5 weeks, TDC family,
That’s all we’ve got left of the session; keen readers will note that those final 1.5 to 2 weeks are “flow-motion”, where the General Assembly hammers out the budget (cough $4.5M for Network bill, cough). That means, that we’ve got maybe 3 weeks to get to our final destination. Timeline update aside, I want to take a small amount of space to talk about scarcity. The issue of “forced scarcity” came to the fore this week with our Katie Beckett bill, which TennCare, in expressing their concern, described adding an HRA option to Part A as “inherently inequitable”.
First, that belies an ignorance of what the word “equity” means, but more importantly, it demonstrates that scarcity is ultimately a policy choice. When I say scarcity, I mean the extent to which resources are limited. Yes, resources, by definition are limited, but the extent to which they are limited is that policy choice. That plays out in what kinds of resources are available, how much, and for whom they are reserved. But scarcity also has a darker side; it pits people against one another in pursuit of those scarce resources, and that creates the “deserving” and “undeserving”. And policymakers often choose to stratify our communities this way by creating scarcity for the purposes of allocating those resources.
I have a lot to say about the idea of scarcity, but this is my point: it doesn’t have to be this way. It ultimately comes down to competing expressions of values, and I happen to think that the disability community has the type of values I’d raise my kid to embody. So, as we watch forced scarcity play out on the national and local level, please remember that we are stronger together than when pitted against one another, and that scarcity is a choice, and one we don’t need to make. Onward.
- HB712/SB1178 - Freedom for Family Care Act – (aka Paid Family Caregiving: Part 1) this bill would prohibit TennCare from developing or implementing policies that discriminate against family caregivers in the provider-based employment
- Success! This bill passed out of Senate Health and Welfare to great aplomb
- Cheered on by what everybody is saying to be hundreds of DDH-ers willing it through
- The bill also passed through the less glamorous House Insurance Committee with no discussion, no need for testimony and a unanimous vote
- Very confusingly, the bill has been assigned to the Government Operations Committee next
- I had thought that it would go through the Insurance Committee and then be calendared for the floor
- But alas, rules promulgation, amiright?
- It feels fishy, but maybe it’s just the cynicism of March at Cordell Hull that makes me suspicious
- I had thought that it would go through the Insurance Committee and then be calendared for the floor
- But overall, a good week for this one
- If you are able to squint and tolerate the conservatorship change from last week
- Next up:
- Success! This bill passed out of Senate Health and Welfare to great aplomb
- HB711/SB706 – TennCare Network Reporting Reform – this bill would require TennCare to collect and publish data about percent service utilization, appointment wait times and time between approval for a service and start of the service, broken down by county and waiver program
- Next week is go time in the House, starting with the often-friendly House TennCare Subcommittee
- Chaired by Good Friend Representative Michael Hale, who also happens to be the sponsor
- TennCare has set its sights on this bill, however. Reminders:
- We initially proposed an expansive reporting bill that encompassed data on all benefits offered by TennCare
- They counter-proposed only LTSS (excluding all medical, like therapies, primary care and specialty care)
- We counter-proposed LTSS, plus 7 carve-outs from the medical side (OT/PT/SLP, home health care, nursing, dental and DME spending)
- And then we cut DME spending
- We moved reporting dates, added “notwithstanding” language and fixed up some drafting errors, at their request
- And the vast majority of this discussion happened in Senator Massey’s office (our sponsor), in front of her
- And yet, they came back to us yesterday (Thursday) with an amendment that excludes all medical, moves the date again, cuts out “appointment wait time reporting”, allows them to use “statistically valid sampling” instead of publishing all data and allows them to interpret their own data and bury it in a year-end report with other “measures” of accessibility
- AND, they said they’d “defer” on the bill and REMOVE ITS FISCAL NOTE
- Which is another reminder that fiscal notes can be and routinely are weaponized by state departments against bills they don’t like
- My answer? Expletive no
- AND, they said they’d “defer” on the bill and REMOVE ITS FISCAL NOTE
- We initially proposed an expansive reporting bill that encompassed data on all benefits offered by TennCare
- All of this is to say that TennCare, un-shockingly, has not been negotiating in good faith
- So we are moving forward with the bill as last amended by us, and we’ll take the fight to committee
- And there, we hope to take TennCare to task about their provider network, and why they are so hell-bent on avoiding scrutiny or accountability
- I’m not going to lie to you and tell you that I think this bill is on track to pass, even if amended
- It still has to be funded, and state departments often get substantial say in that
- It remains, to most viewers, unsexy and complex, which make it difficult to get a majority of legislators on board to include in the budget
- And TennCare will continue to fight it, now noting that we rejected their amendment (making us seem uncooperative)
- But fight we shall, because in my opinion, this is one of those root cause bills that don’t tinker at the edges, but gets right to the heart of why Tennesseans with disabilities can’t access services
- And TennCare should own that
- Next up:
- Next week is go time in the House, starting with the often-friendly House TennCare Subcommittee
- HB1158/SB1053 – Katie Beckett Part A Wraparound Improvement Act – this bill would permit Part A families to utilize HCBS wraparound services funds using an HRA, similar to that in Katie Beckett Part B
- So we were calendared to be heard in TennCare sub on the 11th, but as expected, once it hit the calendar, TennCare had “concerns”
- They “flagged” the bill, meaning that we went 3 for 3 this year in bills “flagged” by TennCare
- Reminder, “flagged” means that an entity of the state, like TennCare, so opposes the bill that the full Governor’s administration then opposes the bill
- Also reminder, getting “flagged” by TennCare is a badge of honor, in my opinion
- And three badges this year? We’re doing something right here.
- But, because it was flagged, we rolled the bill
- So as to get some community engagement on the bill
- Which DDH helped to facilitate
- So as to get some community engagement on the bill
- They “flagged” the bill, meaning that we went 3 for 3 this year in bills “flagged” by TennCare
- On the Senate side, we actually didn’t get calendared, so we won’t be up in Senate Health until March 26th
- But that’s ok, let’s run the playbook in the House and learn from it, then apply those lessons to our approach in the Senate
- Next up:
- So we were calendared to be heard in TennCare sub on the 11th, but as expected, once it hit the calendar, TennCare had “concerns”
- HB1273/SB591 – Threats of Mass Violence Expansion – this bill would expand the types of facilities that would be subject to the enhanced felony penalty for a threat of mass violence
- This one got a little amendment thrown on it, which makes me think that pressure from advocates is working
- The amendment appears to “soften” the bill a little
- It adds legal language like “knowingly” transmitting a threat,
- It scales the penalties, making the threat a lesser offense but taking steps toward carrying out the threat the enhanced penalty
- It also requires that the threat be made toward 4 people, rather than 2
- However, the amendment does not impact the school-based version of this law
- Which conveys a class E felony (or the threat of one) for making a threat of mass violence
- And has disproportionately entangled kids with disabilities in the justice system
- Which conveys a class E felony (or the threat of one) for making a threat of mass violence
- If we’re wearing our optimist glasses here, this could be step 1 (of 2) toward adding a bit of nuance to the existing school-based threats of mass violence law
- “Knowingly” language would help, “valid threat” language would help, more protections for kids with disabilities would be good, differentiating between a threat made by a student and one made by somebody external to the school, scaling the punishment, aligning the “zero tolerance” threats law to this one, etc.
- If we’re wearing our cynical glasses here, this is a misdirection play so that they may appear to be adding nuance while refusing to change the school-based version of the law
- But, in this very small and specific case, I lean toward the optimist’s view
- Next up:
- House Criminal Justice Subcommittee – TBD
- Senate Floor – TBD
- HB793/SB836 – Plyler Challenge Bill – this bill would allow public schools in Tennessee to refuse to enroll undocumented immigrant students unless they pay tuition
- This one has started moving in the House, passing the K-12 Subcommittee on a 5-3 vote
- It’s set for Senate Finance next week too, where the “unknown fiscal impact” will be accounted for
- The Fiscal Note can’t identify how much it would cost, but it does note that the amended version passed by Senate Ed could jeopardize over $1 billion in federal education funding
- Including over $255M for IDEA
- So with that in mind, I think Finance will be a bit dramatic
- The Fiscal Note can’t identify how much it would cost, but it does note that the amended version passed by Senate Ed could jeopardize over $1 billion in federal education funding
- It’s set for Senate Finance next week too, where the “unknown fiscal impact” will be accounted for
- I’ve also heard that the House is not thrilled with the Senate amended version that passed Senate Ed
- And plan to run the unamended version on the House side
- Setting the stage for an intra-supermajority battle on whose bill is best at denying children access to an education
- This has also led to rolling the bill one week in House Ed, giving them time to work it out
- And plan to run the unamended version on the House side
- This is beginning to feel a little wobbly, but those are just vibes
- I’ve heard that the GA is pretty set on getting this across the line and to the courts this session
- But if they, at this point in the session, are in disagreement about how to get it there, there is reason to believe that they might not pull it off
- But I’m not wearing my optimist’s glasses on this one just yet
- But if they, at this point in the session, are in disagreement about how to get it there, there is reason to believe that they might not pull it off
- I’ve heard that the GA is pretty set on getting this across the line and to the courts this session
- Next up:
- This one has started moving in the House, passing the K-12 Subcommittee on a 5-3 vote
Other stuff:
- HB133/SB110 – Residential Pilot Programs – this bill would exempt an organization in East Tennessee from the state’s 4-person/500-yard anti-institutionalization rules
- This bill is very similar to a bill that passed last year permitting two organizations – one in middle and one in west – the same exemptions to those anti-institutionalization laws
- Which, I would note, had the following language:
- “It being the intent of the general assembly that there be one (1) pilot program participant in the western grand division and one (1) pilot program participant in the middle grand division, the department shall not:
- Authorize a residential pilot program other than the residential pilot program created by this subsection”
- “It being the intent of the general assembly that there be one (1) pilot program participant in the western grand division and one (1) pilot program participant in the middle grand division, the department shall not:
- Which, I would note, had the following language:
- We fought very hard against that bill last year, in part, because we knew that if you exempt one from a law (or in this case, two), the law ceases to exist as a barrier to others
- Among other reasons that I won’t relitigate here
- But obviously, we lost that battle, and are now seeing others wanting to come through the door
- We haven’t and don’t plan to take this same approach to this bill, for a variety of reasons, but that doesn’t mean we feel differently about it
- Instead, we’ve worked with the folks behind this bill to ensure that their project comes with guardrails that do a couple things:
- Protect the rights, independence and choices of people with disabilities
- Ensure that no other facilities receive a similar exemption until the three that are/will be in existence have demonstrated that this model can be effective
- And if they can do that, we can reevaluate our stance
- And those behind the bill have accepted this compromise, and accepted an amendment to their bill that establishes those guardrails
- Instead, we’ve worked with the folks behind this bill to ensure that their project comes with guardrails that do a couple things:
- The bill passed the House Health Subcommittee this week, and has already passed in the Senate
- And appears to have a clear path to the TCA
- Next up:
- This bill is very similar to a bill that passed last year permitting two organizations – one in middle and one in west – the same exemptions to those anti-institutionalization laws
- HB18/SB164 – Temporary Medicaid Expansion – this bill expands Medicaid eligibility to 138% of the poverty line with limits on how long individuals may be enrolled
- This bill was a very interesting and creative attempt to expand eligibility for Medicaid by making eligibility and receipt similar to those in TANF
- Individuals could be enrolled for no more than 12 months in a 24 month span, and no more than 60 months over a lifetime
- Similar to TANF rules in Tennessee
- These limits, I assume, were meant to depict Medicaid expansion as less of an entitlement, and more of a safety net
- For example, a person may lose their job because of an illness and need insurance to cover their care, on a temporary basis
- This would cover them
- For example, a person may lose their job because of an illness and need insurance to cover their care, on a temporary basis
- Individuals could be enrolled for no more than 12 months in a 24 month span, and no more than 60 months over a lifetime
- There are some obvious drawbacks as compared to full Medicaid expansion
- While it is eligible for a 90-10 match from the feds (TN pays the 10%), it would not be eligible for the temporary matching rate increase
- Which in Tennessee, would be an additional $1.25 billion over two years from the feds to spend on its Medicaid population
- You could do a lot of good with $1.25B
- Which in Tennessee, would be an additional $1.25 billion over two years from the feds to spend on its Medicaid population
- Some people need Medicaid for the long-term, and the time limits in this bill prevent that
- It is less likely to have the long-term health benefits (and savings) that come with traditional Medicaid
- Those savings depend on people being healthier, utilizing more preventative medicine and utilizing less emergency care, thereby reducing expensive care down the line
- And reducing the costs of uncompensated care to hospitals too
- While it is eligible for a 90-10 match from the feds (TN pays the 10%), it would not be eligible for the temporary matching rate increase
- But unfortunately, the bill died in the House Insurance Committee this week
- By a 4-14 vote, which I think indicates that the appetite isn’t there, and that it isn’t particularly close
- Which tells me that any effort in the future (dependent on the continued existence of the ACA and/or funds/permissions for expansion) continues to be a huge lift
- But a worthy one
- Which tells me that any effort in the future (dependent on the continued existence of the ACA and/or funds/permissions for expansion) continues to be a huge lift
- By a 4-14 vote, which I think indicates that the appetite isn’t there, and that it isn’t particularly close
- Next up:
- Another time
- This bill was a very interesting and creative attempt to expand eligibility for Medicaid by making eligibility and receipt similar to those in TANF
- Other other stuff
Federal Update
- This is becoming a section I fear writing every week
- Last week, I wrote about the news that Linda McMahon and the Trump administration announced the dissolution of the Federal Department of Education
- Well, this week, it began, with deep cuts to personnel across the department
- Including to the Office of Civil Rights, which is responsible for ensuring compliance with IDEA
- A lot remains unclear – we don’t know how the remaining workforce will carry out its typical duties, what duties will be unaccounted for, student loan stuff, implementation of IDEA, and much more
- This much is clear, however:
- We, as a community, need to begin to think about what special education looks like after the Department is gone (or functionally gone)
- How will we enforce special education law and student rights?
- How will we ensure our teachers are trained to work with our students?
- How will we build the next generation of special education teachers?
- We, as a community, need to begin to think about what special education looks like after the Department is gone (or functionally gone)
- But current implementation of IDEA isn’t perfect – we can also partially look at this dismantling as an opportunity to build something better:
- How can we build a pipeline of professionals to meet the need for evaluation, therapies, services and support?
- How can we better implement IDEA, especially for students with behavior needs, at the whole-school level?
- That is not to say that this opportunity means it is good, right or even sensical to dismantle the DOE, just that we should be prepared to fill the void left behind when it’s gone
- This much is clear, however:
- Well, this week, it began, with deep cuts to personnel across the department
- In other federal news, former daytime TV doctor and wet leather Muppet Dr. Mehmet Oz is facing his confirmation hearings for the position of CMS Administrator
- Meaning he would be in charge of Medicaid as Congressional Republicans attempt to slash $880 billion the program
- When asked if he would support cuts to Medicaid, he sidestepped the question
- I sidestep questions when I know the person who asked it won’t like my answer
- Which makes me believe that his answer to that was “no, he won’t protect Medicaid”
- I sidestep questions when I know the person who asked it won’t like my answer
- Scary times, folks
GRASSROOTS Update
- Take a rest, my GRASSROOTS friends, ya did good at DDH
- DDH is always the hyper-fuel that gets me through to the end of session
- The opportunity and privilege to get to spend time with you all, to advocate alongside you and to hear your stories is one I don’t take lightly
- So thank you for DDH, thank you for being part of our community, and thank you for being you – it’s why we do what we do
- The opportunity and privilege to get to spend time with you all, to advocate alongside you and to hear your stories is one I don’t take lightly
- DDH is always the hyper-fuel that gets me through to the end of session
- But if you’re not tired, I’ve got a couple standing options for you
- Use this link to record a short video about your access to TennCare services
- Email the TennCare Subcommittee and Insurance Committee and tell them how important our Katie Beckett and Network Reporting bills are
- BCC!
- I’m gonna need you to get to the end – we’ve got to not only pass our bills, but get them funded as well
- So stay tuned for opportunities
- So stay tuned for opportunities
Media Update
- The Atlantic – from 1941, this article published more than 8 decades ago reports on the development of the flu vaccine and the nascent stages of coordinated public health. It’s a fascinating reminder of how far the field of medicine and public health have come, and the danger of losing them.
- WBIR – if you haven’t seen our fearless leader, Sarah Sampson, on WBIR’s political roundtable show, Inside Tennessee, now is the time. Watch her wipe the floor with a bunch of phonies and pundits and rep the disability community like a star. Way to go Sarah!
- The New Yorker – this is a fascinating story about a team that spares no effort to save the endangered Ibis, a bird made notable, to me anyway, by the short story “The Scarlet Ibis”. A quixotic venture, as the author describes it, involves movable lights, singing, a spartan fan glider and a belief that all of us are responsible for those around and among us, and that that responsibility doesn’t stop at humans.
I’ll say it once again, it is an unbelievable privilege to work for the Tennessee Disability Coalition, and that’s because I get to work with you. This community is strong, and has the CV to demonstrate that. We shall and will overcome, and that’s what is beautiful here. I’m going to lean on you all to show everybody what kindness is, what generosity is and what justice looks like. Onward.