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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Leslie Small

Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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