Get to Know the State Budget Process

State departments have begun presenting FY 22-23 budgets to House and Senate committees, one component in the annual budget development process. Read on to learn more about what these budgets mean for health centers.
The Tennessee state budget reflects the priorities from the governor and the Tennessee General Assembly. Budget preparations occur months in advance, as departments formulate estimates for the upcoming year and present their requests to the governor. The governor and his staff then develop a proposed budget, which is presented to the General Assembly during the State of the State address. The governor's proposed budget is crafted into an appropriations bill, which must ultimately be passed by the General Assembly.1 
State of the State 
This year, Governor Lee delivered his State of the State address to the General Assembly on January 31, 2022 where he outlined his administration's priorities, including the following related to health care:  
  • $25.5M to provide adult dental benefits for 610,000 Tennesseans eligible for TennCare 
  • $11.8M toward a multiyear commitment to recruit and retain dental providers, as well as provide dental care for prosthodontic services 
  • $18.6M to attract over 150 new primary care residents 
  • $7M for substance abuse clinical treatment and addiction recovery programs  
  • $82M to reimburse public hospitals for uncompensated care, primarily in rural communities  
  • $55M to increase access to services across each of the Medicaid Pathways to Independence programs 
  • Expansion of TennCare's Health Starts Initiative to put greater emphasis on maternal health and holistic care for mothers and children 
Tennessee General Assembly 
Following the State of the State, the budget heads to the Tennessee General Assembly where certain House and Senate committees hold hearings for state departments to present their budgets. The Tennessee Department of Health and TennCare, the state's Medicaid agency, have both presented their FY23 budgets before committees in recent weeks. Each agency's budget reflects myriad health care priorities but below are the proposals with the most impact on community health centers.  
Investments in Oral Health  
The Tennessee Department of Health and TennCare both proposed significant investments in oral health care this year. The Department of Health's FY 22-23 budget includes $11.8M for the first year of a five-year pilot program to expand slots at the state's dental schools, to recruit and retain dentists primarily through loan repayment, and to provide prosthodontic services. TennCare's budget includes $25.5M in state funding to provide an adult dental benefit for an estimated 600,000 Tennesseans.  
Health Care Safety Net
The Care Safety Net fund, administered by the Department of Health, partially offsets the cost of providing primary care to uninsured adults in Tennessee at community health centers and community and faith-based clinics. During FY21, the Health Care Safety Net fund supported more than 326,000 visits and care for more than 162,000 patients.2 The proposed amount of funding Health Care Safety Net for FY22-23 is $21.9M in recurring funding, which is an expense that is expected to occur each year.3 This is $3M less than the previous year because the $3M was non-recurring, which is a one-time expense.4 
Maternal and Child Health 
TennCare's FY 22-23 budget includes investments in maternal health, including about $6.5M in state funding to support the expansion of postpartum coverage from 60 days to one year. The budget also includes $13M in state funding to support the Health Starts Initiative, to address non-medical factors that affect health and provide more holistic care. 
What's next for the budget? 
Committees in the House and Senate are continuing to hold budget hearings. Finance Committees work on the budget first, but the House and Senate can also approve additional amendments to the appropriations bill. Eventually, an identical appropriations bill must be agreed upon and passed by the House and the Senate, which then goes to the governor for signature. The budget process typically wraps up toward the end of the state legislative session, usually around April, and the new fiscal year begins on July 1.5  
[1]  The Sycamore Institute, “Tennessee State Budget Primer: A Foundation for Understanding Our State's Public Policies (2nd Edition),” 2018. 
[2]  Tennessee Department of Health. (2022). 2021 Uninsured Adult Healthcare Safety Net Annual Report. Retrieved from 
[3]  The Sycamore Institute. (2018). Tennessee State Budget Primer: A Foundation for Understanding Our State's Public Policies (2nd Edition). Retrieved from
[4]  Ibid.
[5]  Ibid.



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