Tennessee’s ‘Aggregate Cap’ Medicaid Waiver Gets CMS OK

Continuing its spree of approving ambitious waivers before the end of the Trump administration, CMS on Jan. 8 gave Tennessee its blessing to become the first state in the nation to cap its Medicaid funding in exchange for a range of operating flexibilities. Industry insiders tell AIS Health that while the future of Tennessee’s demonstration is uncertain, its approval could still be a point of concern for Medicaid managed care organizations.

“Similar to medical loss ratio (MLR) requirements in the Medicaid managed care final rule, the waiver would give Tennessee more oversight over their Medicaid plans, from flexibility in managed care contracting to rate setting,” explains Abner Mason, founder and CEO of ConsejoSano, a health tech startup specializing in linguistically and culturally aligned Medicaid and Medicare health plan member outreach.

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