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Capitol Correspondence - 05.04.19

Tennessee Requests Being First State to Implement Medicaid Block Grants

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ANCOR is sharing this article by Politico because most supports that assist people with intellectual / developmental disabilities (I/DD) are funded by Medicaid. While ANCOR understands that Medicaid can be improved, we opposed 2017 legislative proposals with Medicaid block grants or per capita caps because they could end people with disabilities’ guaranteed access to Medicaid.

As written by Politico:

“Tennessee is charging ahead to become the first state in the nation to ask the Trump administration for Medicaid funding in a lump sum — a radical overhaul of the entitlement program that critics warn could force major cutbacks in health coverage for low-income people.

State Republican lawmakers on Thursday, emboldened by the Trump administration’s promise to provide states with more flexibility to run their Medicaid programs, approved legislation requiring Tennessee to submit a Medicaid block grant plan to the federal government within six months. The legislation now goes to Republican Gov. Bill Lee, who will sign the bill, a spokesperson said.

However, it’s not clear whether the Trump administration could approve the plan upending how the program is financed. The administration for months has been studying whether it legally can allow states this leeway, and Democratic lawmakers have vowed to fight block grants if the administration approves them.

Medicaid for decades has been an open-ended entitlement, without strict limits on how much the federal government pays to states as costs rise. Republicans have long championed Medicaid block grants, arguing that states could better manage their programs if the federal government gave them predetermined funding and significantly greater freedom to set eligibility and benefit rules.


But critics warn that states would receive significantly less federal funding under block grants, leaving states with little option but to slash Medicaid enrollments and benefits.


Tennessee’s plan will be fiercely contested by the health care industry and low-income advocacy groups as the state negotiates with the Trump administration. If the administration approves the plan — the review process will likely take months — litigation seems inevitable.


While other states, including Alaska and Utah, have contemplated Medicaid spending caps since President Donald Trump took office, those plans would have primarily affected adults who gained coverage through the Obamacare expansion. Tennessee’s approach is notable because it would affect people traditionally covered by the program: children, pregnant women, impoverished seniors in nursing homes and people with disabilities. Republicans in Washington, who have criticized the Obamacare expansion, have said it’s crucial to protect Medicaid for these populations.


The block grant legislation, which calls for the state to receive “maximum flexibility” from federal mandates and regulations, says federal funding should rise with population growth, inflation and other factors. However, it doesn’t say funds increase if program enrollment grows — as it typically does during a recession.”