Providers, Patients, Advocates Oppose Tennessee’s Medicaid Block Grant

Tennessee’s proposal to radically change TennCare, the state’s Medicaid program, including by converting its federal financing to an unprecedented block grant, would jeopardize access to care for the 1.4 million Tennesseans that the program covers — particularly for children, low-income parents, and people with disabilities. Many providers, patients, and advocates have submitted comments to the state and to the Centers for Medicare & Medicaid Services (CMS) opposing the plan.

The state received an overwhelmingly negative response to its prior version of the proposal: of the more than 1,700 comments filed in September and October, just 11 supported the proposal. Now, CMS has received about 6,200 comments during the federal public comment period for its most recent version of the proposal.

National organizations representing health care providers and patients were among those strongly opposed to the proposal:

• “AARP is deeply concerned about Tennessee’s proposal to fundamentally alter the nature of the Medicaid program by requesting that the state receives federal Medicaid funding in the form of a block grant. A block granting or cap on the program’s funding could leave millions, including seniors, at risk of losing the care they need and, over time, erode their ability to remain in their homes and communities as they age. For these reasons, AARP opposes block granting or capping funds in the Medicaid program.
  
  Moreover, AARP is concerned that the TennCare II Demonstration Waiver may worsen health outcomes, create significant financial hardship for many Tennessee Medicaid beneficiaries in need of coverage, increase administrative costs to the state, and result in increased uncompensated care costs for Tennessee’s health providers.” – AARP
• “If approved, this unprecedented proposal could undermine national standards protecting children’s and pregnant women’s access to care with long-term profound consequences for the health care system and beneficiaries alike…. The proposed block grant funding threatens the long-term financial stability of the Medicaid program should the state face unforeseen costs such as health epidemics, and would create an incentive for the state to consider reducing access through eligibility, benefit, and payment reductions in order to utilize more ‘shared savings.’ We urge you to deny the proposed Amendment 42 and instead work with the state and community partners to improve children’s access to care.” – American Academy of Pediatrics, Children’s Defense Fund, Children’s Hospital Association, Family Voices, First Focus on Children, Georgetown Center for Children and Families, March of Dimes, and National Association of Pediatric Nurse Practitioners
• “We are opposed to the request to cap federal financing of Tennessee’s Medicaid program under the proposed block grant structure. We believe capping federal support could lead to program cuts over the long term that would negatively impact children’s health. Establishment of a cap or block grant for federal Medicaid funding is in direct conflict with our longstanding waiver principles.” – Children’s Hospital Association
• “The undersigned organizations represent millions of individuals facing serious, acute and chronic health conditions across the country.… Unfortunately, our organizations fear that by changing the financing structure of TennCare to a block grant, the state will jeopardize access to quality and affordable care for patients with serious and chronic health conditions. The block grant will include vulnerable eligibility groups such as children and people with disabilities and requests unprecedented changes that could make it harder for patients to get the treatments and services that they need. Our organizations urge you to reject the waiver.” –17 national patient groups, including the American Lung Association, Leukemia & Lymphoma Society, Lutheran Services in America, March of Dimes, and National Alliance on Mental Illness.
• “The proposed block grant and operational flexibilities could seriously limit eligibility and access to care for some of the most vulnerable Tennesseans, including those with cancer, cancer survivors, and those who will be diagnosed with the disease. We strongly urge the Centers for Medicare and Medicaid Services … to consider stakeholder comments and reject Tennessee’s block grant waiver.” – American Cancer Society Cancer Action Network
• “The Health Task Force opposes the conversion of the federal Medicaid program to a block grant, and we oppose the conversion of any portion of Tennessee’s TennCare program to a block grant…. Overall the Tennessee proposal establishes a dangerous precedent and undermines Medicaid’s program integrity by limiting federal oversight. Allowing the state to operate the program with limited federal oversight and information is particularly threatening to people with disabilities. If harmful or discriminatory policies are implemented by the state, or the managed care organizations, there are few avenues to address the issue.” – Consortium for Citizens with Disabilities, Health Task Force
• “The FAH believes that any block grant proposal is inconsistent with the federal matching requirements under federal Medicaid law and cannot be approved by CMS…. Given that CMS has no authority to approve block grant proposals on a state-by-state basis, it is obliged to not approve the state’s request. It is imperative that Federal funding for Medicaid remain stable and clearly dedicated to the program’s mission enabling states to focus on maintaining coverage and ensuring access to care.” – Federation of American Hospitals
• “The American College of Physicians has serious concerns about the proposed amendment to the TennCare II demonstration and urges CMS to reject the state’s application. We are concerned that the state’s proposed waiver prioritizes cost-containment over the health of vulnerable patients, including low-income families, pregnant women, and people with disabilities, and would severely undermine crucial federal oversight of the program…. ACP strongly opposes transforming Medicaid’s existing financing structure into a block grant approach.” – American College of Physicians

The opposition demonstrates the essential role that Medicaid plays for individuals, providers, and communities. Other states considering similar proposals should instead look for opportunities to strengthen access to Medicaid — such as by adopting the Affordable Care Act’s Medicaid expansion, which in Tennessee would cover over 200,000 uninsured people and secure $800 million in federal funding each year.