Reaction to Tennessee Medicaid block grant waiver proposal


Tennessee would become the first state to convert its Medicaid funding into a block grant under a proposal published yesterday by the Lee administration. Reaction was swift but muted from supporters and opponents, with much information yet to be fully vetted.

Lamar Alexander (R-TN), chairman of the health committee in the U.S. Senate, said he has always supported block grants and “Last Congress, I supported legislation in the United States Senate that would have taken Affordable Care Act money and turned it into block grants that states, including Tennessee, could decide how best to spend.”

The Tennessee Health Care Campaign, an organization that opposed the block grant proposal during the legislative session, said in a release the proposed plan has addressed some of its concerns. THCC Executive Director Jacy Warrell said, “Traditional block grants do not adjust for recession, growth, or public health crisis. This block grant waiver appears to have addressed many of our concerns.”

The Sycamore Institute, a Nashville think-tank said caution is warranted. “Achieving cost-savings for taxpayers and/or providing a slimmer TennCare benefit to more people may have negative effects on current TennCare enrollees. Alternatively, any downward pressure on federal TennCare funding might require state policymakers to balance the budget by reducing TennCare eligibility and benefits, cutting provider payments, requiring more of enrollees, shifting money from other priorities, and/or raising taxes. All of these decisions would pose trade-offs.”

Medicaid originally was designed to mandate the federal government pay each state a certain percentage of the cost of care for anyone eligible. Under the block grant proposal, the federal government would instead pay Tennessee a lump sum each year while freeing the state from many of Medicaid’s rules, including who must be allowed into the program and what conditions and treatments are covered.

A 30-day public comment period has commenced at

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