But the supplemental payments cover the actual cost to the clinic of treating TennCare patients. TennCare's per-office visit payment does not cover the entire cost of the visit.

In urban areas, hospitals or large physician practices typically can negotiate higher payment rates with the private insurance companies that manage Tennessee's Medicaid program.

Clinics in rural areas with a single doctor or nurse practitioner have less negotiating power and get lower rates, said Rebecca Jolley, executive director of the Rural Health Association of Tennessee.

Without the wraparound payments, clinics are paid 20 to 30 cents on the dollar of their actual costs to see patients, Jolley estimated.

"These clinics are facing a dire financial situation," Jolley said.

In small-town Tennessee, rural health clinics struggle as state freezes payments

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Lost Medicaid Funding

To date, the failure to expand Medicaid/TennCare has cost the State of Tennessee ? in lost federal funding. (Source)

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