Capitol Correspondence - 01.21.20

Block Grant Updates – Congress Concerned by TN Proposal, Administration Still Planning Guidance

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The article below by The Hill both flags concerns by key congressional Democrats who oversee Medicaid about Tennessee’s block grant proposal, and hints that the Trump Administration might be slowing down its own block grant draft guidance. Note, however, that the Wall Street Journal has scooped that the Centers for Medicare and Medicaid Services (CMS) plans to still issue the guidance. ANCOR has previously opposed block grant proposals because of their potential to destabilize supports for people with disabilities, the majority of which are funded by Medicaid. We monitored Administration block grant proposals for most of 2019 and will continue to do so in 2020.

“A pair of Democrats from the House and Senate want a government watchdog to make sure Tennessee does not abuse funding if the Trump administration approves the state’s request to block-grant Medicaid.

In a letter sent Tuesday, Sen. Ron Wyden (D-Ore.) and Rep. Frank Pallone Jr. (D-N.J.) urged the Department of Health and Human Services’ Office of Inspector General to ‘exercise vigorous oversight’ if Tennessee’s waiver request is granted. [ANCOR note: Sen. Wyden is Ranking Member of the Senate Finance Committee, Rep. Pallone is Chair of the House Energy and Commerce Committee.]

Tennessee’s waiver request would cap the amount of federal funding the state receives to provide care for Medicaid beneficiaries. If approved, it could be the first block grant–type program in the nation.

Under Tennessee’s proposal, the state would receive a nearly $7.9 billion block grant from the federal government. The state would be responsible for any costs above that amount, but if it spends less, the state would keep half of all the unspent money.

Wyden and Pallone said the system would create a financial incentive for Tennessee to cut coverage benefits for consumers. 


Imposing block grants in Medicaid has long been a major conservative goal and has been encouraged by the Trump administration

Administration officials had drafted a guidance that would make it easier for states to apply for a capped payment or block grants, but the document was quietly removed from the White House’s Office of Management and Budget

No states have been granted permission to date, but if Tennessee’s plan is approved, it would likely embolden other Republican-led states.”