabled.”
  • NYTimes – Brooke Ellison, notable Stony Brook professor and disability advocate, died last week. Ms. Ellison was paralyzed in a childhood accident, and went on to graduate from Harvard, becoming a staunch advocate for Americans with disabilities and the possibilities of stem cell research. She was 45 years old. 
  • Tennessean – I guess this one isn’t a fun one like typically ends the Media Highlight section, but I think it’s an important one for the disability community (and a plug for our 2023 TDC Disability Scorecard). New Nashville Mayor Freddie O’Connell wants to put public transit on the ballot this November. Nashville needs it, Greater Tennessee needs it, BUT, does the public at large agree? 

 

So I guess that wasn’t short, and I know I’m late to your inbox at this point, but I hope you take/took a minute and check in with the update. We’ve got DDH coming your way very, very soon, and I want to make sure we make the most of it. So please feel free to reach out to me about anything, consider doing your stretches and practicing your skeptical-eyebrow-raises, because we’re gonna need ya. Until then though, happy Presidents Day! Onward!