Governor Bill Lee of Tennessee announced that $400 million of federal COVID-19 relief funds will be used to provide home- and community-based services (HCBS) to individuals with disabilities and elderly individuals. This investment is made possible with funds from Section 9817 of the American Rescue Plan Act (ARPA), which provides qualifying states with a temporary 10% increase to their Federal Medicaid Assistance Percentage (FMAP) for certain HCBS expenditures between April 1, 2021 and March 31, 2022. States must use the funds exclusively for Medicaid HCBS services by a deadline of March 31, 2024, or they will be lost. The Center for Medicare and Medicaid Services (CMS) approved Tennessee’s $400 million allocation, and TennCare, Tennessee’s Medicaid program, will oversee distribution of these funds, working closely with the Tennessee Department of Intellectual and Developmental Disabilities (DIDD). This is the largest one-time investment in HCBS in the state’s history.
CMS created a toolkit to help state partners plan their funding. The toolkit lists multiple ways a state can use the money to improve their HCBS. CMS urges states to do this by expanding eligibility and increasing access to HCBS, offering a broader range of these services, making long term investments into HCBS, taking action to strengthen the direct service workforce by increasing the salaries of direct support professionals, and acknowledging the deciding factors of health discrepancies amongst the elderly and people with disabilities. TennCare built upon these recommendations, gathering extensive stakeholder input in developing the HBCS spending plan. “Tennessee is excited to begin implementing the initial spending plan which prioritizes services for people who need them and investments in the front-line work force who deliver them. The plan reflects input from a variety of stakeholders both as part of broader discussions related to the HCBS delivery system and specifically linked to this funding. Tennessee is committed to investing these funds in ways that will have sustainable impact on the Medicaid HCBS service delivery system and on the lives of those we serve and their families,” says Katie Moss, deputy chief of long-term services and supports with TennCare.
Community advocates are also enthusiastic about this spending plan. April Burn-Norris from Tennessee’s Community Bridges Inc., “Under the Tenn Care CHOICES Home and Community Based Services (HCBS)/Long Term Services Supports (LTSS), the adult children of aging parents can be paid as caregivers. If the proposed plan to spend $400 million on these programs will ensure that eligible adult children are paid to provide care to their nursing home eligible disabled parents, it would be a great way to assist under-staffed nursing facilities and an opportunity to help otherwise financially burdened Tennesseans. I look forward to seeing the resources spent on this program address the need for paying more adult children to provide care to their nursing home eligible disabled parents in Tennessee.”
Tennessee's HCBS spending plan focuses on three key areas of opportunity: 1) to improve access to HBCS for persons supported and family caregivers; 2) to invest in HCBS workface capacity and competency; and 3) to invest in HCBS provider capacity.
Additionally, the plan aligns with two priorities established by Governor Lee and the Tennessee General Assembly prior to the pandemic: 1) to “provide services to 2,000 individuals with intellectual and developmental disabilities,” resulting in a reduction of the TennCare Employment and Community First CHOICES program waiting list by more than half; and 2) to “invest in recruitment, training and retention of frontline support staff to better serve Tennesseans with disabilities.”
Thanks to the proposed HCBS spending plan, individuals and families in Tennessee will be able to access resources to live a more dignified life.