Tweeting and Tennessee: The story of a block grant

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

Tennessee State CapitolTennessee is pursuing a variant of a block grant for Medicaid (although it’s not strictly a block grant but more on that in a second.) Brett Kelman has been covering it for the Tennesseean. Much of his work is behind a paywall so we can’t share all of it (here’s one good ungated sample).

We did want to draw attention to what’s going on in Tennessee and point you to an epic Kelman Twitter thread that shed light on his reporting, shows the value of old-fashioned legwork (or in this case, a cyber-variant), and even made Medicaid news an awful lot of fun to read.

Basically Tennessee’s Medicaid program – called TennCare – wants to scrap the traditional federal-state joint funding formula and get a block grant from Washington. The state would have more flexibility to run Medicaid – and keep half the savings if it does in fact save. How it plans to save is not at all clear – it has said it would not reduce enrollment or services. About 1.4 million low-income people are covered by TennCare, and roughly 1 million would be affected by the block grant.

Republicans have pursued a block grant change to Medicaid on and off all the way back to the Reagan years. They made a big push during the failed ACA repeal effort in 2017. After that federal GOP initiative failed, CMS has indicated states could pursue this block grant path although none has yet done so (and any such plan, including Tennessee’s, requires CMS approval of the details and would likely face court challenges as well.)

A “pure” block grant is a chunk of money the state would get each year – and it would rise under a pre-set formula but the goal is to spend less on Medicaid than the government does now; it would grow more slowly than current spending. Tennessee gave itself an out – it requested a block grant that would be adjusted annually for inflation AND it would get more money if more people enrolled (perhaps during a recession). But it would not lose money if enrollment decreased.

Later, the state said it would revise the plan given public feedback but it didn’t reveal what the changes would be until it submitted the new version to federal authorities. Kelman reported that the biggest change is giving the state more flexibility in how to spend any savings – and not require that the saved dollars be directly re-invested in TennCare. (He also tweeted that advocates of the block grant said he’s overreacting…)

Brett Kelman

Brett Kelman

The Medicaid block grant proposal to date has not gone over well with the public. Kelman reported on how few people spoke out in favor at a public hearing. Then he went further. Through a public records request, he obtained all 1,800-plus public comments. He read each and every one of them. And he turned it into a 2,272 page searchable PDF. With a running tally, he categorized them (1,716 negative, 75 neutral and just 11 supportive.).

And he tweeted a lot about it. And made screenshots. And even found a poem. Also delightful Medicaid sarcasm. (Which isn’t a hashtag but probably should be.) It’s worth looking at the thread not just to learn more about Medicaid, but for a particularly fine example of how to use social media to report and explain and educate – and elaborate on your more traditional reporting. Kelman also used it as a way of reminding the public about what journalists do – and why it matters.

The thread, posted on Nov. 5, began like this (click on his tweet to see the whole thread):

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