Tennessee Disability Coalition presents 2024 scorecard, outlines legislative priorities on caregiving, TennCare and housing

Jeff Strain, director of public policy for the Tennessee Disability Coalition, presented the coalition's 2024 Disability Scorecard and outlined policy priorities the group plans to pursue during the 2024 General Assembly session. Strain said the state retained an overall grade of D on the scorecard and said the coalition will advance a slate of bills addressing family caregiving, TennCare reporting, housing, education and other areas.

"This year again the state gets a D," Strain said. He said the coalition proposed 21 policy changes over the past two years and the state adopted about 10 of them, but the overall experience for people with disabilities had not improved enough to raise the grade.

Strain highlighted two top priorities for the current session. First, a two-part paid family caregiving initiative: part one would bar TennCare from writing rules that prevent provider agencies from hiring family caregivers and would require a guidebook for agencies on how to employ family caregivers; part two, planned as a follow-up in a later session, would create upskilling and credentialing pathways so family caregivers can be paid at rates commensurate with more complex care skills.

Second, Strain described proposed changes to TennCare reporting that would shift evaluation of provider networks from supply-side measures (how many providers are enrolled within a given time or distance) to demand-side metrics: how many promised services are actually delivered, wait times for appointments and the lag between approval and receipt of services. Strain said the proposal is modeled on the Centers for Medicare & Medicaid Services' pending home-and-community-based-services access rule but would seek faster, state-level reporting and county- and demographic-level breakdowns.

Strain cited data and specific problems the coalition aims to address: AARP ranked Tennessee 51st in support for family caregivers, the coalition found that 20% of family caregivers report half of their days each month are poor mental-health days, and he said Tennessee ranks near the bottom in Medicaid spending per enrollee. He said that 44% of enrollees in Tennessee's ECF Choices waiver report waiting for services that have not arrived.

Other priorities Strain described included: reconvening a TennCare oversight committee; addressing a severe shortage of accessible and affordable housing for people with disabilities, including support for policies such as unbanning inclusionary zoning to incentivize accessible affordable units; an education proposal to create an academic and behavioral specialist teacher license to better support students with behavioral needs; drawing down waiting lists for the Choices program group 3 for older adults at risk of nursing-home level care; mental-health access improvements; changes to how school districts can bill TennCare for services; reforms to employment-support policies such as ending automatic job-coaching fading; and protections for students with disabilities in laws addressing threats and criminal offenses.

Strain said the coalition plans to run eight bills this year and encouraged council members to use the scorecard in advocacy, including Disability Day on the Hill on March 12. "We would like to tell people about [these gaps] so the general assembly will see that to be a problem," he said.

Council and attendees asked questions and offered feedback. Stephanie Cook, the city's Americans with Disabilities Act coordinator, thanked the coalition and invited Strain to participate in ADA trainings and other city-level discussions.

The coalition's full 2024 scorecard and supporting documents were made available to council members via email and in the meeting chat.