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4.4.25 TDC Weekly Public Policy Update

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

Happy April, TDC Family!

Less than 2 weeks, dear reader. That’s all we’ve got remaining in this session. We know this because the GA, for the first time in my (short) stint at Cordell Hull, have a hard-stop date: April 17th. And that is because more than 20 legislators have been called for the federal trial of Cade Cothren, former staffer for disgraced former speaker Glen Casada, who faces corruption charges. Believe me, there has been MUCH drama about the upcoming trial (including the question, “who wore a wire?”). Drama aside, the closing weeks of the session will take us into “flow motion”, which is when all schedules and calendars go out the window and the GA alternates between the finance committee and floor sessions. Essentially, they take a list of bills, decide which they will fund, then take those bills straight to the floor to vote on (leaving the poor unfunded bills to whither). Flow motion signals the waning days of session, begets some grumpy legislators, and portends some finality to the legislation. While not as dramatic as the Cothren trial, the final days will prove to be, at minimum, interesting. But in the meantime, here is what happened this past week: 
 

2025 TDC Priority Bills

  • 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
    • We are through! The bill passed on the House floor on Monday with a unanimous vote
      • It will now head to the Governor’s desk for his signature, and ultimately, place in the Tennessee code
    • Reminder, this is just the start – the intention here was to establish a foundation from which we can build
      • Paid family caregiving is now formally “a thing”
        • What that thing is now is very basic, but it upends decades of TennCare obstinance in the face of this issue
      • Now, it is up to our community to take this thing and make it not only work for families, but to build something betters people’s lives
    • We will once again be leaning on our communities to tell us how to make this system not just work, but to be a thing that finally makes living with a disability or being a caregiver of a person with a disability just a bit easier in Tennessee
    • Next up:
      • The Tennessee code
  • 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
    • As I noted last week, the bill has reached its destination for the year
      • The bill was introduced briefly in committee, and then taken off notice
        • “Taken off notice” is the legislative term for when a bill is removed from consideration in committee
        • It doesn’t mean that the bill is dead and buried, it just means that it is not currently under consideration
      • The advantage of taking the bill off notice at this point in the process is that now, the House Insurance Committee has the option to take it back up for consideration next year
        • And thereby gives advocates a forum to discuss this issue and a solution to point to
      • It does not change the fiscal note, which will remain the biggest impediment to this bill’s success
        • But the bill has support on merit, and we can work with that
    • TennCare needs accountability – the provider network is threadbare, the service delivery system is broken, and they are not moving to fix these issues themselves
      • Shining a light on the extent of these issues is the best way to empirically establish this problem, and that’s what we hoped this bill would do
      • But friends, I feel like the tide is turning – outside of setting up fiscal note spike strips, TennCare lost a lot this year
      • It is becoming reality at Cordell Hull that TennCare is not meeting the needs of the population it serves, which makes me think the appetite is growing to fix the system
        • And it is becoming a bipartisan reality
      • It won’t happen in one fell swoop, or with one bill, but the more pressure we continue to put on TennCare and the GA to do something, the more likely it is that the pieces begin to fall in place
    • Next up:
      • Next year
  • 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
    • Good news: the bill passed through the House Insurance Committee unanimously
      • But not without some bumps
    • Also good news: the committee called TennCare up to account for the issues raised by the bill
      • Namely, that TennCare makes its Katie Beckett program too difficult to use
        • And that that harms Tennesseans with disabilities and their loved ones
    • The bad news: TennCare blunted a lot of the committee’s criticism in typical TennCare form
    • The bill heads to House Finance, Ways and Means next, where we will have to make the case that the GA should fund the bill and bail TennCare out (this one time)
      • But this is no easy lift – there is simply very little money available to pay for bills
        • Reminder, we spent $144M on vouchers that legalize disability discrimination, we spent $100M in “shared savings” aka Medicaid funds TennCare failed to spend on its existing Medicaid population to East TN for hurricane relief
        • And in recent years paid out over a billion dollars in tax refunds to businesses, gave Ford $500M for a facility that is yet to be built, gave $500M for a new Titans stadium
        • All while shrinking state revenue to darn near nothin’
    • So, rant aside, we’ll need to demonstrate support for that funding
      • Our Speak4 system is not working, so here’s my alternative:
        • Here is the email list for House FWM
        • Here is the email list for Senate FWM
        • Send ‘em an email (use BCC!)
        • Here is essentially what I would cover
          • The Katie Beckett program is very important
          • After 5 years, we are looking at what works and what doesn’t
          • This part – the HCBS funds – doesn’t work
          • (personal story, if you’ve got it, here)
          • It is frustrating that this bill costs money – the GA allocates $25 million/year to fund this
          • And TennCare says that that is not enough to pay out the full extent of the benefit they promised
          • Please consider funding this bill so that TN families in the Part A program can better support their kids
        • But I encourage you to make it your own, feel free to look at what I’ve previously written in these little dispatches about the funding for this bill
      • Please, and thank you
    • Next up:
  • 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
    • I’ve got an embarrassing confession here: I’ve been following the wrong bill here
      • This one is bad, and still does TMV bad stuff
      • But this is the one that is actually moving: HB1314/SB1298
    • HB1314/SB1298 creates a new felony offense of threatening an act of mass violence anywhere, and enhances the penalty of the threat is directed toward a school, government property or house of worship
      • It also enhances the penalty if a person takes steps toward carrying out the threat or has a prior conviction for threats of mass violence
    • It has some potentially encouraging portions, like considering the threat’s validity (“knowingly”) and ability to carry out the threat
      • Potentially protecting kids
      • But has no explicit protections for people with disabilities or children, leaving a bit too much discretion in the hands of authorities, who have been more than willing to already wield TMV laws against vulnerable populations
    • But mostly, the bill makes it more likely that people will get charged in relation to threats, and does nothing to address the many, many concerns that have arisen from application of the school-based TMV law
    • The bill passed Senate Judiciary on a 6-2 vote, despite valiant testimony from Zoe at DRT and Beth Cruz from Vanderbilt Law School
      • But the testimony sparked some real scrutiny of the bill proposal, as well as the concept of felonies for TMV’s more broadly
      • Maybe this leads to some improvements on the school side of things, where it is desperately needed?
        • Maybe, but that responsibility is gonna fall on disability advocates and the GRASSROOTS
    • Next up:
  • 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 passed Senate Finance, Ways and Means 7-4 this past week, while its House companion awaited a Gov Ops date
      • And that Gov Ops date will be next Monday, April 7th at 8:30 am
    • The bill is by no means a slam dunk to pass – BUT, in sniffing around and the vote count, it’s awful close to a “no” on the House side
      • I don’t know about the Senate side, but I don’t think they are going to let the House dictate their outcome
      • And the Senate and House versions remain different from each other
        • They differ on mandate vs permissiveness
      • The House side, though it keeps flip flopping back and forth, is broadly permissive about checking documentation status and potentially requiring tuition for undocumented children
      • The Senate side requires schools to check immigration status, and is permissive about charging undocumented children tuition
    • But mostly, those differences, and the distinction between mandatory and permissive, is just another job for schools to do, taking time and resources away from our children
      • Again, not commenting on immigration debates here, but this bill is a bad idea
      • It tees up schools to violate their IDEA-mandated child find obligations, and threatens a free and appropriate public education (FAPE), as required by IDEA
        • Will schools refuse to evaluate and offer services to undocumented students? Will they charge children with disabilities tuition?
          • I don’t know, the bill is silent
          • But they would probably be more likely to do so than they would before this bill
        • But in the absence of explicit requirements in the bill, it remains up in the air
        • And if immigration status is a precursor consideration of abiding by IDEA, we are teeing up schools to fail at this responsibility in the new, murkier waters of a non-Plylor world
    • And to address the (ostensible) argument for this bill (not the obvious attempt to get back to DC for press conferences in front of the Supreme Court), that undocumented students present a resource burden on schools, I am very concerned
      • Essentially, the sponsors argue that undocumented students cost too much money to educate, so we should charge them
      • Let me tell you about another student population that is expensive to educate…. Students with disabilities!
        • Am I saying that we’re next? No.
        • What I am saying is that there is a logical next step and conclusion to that line of reasoning, and that’s a scary possibility for us.
    • Next up:


Other Stuff:

  • HB372/SB334 – Tennessee Medicaid Modernization and Access Act of 2025 – this bill would align Medicaid reimbursement for some services to Medicare or commercial reimbursement rates
    • A VGB, and traveling companion of our TennCare Network bill, this one passed House finance this week
      • And is based on a different part of the HCBS Access Rule
    • It’s got a huge fiscal note, but this is an important bill, and, if not funded, an important conversation
      • Like many efforts to move TennCare, it gets at our provider networks, our reimbursement rates and ultimately, access to providers for Medicaid enrollees
    • Next up:
  • HB1244/SB881 – PBM Reform – this bill establishes numerous guidelines about the timeliness and accuracy of payments made to providers through Pharmacy Benefit Managers (PBMs) and establishes penalties for non-compliance
    • Last week, I spoke about the numerous entities that medical payments must pass through to compensate care
      • Pharmacy Benefit Managers are one of them, and they tend to be rogue ones
    • There have been several PBM reform bills in recent years, mostly getting at practices that extract costs from consumers and providers at the expense of care
    • This one is a good one, and it’s on to Gov Ops next week after passing House Insurance this week
      • It’s already passed, unanimously, on the House floor as well
    • Next up:
  • Other other stuff

Federal Updates

  • This space has spent the past several weeks outlining and decrying the destruction of our country’s health infrastructure and expertise
    • This week has been relatively quiet on that front – it’s been tariff week instead!
      • Now, this might seem to be a welcome reprieve from the bad news, but I’m sorry to say, dear reader, this is not the case
    • Health care, as I’m sure you know, requires a lot of stuff!
      • And we get a lot of that stuff – needles and tubes, x-ray and dialysis machines, diagnostic tests and personal protective equipment – from abroad, or at least through global supply chains
      • And that stuff is about to become more expensive
        • Moreover, it is rumored that tariffs on foreign pharmaceuticals are next up
    • And tariffs, more generally, typically negatively impact the pocket books of people with lower incomes
      • Which, as you know, disproportionately includes people with disabilities
        • Who also spend, in Tennessee, 51% more to achieve a similar standard of living as those without disabilities
    • It will take some time to see the entirety of the impacts of these tariffs, but by most measures and estimates, prices are going up

GRASSROOTS Update

  • Send an email to the respective House and Senate FWM Committees
    • Tell them why they need to fund the Katie Beckett HRA bill
  • Email our Congressional delegation asking them to reverse course on the dismantling of the Administration for Community Living
  • Be nice to a neighbor, we could all use that these days


Media Update

  • CBS News – not to dive too far into this debate, but one side effect of the Trump administration’s dismantling of DEI initiatives that has mostly gone unnoticed is the rollback of efforts to improve access for people with disabilities. A lot of that is research, but also hiring practices, civil rights protections and public accommodations.
  • WRDW – The Georgia legislature recently passed a law that lowered the threshold for proving an intellectual disability in death penalty cases. If you’ll recall, TDC and partners passed legislation to modernize the definition of ID in the state code to better protect people with ID from unconstitutionally being put to death. This is a good step forward for Georgia.
  • Tennessean – Family Voice’s own Tonya Bowman was featured in a wonderful opinion piece arguing that divisive politics only serve to harm our state’s most vulnerable and marginalized citizens. Kudos Tonya on a very important message for our time. 

 

That’s all folks, it’s almost time for them to go home, which is both a blessing (they can’t do more harm) and a curse (there remains TONS of work to be done). Stick around for 2 more weeks and see how the twilight of the first year of the 114th General Assembly session plays out.