Tough week, friends. In fact, tough last couple of weeks. Big hugs and best wishes your way. But we’re getting close to the end (2 weeks?) and we’ve got (very good) things to look forward to passing, which will be our saving grace for this session. We’ve got a lot of short- and long-term work cut out for us, TDC family, let’s get across the finish line and we can look toward how we make Tennessee a better place to live for people with disabilities over the coming year. Onward!
- 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 finally back on the move this week, with this VGB being heard in Senate Health
- This is our last big “hurdle of substance” before we get to the dollars and cents part of our advocacy
- AKA, this is the last time, maybe besides the floor, where we’ll have to argue on the concept of the bill
- This is our last big “hurdle of substance” before we get to the dollars and cents part of our advocacy
- Sen. Watson did a brilliant job of ferrying this one through Senate Health, weathering some questioning from the committee
- (cough Joey Hensley cough)
- And got us through on a 9-0 vote
- He even stated that he wants to “work with the Bureau” aka TennCare on the “possibilities” of addressing “financial constraints” presented by the bill through the shared savings program
- AKA, “vote on the merits of this bill and let us deal with the dollars and cents in finance”
- The powerful committee that our sponsor Sen. Bo Watson chairs
- So we’re on to Finance, and next week will be about working on that fiscal note
- Reminder, the fiscal note states that the department believes that the bill will cost $10M next year and $18M per year after that
- We disagree, and let me tell you our primary points of disagreement
- TennCare believes that 3300 Tennesseans will enroll in the first year
- We say: that’s far too many. Washington, which is similar in size to TN, has 1,729 enrollees after a full decade
- After 5 years, Washington has 1,513 enrollees
- AND, even at peak enrollment (1,895), total state spending in Washington was $6.2M/year
- This is the primary driver of our inflated fiscal note, and presenting a more accurate picture of enrollment will do us wonders
- Another good piece of WA evidence here
- TennCare believes that all enrollees will be new to Medicaid, and represent entirely new spending
- We know that in the example of Massachusetts, almost 80% of enrollees in the newly formed Buy-In program were already in traditional Medicaid
- And the cost of enrollees in Buy-In programs is significantly less than that of traditional Medicaid
- In part because many receive employer-sponsored health insurance, making Medicaid the secondary payer
- Usually only paying for home- and community-based services like home health care
- TennCare believes that the per member per month (PMPM) cost is higher than we estimate
- We likely can’t challenge this, because TennCare is drawing this from their own data
- But it should be noted that many of the folks who would enroll in this program are likely to require less care and support and thus, likely to cost the state less than average
- Plus, the 80% number above
- TennCare wants $10M for “IT upgrades”, and about $750k/year for new employees to operate the program
- We also likely can’t challenge this, but c’mon
- TennCare believes that 3300 Tennesseans will enroll in the first year
- So we’ll work with our local and national partners on producing some evidence to back us up on these points
- We’ll bring that, at his request, to Sen Watson, as well as Rep Hicks and Speaker Sexton (who agreed to help us with this!)
- And they can “challenge” the fiscal note if our case is strong enough
- We’ll bring that, at his request, to Sen Watson, as well as Rep Hicks and Speaker Sexton (who agreed to help us with this!)
- In the event that our case is not strong enough, we have one backstop – move the enactment date to July 1st, as opposed to enactment upon passage, and we can get a bite at next year’s shared savings apple
- Because somehow, the GA has only like $8M in unobligated shared savings funds
- Meaning they’ve already obligated like $325M of their 2023 shared savings
- (quick reminder and caveat that shared savings are funds split between the state and the feds out of the pot of dollars that TennCare failed to spend on existing members, which is bad)
- Because somehow, the GA has only like $8M in unobligated shared savings funds
- Next up:
- House – behind the budget
- Senate Finance, Ways and Means Committee – 4/9 @ 8:30am CST OR 4/10 at 2:00pm CST
- We’re finally back on the move this week, with this VGB being heard in Senate Health
- 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
- On its way! This guy passed House full, no questions no problems
- Remember, this is our jumping off point for a full effort next year to pass legislation
- By passing the resolution, we give TennCare a “chance” to do the right thing, and demonstrate support in the GA
- Will TennCare do the right thing?
- By passing the resolution, we give TennCare a “chance” to do the right thing, and demonstrate support in the GA
- Next up:
- House Floor - TBD
- Right to Repair pt. 2 – this bill would require suppliers of power and manual wheelchairs to offer annual preventative maintenance, and creates a pathway for independent repair persons to do some types of simple, non-clinical repairs.
- As my (sorry) Tuesday updated noted, this one passed out of House Health this last week, no problems
- It’s on to Commerce next, which is a new committee for me
- But I don’t anticipate any problems, we’ll chat with the members on the committee and let them know it’s coming
- And if they are anything like every other member of every other committee this one has gone through, we’ll likely see strong support
- But I don’t anticipate any problems, we’ll chat with the members on the committee and let them know it’s coming
- Oh, and it’s up on the Senate floor Monday night – tune in!
- 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
- HB2497/SB2146 – IDD Residential Licensure Exemptions – this bill would establish a carve-out to the licensure requirements for residential facilities that serve individuals with intellectual and developmental disabilities, permitting the construction and operation of large scale, segregated and congregate facilities by two companies in the state
- Well, there is no better way to say this than to just say it, but we lost this week
- The bill was up in House Health last week after a 1-week roll, and it was voted on by voice vote
- Trying to count by reading lips, we maybe had 5 no’s, maybe 6
- And we needed 14
- Trying to count by reading lips, we maybe had 5 no’s, maybe 6
- The bill was up in House Health last week after a 1-week roll, and it was voted on by voice vote
- I’ll tell you what though, I am SO proud to be a little part of the team who testified
- Seriously, if you’ve got an hour and a half(!), watch these folks cook
- They made our case, and I think they made a better one, but the legislators didn’t
- Seriously, if you’ve got an hour and a half(!), watch these folks cook
- Speaking of legislators, we have a lot of work cut out for us in the community
- The language and sentiment expressed by legislators about people with disabilities was painful
- Several members depicted us like porcelain cherubs to be kept safe in a china cabinet, others as a menagerie of mystical and sacred creatures whose disabilities allowed them to see past reality and reveal some secret, purer world
- I’ve got an inappropriate-for-this-little-digest phrase for that, ask me some time
- But it was tokenism, it was demeaning, it was, frankly, offensive
- But it informed their “yes” votes, and that’s our reality
- Several members depicted us like porcelain cherubs to be kept safe in a china cabinet, others as a menagerie of mystical and sacred creatures whose disabilities allowed them to see past reality and reveal some secret, purer world
- The language and sentiment expressed by legislators about people with disabilities was painful
- So we need to do a couple things here:
- We need to work on healing this rift in the community, probably first and foremost
- We need to put boots on the ground to demonstrate that people with disabilities are human beings with agency, who have the right to self-determination
- Not children, not unicorns, not objects of our pity and do-gooding
- And not to be underestimated
- We need to reeducate our legislators on why we believe what we do
- House Health was the last big hurdle to passage for this bill
- They still need to get it funded, but through unforeseen (and silly) events out of our control, they have a much smoother path to that happening after last week
- We can still say our piece, but in a war of ideas, they have won for the time being
- Again, this is the beginning of a lot of work, and a long road forward, so I hope you’re willing to buckle up and come with me
- Lookin’ at you, GRASSROOTS
- Again, this is the beginning of a lot of work, and a long road forward, so I hope you’re willing to buckle up and come with me
- Next up:
- Well, there is no better way to say this than to just say it, but we lost this week
Other stuff
- HB2297/SB2864 – Slots for KB Part B – this bill would require DIDD to add an additional 1,000 Katie Beckett Part B slots to serve eligible children with disabilities
- I haven’t covered this one extensively, I don’t think – other than to note our brief flirtation with adding in some Part A fixes on the back of this bill
- But it’s a good bill – the need for these slots is there and adding kids to the Katie Beckett program is a good thing
- In chatting with the sponsors – Good Friend and soon-to-be-retired Rep. Sam Whitson and KB OG Sen. Kerry Roberts – we were able to discuss the need in art B, but also the needs in Part A
- And Sen. Roberts deftly wove that into his narrative of the bill, noting that the demand in Part B is partly a function of the dysfunction in Part A
- And that Part A-eligible families were choosing Part B instead because Part A was complicated and inflexible
- And Sen. Roberts deftly wove that into his narrative of the bill, noting that the demand in Part B is partly a function of the dysfunction in Part A
- So they are laying the ground work to build off of this bill and provide a legislative fix to Part A next year
- Next up:
- I haven’t covered this one extensively, I don’t think – other than to note our brief flirtation with adding in some Part A fixes on the back of this bill
- HB1183/SB503 – The Voucher Bill – this bill would create a statewide, universal private school voucher program
- We’re down to like 2 weeks to go here, and we’re not seeing much movement or momentum
- Which leads me to believe that the support isn’t there
- That said, I smell an April Surprise coming
- We could see House farrier Rep Scott Cepicky try to skip committee and force a vote on the House floor
- Which would be endless entertaining and likely a delicious disaster
- And, should it fail, would likely everybody in the caucus in a tough spot by making them put their name on an up/down vote
- We could see the Gov step in
- It could be to facilitate a House/Senate compromise (lol)
- It could be just a loud and visible push
- It could be to throw the GA or somebody in the GA under the bus
- We could see a House/Senate compromise all on their own!
- Support could come out of seemingly nowhere
- Hey, maybe we’re getting played
- Maybe they have the votes and they are being dramatic
- Hey, maybe we’re getting played
- We could see House farrier Rep Scott Cepicky try to skip committee and force a vote on the House floor
- Keep an eye out! This is the Gov’s signature proposal this year, there’s a lot of out-state money poured in on this and some very loud voices calling for its passage
- Next up:
- We’re down to like 2 weeks to go here, and we’re not seeing much movement or momentum
- HB1202/SB1325 – Gun Carry in Schools – this bill would allow some school staff to carry guns in schools
- To expand a bit, the bill would allow non-SRO staff (teachers, admin, SEA’s, etc.) to carry guns in and on the school premises with an enhanced carry permit and annual training
- Which, just on its face, seems like a bad idea
- The bill has suddenly been awoken from the grave, and started moving this week
- It sat buried for a while, but the law enforcement bodies (the Sheriff’s Association, TBI, etc.) have apparently all gone neutral on the bill
- After previously opposing
- Eliminating most opposition (besides, you know, the schools and teachers)
- It sat buried for a while, but the law enforcement bodies (the Sheriff’s Association, TBI, etc.) have apparently all gone neutral on the bill
- I think this is bad for the disability community, for a couple reasons:
- All children, disability or not, are subject to accidents in the presence of guns
- Children with behavior needs are misunderstood, and the manifestations of their needs are very often misinterpreted
- Could a misinterpretation of a disability-related behavior be addressed with the use or threat a gun?
- The relationship between teacher and student becomes very different when you add a weapon to the mix
- And those relationships, particularly for kids with disabilities, are vital to a student’s success
- If the intent is to stop school shooters, evidence shows that evened trained and armed officers don’t do that
- And, no school or district currently has liability insurance that covers guns and shootings, and many would likely not extend coverage or offer coverage
- Because if a kid gets accidentally shot by a school employee (not an SRO, who is under contract as an employee of local police departments), that district is going bankrupt
- And no insurance company wants to be on the hook for that
- But that’s an aside, because it’s a bad idea for all those other reasons before that
- Because if a kid gets accidentally shot by a school employee (not an SRO, who is under contract as an employee of local police departments), that district is going bankrupt
- Next up:
- House Floor – placed on desk (to be revived on House floor at any time)
- Senate Floor – 4/9 @ 1:30pm CST
- To expand a bit, the bill would allow non-SRO staff (teachers, admin, SEA’s, etc.) to carry guns in and on the school premises with an enhanced carry permit and annual training
- HB2445/SB2419 – Emma’s Bill – this bill would require TennCare to consider a patient’s overall condition when determining medical necessity and funding of items, services, therapies and care
- Rep Rebecca Alexander has carried a couple late-blooming heart-rending and rage-boiling bills the last two years
- Last year was requiring coverage of follow up breast cancer screenings
- This bill stems from the experience of a teenager who was abruptly affected by a previously unknown neurological disorder that left her severely impacted and, in a coma
- She required a ventilator for much of the day, but as she started to improve and her medical team wanted to wean her off of the ventilator,
- And, of course, TennCare began to cut funding for her care
- Leading to life-long complications
- And, of course, TennCare began to cut funding for her care
- She required a ventilator for much of the day, but as she started to improve and her medical team wanted to wean her off of the ventilator,
- This one is a no-brainer, one we in this community know too well
- That more often than not TennCare is ultimately more concerned with the bottom line than the health and welfare of those enrolled in its programs
- This one passed Senate Health this week (where it came onto my radar), and is behind the budget in the House
- It’s got a big fiscal note - $10M/year – but it seems well worth it
- Next up:
- Rep Rebecca Alexander has carried a couple late-blooming heart-rending and rage-boiling bills the last two years
- Other other stuff:
- House Subcommittee Calendar (no update, I think they’re all closed now?)
- House Committee Calendar
- Senate Committee Calendar (no update, but not all closed yet)
- TDC Big Net Calendar Report
Federal Update
- CMS released a long-awaited final rule streamlining CHIP and Medicaid services
- Some of the biggies in this rule are making transition from CHIP to Medicaid upon turning 18 easier, setting rules about redetermination procedures for state Medicaid agencies and lifting benefit caps on children
- These things can be slow, but often rulemaking benefits the consumer by placing restrictions on state Medicaid agencies (like TennCare)
- Some of the biggies in this rule are making transition from CHIP to Medicaid upon turning 18 easier, setting rules about redetermination procedures for state Medicaid agencies and lifting benefit caps on children
- I’m eagerly waiting a follow up on this one from last summer
- And if it doesn’t pop up soon, I think we should just make Tennessee do this stuff anyway
GRASSROOTS Update
- I’m going to refocus here on our own good and very good legislation proposed by the TDC on behalf of our community this year
- Right to Repair Part 2: one of the things I noticed about Part 1 was that it often went unimplemented by insurance companies last year, in part, they say, because they didn’t know about it!
- So, as we watch the progress of this one, I hope my GRASSROOTS can help me think about how to spread the word on this (should it pass)
- That said, this one has a clear path to a floor vote, and it doesn’t cost any money
- So stay tuned on action items, but nothing needed right now
- So, as we watch the progress of this one, I hope my GRASSROOTS can help me think about how to spread the word on this (should it pass)
- Pathways to TennCare
- We need this one funded! We’ve got a plan, but we need some pressure from supporters
- It’ll be up in the respective Finance committees next week, so if you’re so inclined, you could reach out and let them know that this is important to us!
- Here are the members House committee, and the Senate committee
- Remember to be nice!
- We need this one funded! We’ve got a plan, but we need some pressure from supporters
- And, since you are all private citizens with no restrictions on supporting or opposing candidates, take a look at the now-finalized playing field for our fall General Assembly elections (and August primaries)
- Take note of our friends (sponsors, good ones and key votes) and our less-than-favored pals (foes, bad ones, stinky ones and icky ones)
- And then consider supporting our friends!
- This isn’t always financial – sometimes somebody on the fence just needs to hear that a candidate is a good one
- Or that they are icky
- This isn’t always financial – sometimes somebody on the fence just needs to hear that a candidate is a good one
- And then consider supporting our friends!
- Take note of our friends (sponsors, good ones and key votes) and our less-than-favored pals (foes, bad ones, stinky ones and icky ones)
- I also think it’s fascinating, so ask me about my thoughts on the field some time
- Right to Repair Part 2: one of the things I noticed about Part 1 was that it often went unimplemented by insurance companies last year, in part, they say, because they didn’t know about it!
Media Highlights
- The Atlantic – the opposing side of our inclusive housing advocacy and debate published a manifesto of sorts in the Atlantic about a decade ago. I personally and professionally disagree with almost all of it, but if you want to see the extent of the other argument, this is pretty comprehensive.
- CBS Reports – in the same inclusive housing debate, this is more along the lines of our side and my thinking. I believe in the capacity of people with disabilities to make decisions, to choose their own lives and demonstrate self-determination, and this video is full of self-advocates exemplifying that belief. If you’ve got 20 minutes or so, check it out
- NASA – the sun, our planet’s benefactor and the sustainer of all life on earth, will briefly disappear on Monday. But not to worry, that pesky moon is just getting in the way, for just a sec. We won’t get to see the full thing here in most of Tennessee, but don your special specs, take off your jacket, and prepare to see and feel the solar eclipse.
Hang in there, TDC family, it’s tough out there, but we are tough too. No loss is forever, and as we’re finding out, no win is either. This is our perpetual battle, but it’s one that I’m very glad to be waging by your sides. Stick with me for a couple more weeks, and we’ll keep carrying on in the mission. Thank you, TDC family.