Tenn. ‘Block Grant,’ Other Waiver Approvals May Be Moot

As part of its late-term rulemaking and waiver-approving blitz, the Trump administration on Jan. 8 cleared the way for Tennessee to become the first state to accept a fixed amount of federal funds in exchange for a range of flexibilities in its Medicaid program. Although CMS’s approval of Tennessee’s demo is likely to be revisited by President Joe Biden, who was sworn in as the 46th U.S. president on Jan. 20, experts suggest if implemented it would have a downstream effect on the managed care organizations that serve 1.5 million TennCare beneficiaries.

The Tennessee demo was approved for 10 years, similar to other recently approved section 1115 waiver requests made by nonexpansion states such as Florida and Texas. Through an “aggregate cap” approach, Tennessee will receive federal Medicaid funds based on a fixed budget target that is determined by CMS and the state using “well-established, historical enrollment and Medicaid cost data,” according to a Jan. 8 press release. If it spends less than its target cap while meeting quality goals, Tennessee can earn up to 55% of annual savings to reinvest back into other state health programs, such as those that address the social determinants of health or behavioral health, explained CMS in its approval letter.

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Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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