Emails: TennCare work mandate held up amid feds’ questions

February 6, 2020 GMT

NASHVILLE, Tenn. (AP) — Tennessee’s push to establish Medicaid work requirements remains hung up amid questions from the federal government about using welfare money to fund the program, according to emails obtained by The Associated Press in a public records request.

TennCare, Tennessee’s Medicaid program, included a plan in a November letter to answer federal officials’ questions about its plans to use Temporary Assistance for Needy Families money to cover anticipated costs for the program. The spending would range from job skills assessments to covering child care or transportation costs so beneficiaries can go to work.


The state is still awaiting guidance from the U.S. Administration for Children and Families about whether Tennessee’s plan to spend the federal money meets the mark, said TennCare spokeswoman Sarah Tanksley Stockton. Multiple times in December, TennCare asked for an update and the federal administration replied that it needed more time.

“Recently, South Carolina has been approved to implement work requirements,” TennCare Chief Operating Officer Brooks Daverman wrote in a Dec. 17 email to federal officials. “However, Tennessee can not move forward until we know which activities and expenses can be funded with TANF funds. Therefore we would like to know when we can expect actionable guidance from you.”

South Carolina became the 10th state to be granted a work requirement waiver in December under an option offered to states by President Donald Trump’s administration, according to the Kaiser Family Foundation. Court challenges have blocked the requirements in New Hampshire, Arkansas and Kentucky, where a new Democratic governor has since scrapped the requirements altogether.

Tennessee lawmakers voted in April 2018 to order work requirements, then TennCare submitted its plan to implement them for federal consideration that December. It needs approval from the Centers for Medicare and Medicaid Services and the Administration for Children and Families, since it relies on welfare money.

TennCare’s plan would require that, for at least four months out of six-month periods, able-bodied, low-income adult beneficiaries must log an average of 20 hours of weekly qualifying work, community service or education. Violators generally would face suspension until they show they have complied for a month.

A number of groups would be exempted, including one primary caregiver per household with a child younger than 6, those on short- or long-term disability or with certain acute medical conditions, caregivers for the disabled or medically frail, people receiving unemployment benefits and others. Other circumstances could warrant a “good cause” exemption.


Republican lawmakers initially hoped they could tout the program as a cost-saver for the state. They switched course and ask to rely on federal money after a legislative analysis in 2018 estimated the requirements would cost a net $34 million annually.

Critics have pointed to the limited reach and multimillion-dollar price tag of the work requirements in a state that hasn’t expanded Medicaid under the Affordable Care Act. About 56,000 people on TennCare would be affected, TennCare has estimated.

TennCare covers about 1.4 million low-income people, including pregnant women, children, caretaker relatives of dependent children and the elderly, and disabled adults.

TennCare wrote in November that it plans to use the federal money for a variety of costs, including skills and work experience assessments and employment resources; child care and transportation; outreach and education; staffers for program management, audits, eligibility and appeals; computer system changes; development of a process to identify medically frail members; and design and operation of a program evaluation.

In a statement, the federal administration said it wants “to be sure that the state uses TANF funds for allowable purposes and for eligible recipients, and to be sure that the state understands what those are,” saying there is wide latitude in setting program goals and offering services.

Tennessee has built up $732 million of the kind of federal welfare funds it wants to use for work requirements. The stockpiled money has prompted criticisms, leading to plans to spend some of the money and the formation of a task force to look into solutions.

“Regarding unspent funds, the state has the flexibility to keep as large a rainy day fund as it wishes, although the administration does want to see states support vulnerable families with their TANF funds, especially by promoting work as the best pathway to self-sufficiency,” ACF spokesman Pat Fisher said.