All 11 members of Tennessee's congressional delegation have signed a letter seeking $80 million for financially struggling hospitals in the state.
They are asking that TennCare money lost from one federal grant program be replaced through another program, an action that requires a waiver from the Centers for Medicare and Medicaid Services.
In the letter to Marilyn Tavenner, who heads the federal agency, the delegation makes the case that Tennessee is treated differently from other states because of another waiver – one that was granted back in 1994 when the state transformed its Medicaid program into TennCare.
Tennessee is the only state that does not have guaranteed access to Medicaid's disproportionate share hospital (DSH) program. However, Congress in its past four sessions has passed legislation that did grant Tennessee partial DSH payments. The program allocates grants to hospitals based on the amount of Medicaid and indigent care they provide.
"Hospitals are about the most important institutions in our state," said U.S. Rep. Jim Cooper. "Without hospitals, you don't have good health care. You don't have a chance to build a strong community. You can't attract industry. Tennessee hospitals are in serious trouble right now because they see a lot of patients that can't pay the bills."
The letter points out that Tennessee hospitals provided more than $700 million in unreimbursed TennCare costs last year, gave $970 million in charity care and lost another $730 million in services provided to Medicare patients.
"Without this waiver, emergency room lines are likely to be longer and hospitals – especially in Memphis, Nashville, Chattanooga and Knoxville – would struggle to serve Tennesseans who have the most difficult time paying for health care," said Sen. Lamar Alexander. "Governor Haslam has come up with a creative solution to a difficult problem."
Although the DSH program is being greatly diminished because of the Affordable Care Act, it will remain an important revenue source for many hospitals for the next few years. The program is losing billions of dollars in funding because hospitals were supposed to have new sources of revenue, including the expansion of state Medicaid programs to cover more people.
Tennessee, at this point, is not expanding TennCare.
"The real issue that is not touched in the letter – and the best way by far to help Tennessee hospitals — is to expand Medicaid in Tennessee," Cooper said. "It's good that the letter asks for this help, but Tennessee really needs to expand it's Medicaid program."
Medicaid expansion would direct billions of dollar in federal funds to Tennessee hospitals, he said, compared to the $80 million sought in the letter.
But the $80 million means more to some hospitals than others, said Craig Becker, president of the Tennessee Hospital Association.
"These dollars go to those hospitals that provide the most uncompensated care and TennCare so it helps those hospitals that treat the poorest of the poor," Becker said. "For some hospitals, it's their bottom line."
Reporter Shelley DuBois contributed to this report.
Contact Tom Wilemon at firstname.lastname@example.org or 615-726-5961 or follow him on Twitter @TomWilemon.