In Tennessee's second day of public hearings on a controversial proposal to shift the funding of its Medicaid program to a federal block grant, dozens showed up to an East Knoxville public library to make their opinions known.

And for the second day, not a single person spoke in favor of the plan.

"If Tennessee becomes the first state in our country to switch Medicaid to a block grant, it will move into last place in our country as to how it treats its most vulnerable," said the Rev. Larry Boudon, pastor of Grace Lutheran Church in Oak Ridge.

Tennessee could become the first state to strike a deal with President Donald Trump's administration to convert Medicaid funding to a block grant, or a capped lump sum with increased state flexibility — an initiative Trump has supported as a cost-cutting measure.

Roughly 65 people showed up to the hearing, 23 of whom stepped up to the podium to share comments. Three individuals provided comments that could be considered neutral, while the others were opposed to the block grant plan.

The first of the listening sessions was held Tuesday in Nashville. A third forum is being held Thursday in Jackson, and the state plans to hold two more in Memphis in Chattanooga, though no dates have been set for those meetings. The final day to submit public comments to the state on the plan is Oct. 18.

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Sen. Richard Briggs, R-Knoxville, attended the hearing, along with Knoxville Democratic Reps. Gloria Johnson and Rick Staples.

Briggs was the sole Republican to vote against the legislation requiring Gov. Bill Lee to apply to the Centers for Medicare and Medicaid Services for block grant funding for TennCare, the state's Medicaid program that services 1.4 million people.

"There's a lot to gain, but there's also something to lose," said Briggs, a heart surgeon who was a rare Republican proponent in the Tennessee legislature for expanding Medicaid under the Affordable Care Act. "A lot of my concerns are more financial."

In an interview after the forum, Briggs said he is concerned that basing the block grant funding calculation on enrollment numbers from the last several years, when unemployment has been low, could pose a problem when an anticipated recession hits in the next year or so.

Johnson cited legal questions about a block grant proposal.

"Federal law does not provide the Trump administration the authority to change Medicaid’s funding mechanism," Johnson said.

Opponents of block grants, including U.S. Rep. Frank Pallone Jr., D-N.J., chairman of the House Energy and Commerce Committee, have argued that Congress has not authorized the U.S. Department of Health and Human Services to approve a Medicaid block grant deal.

Proposal to 'cut further already inadequate spending'

The state is asking for a $7.9 billion block grant to use on some of its Medicaid services, rather than receiving an unlimited amount of funding based on claims filed, which is the current funding model. In the state's proposal, some current Medicaid services would continue to be billed the same way to the federal government.

The block grant amount would increase on a per capita basis for each new member enrolled in the future, and would be adjusted each year for inflation.

While the state argues the increased flexibility and savings would allow Tennessee to expand TennCare coverage to some of the hundreds of thousands of residents who currently do not qualify for state insurance, opponents say the plan could result in cuts in benefits for those currently enrolled.

Tennessee is also proposing an unprecedented arrangement of splitting 50-50 any savings with the federal government by coming in beneath CMS annual spending projections for TennCare.

Lee has argued that if the federal government approves the plan as it currently stands, the state could see savings of up to $1 billion each year. He also cautioned that number is contingent on negotiations with CMS.

"What the block grantproposal promises to do is cut further already inadequate spending so Tennessee can split the savings with the federal government," said Mark Siegel, a retired Social Security administrative law judge.

Parents of disabled children raise concerns over pharmacy limits

Michelle Gross of Jonesborough traveled to the forum with her 6-year-old daughter, Asher, who has a chromosomal condition and lives with chronic lung disease. Asher already has been hospitalized four times this year.

She is concerned about the state's plan to cover fewer drugs under the block grant in order to negotiate lower prices with drug companies.

"The proposal does not specify any appeals process" for obtaining certain drugs, Gross said. "Which means my child may not be able to access the medication she needs to help her breathe."

With Gross was Jessica Fox and Mallorie Hatcher, two other upper East Tennessee mothers of children with significant disabilities. They are concerned that a pending Katie Beckett Waiver for Medicaid, which will provide funding for treatment for children like theirs, could be in jeopardy under a block grant scenario.

The state has said the future Katie Beckett program won't be affected.

Speakers level complaints on TennCare operations

Knoxville resident Sherrie Raymond was the sole speaker to call for tossing out TennCare altogether and returning to federal Medicaid, though she was not the only one to make general complaints about how TennCare is run.

Raymond said she was born with “mild birth defects” that gave her problems as an adult, like deformed bones at the base of her spine, a cyst in the middle of her back and a defective kidney.

For most of her adult life, she had employee-sponsored commercial insurance, but when she no longer had that job and COBRA expired, she would have qualified for Medicaid in most states. But TennCare enrollment was closed to adults except for the very poorest and most disabled.

Raymond said TennCare is a "deeply flawed system," and supporting a block grant is “throwing good money after bad.

"TennCare was not a good program to begin with," she said.

And further limiting services, as the block grant proposal has the potential to allow, means “people will die,” she added. Her comment was met with applause.

Attorney Glen Kyle, of Knoxville’s Franklin and Kyle Elder Law, characterized the a block grant system as “ideology hurting real people" while making an impassioned appeal against the plan.

Kyle called the proposal reckless, particularly given TennCare’s history of problems with TennCare managed care organizations.

“This isn’t a system that has earned the right to get around federal oversight,” Kyle said.

Reach Natalie Allison at nallison@tennessean.com. Follow her on Twitter at @natalie_allison.