CMS Opens Comment Period on Tennessee Block Grant Proposal
On Dec. 2, the Centers for Medicaid & Medicare Services (CMS) opened a comment
period on Tennessee’s Medicaid block grant proposal. As covered in the Oct.
1 edition of the ADEA Advocate, the proposal would shift Medicaid funding in Tennessee
from an open-ended arrangement under which the federal government pays a percentage
of the state’s Medicaid costs based on per-capita income, to an arrangement
where the federal government provides a fixed amount of funding annually. The
state submitted a 60-page
proposal to CMS that calls for a modified version of a traditional
block grant that, if approved, would require the federal government to provide
additional funds during times of growth in Medicaid enrollment. In exchange for
accepting fixed funding, the state would have fewer restrictions in the way it
is required to spend Medicaid dollars, which the state claims would lead to cost
savings and innovation. According to the proposal, if Tennessee can save funds
under the block grant, the difference between the amount spent and the fixed block
grant would be split in half between the state and the federal government.
In its proposal, the state claims that the funding arrangement
will not lead to disenrollment or reductions in benefits. The state would also
continue to cover Early and Periodic Screening, Diagnostic and Treatment
requirements, which include dental benefits for enrollees under the age of 21.
Further, the state claims that savings could be used to add dental benefits for prenatal and postpartum women.
Despite these assurances,
critics
of the proposal are not convinced the state would avoid cuts to services.
As noted
in a recent analysis from Health Affairs, the state’s
requests for flexibility include an exemption from all minimum coverage requirements,
and the ability to impose a 12-month lockout period for undefined “member fraud.”
Others have also claimed the ability to keep any money saved under the block grant
creates an incentive for the state to keep enrollment low.
If the proposal is approved, Tennessee would be the first state to receive funding
under a block grant. CMS will accept comments until Dec. 27.