Chas Sisk

The Tennessean

NASHVILLE — Tennessee Gov. Bill Haslam will get a chance to reopen talks with the federal government over expanding the state's Medicaid program when he sits down Sunday with the Department of Health and Human Services' new leader.

The Republican governor and Secretary Sylvia Mathews Burwell are scheduled to meet for the first time since Burwell replaced Secretary Kathleen Sebelius last month. The closed-door meeting will take place on the final day of the National Governors Association's summer conference in Nashville.

The meeting comes as Haslam faces mounting criticism for not agreeing to offer TennCare, the state's Medicaid program, to more adults as called for under the 2010 Affordable Care Act. Haslam and Burwell also will sit down a day before a deadline for the state to respond to a stinging letter from federal Medicaid director Cindy Mann that said Tennessee is failing to meet the law's requirements.

"I wouldn't call it a totally new start," he said. "But I think when you have a new, key player it matters to sit down."

On Saturday, Haslam presided over a panel at the NGA conference that touched on Medicaid expansion and state innovation.

Andrew Dreyfus, president and chief executive of Blue Cross Blue Shield of Massachusetts, said his state had all but eliminated the uninsured since it put its version of the ACA into effect in 2007. He also said the state had begun to make headway on costs, mainly by shifting doctors into programs that pay them for how well their patients do, rather than for each service they provide.

Dreyfus said the federal government should give states latitude to design their own programs.

"We're actually going to end up with five or six flavors, or variations, of how the ACA is going to play out," he said. "I think that state experimentation with varieties is going to take us very far."

Bill Rutherford, chief financial officer and executive vice president of Nashville-based Hospital Corporation of America, said during his remarks that its costs to provide care to the uninsured had dropped 30 percent in the five states that the company operates in that had expanded their Medicaid programs.

Haslam said he believes providers and insurers in Tennessee would be more willing to give up pay-for-service arrangements if the state expands TennCare.