Tennessee’s Medicaid Block Grant Waiver Challenged in Court | state


(The Center Square) – A group of Tennessee Medicaid recipients have filed a lawsuit in the United States district court, claiming that the decision of the United States Department of Health and Human Services to approve a waiver of the TennCare block grant violates federal rules.

The lawsuit came after Democrats in Tennessee asked President Joe Biden’s administration to reverse the decision.

The basis of the lawsuit – filed late last month by the National Health Law Program, the Tennessee Justice Center and King & Spalding LLP on behalf of 13 beneficiaries – is that the ruling allows the state to restrict drug coverage by prescription, it eliminates the three-month “retroactive coverage and it requires beneficiaries to join managed care plans.”

Tennessee has used managed care plans for Medicaid since 1994. More than two-thirds of Medicaid recipients nationwide receive care through managed care plans.

“The hardships experienced by the plaintiffs who brought this case show the damage caused by the state’s decision to radically restructure TennCare. Tennessee has a long history of mismanagement and bad Medicaid policy, ”said Tennessee Justice Center executive director Michele Johnson. “Tennessee is the last state that should have an experimental exemption that puts vulnerable populations at risk. We stand with our customers and all Tennesseans against the further restriction of vital health services and prescription drugs. “

A TennCare block grant was approved in the final weeks of former President Donald Trump’s administration, then cleared by the Tennessee Legislature before it was released. signed in law by Governor Bill Lee.

As part of the block grant, Tennessee would receive federal money for the state Medicaid program all at once instead of periodically. Tennessee is the first state to receive a Medicaid block grant.

“Our TennCare system is one of the best Medicaid programs in the country and this new flexibility under the block grant model allows us to improve the health of Tennesseans and our communities,” Lee tweeted after signing the legislation.

TennCare provides health care services to approximately 1.2 million low-income and disabled Tennesseans.

The complaint states that HHS ‘decision to grant an experimental Section 1115 waiver for TennCare violated federal Medicaid requirements.

“The Trump administration overstepped its authority when it approved TennCare III, allowing Tennessee to ignore Medicaid funding and coverage provisions that Congress does not allow states to ignore,” said Jane Perkins, Legal Director of the National Health Law Program. “In a rush to approve the project in its final days, this administration has also gone out of bounds by excluding the public and approving TennCare III without notifying the public and without having the opportunity to comment as required by federal law.

The complaint also claims that the Trump administration has put in place additional measures to delay overturning its decision.

The block grant would allow Tennessee to capture half of the savings, if it spends less than the federal allocation for the program, and in turn spend that money on future health care savings initiatives. Previously, these savings could only be saved to be used against future exceedances of the federal Medicaid funding cap.

The state can still use its $ 6 billion in savings over the federal cap it collected over the past five years.

The TennCare III funding cap will then reset in 2026 based on the amount the state spends, per capita, between 2021 and 24.

Prior to the block grant’s approval in January, the TennCare program’s agreement with the federal government was scheduled to expire on June 30.

The federal government covers about 65% of Medicaid costs for Tennessee beneficiaries, according to the Sycamore Institute of Tennessee.

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