Legal group charges Tennessee block grant proposal vague, asks CMS to punt back to state

Dollar bill with a hole in Washington's face on it and the word "Medicaid" in its place
A legal advocacy group wants CMS to call on Tennessee to clarify its application to convert Medicaid dollars into a block grant. (zimmytws/GettyImages)

Tennessee’s waiver proposal to convert its Medicaid program into a block grant is vague and short on specifics, according to an advocacy group that has successfully fought the Trump administration on its efforts to revamp Medicaid.

The National Health Law Program questioned in a letter Tuesday to the Centers for Medicare & Medicaid Services if the public could accurately comment on Tennessee’s block grant waiver because of the lack of detail. The program has backed lawsuits successfully challenging several states’ efforts to install work requirements for certain Medicaid beneficiaries.

“The document is extremely vague on the specifics of what the state is proposing to do and how those proposals will affect stakeholders, from enrollees to managed care organizations,” according to the letter referring to Tennessee’s plan, which was released last week.

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Chief among the concerns is what Tennessee would do with any savings from the block grant. The proposal said that any savings from the grant would go towards healthcare costs.

RELATED: GAO: Staff shortages, social factors barriers to treating high-cost Medicaid beneficiaries

But “what does health mean?” asked Jane Perkins, legal director for the National Health Law Program.

“Will [the state] take money out of Medicaid and improve health by improving bridges and roads?” Perkins told FierceHealthcare.

Another concern is that Tennessee does not want to follow federal rules for managed care plans, according to the letter. Tennessee’s waiver application asked to file an amendment to its Medicaid program that would convert federal dollars into a fixed amount via a block grant.

But the National Health Law Program contends that the block grant proposal is a radical overhaul of how Medicaid is structured and shouldn’t be treated as just an amendment.

“Even if this document is considered an amendment, there needs to be a meaningful comment process,” the group’s letter to CMS said.

The group calls for CMS to send the application back to Tennessee to clarify it.

Currently, the federal government matches state spending on Medicaid and there is no cap on spending. But the state is asking for a block grant for its federal spending instead. The block grant would be based on the historical Medicaid spending in the state from 2016 to 2018.

RELATED: Medicaid managed care executives say plans must tackle social determinants, opioid epidemic

Some services under Medicaid would remain under the current federal-state match, such as prescription drug coverage and uncompensated care for hospitals.

Tennessee is the first state to pursue a block grant but may not be the last.

CMS had been pursuing guidance to offer states on how to make similar applications but that guidance has been withdrawn for consideration by the White House’s Office of Management and Budget.

CMS did not return a request for comment as of press time on the completeness of Tennessee’s block grant proposal.

The comment period on the block grant proposal started on Wednesday and lasts until Dec. 27. Other advocates are worried about the timing of the comment period right around the holiday season.

"TennCare Block grant comment period is open, giving concern citizens from the day before Thanksgiving until two days after Christmas. Classic," tweeted Michele Johnson, executive director of the advocacy group Tennessee Justice Center. 

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