TennCare Block Grant: Trump Administration Has Its Own Ideas, And They’re Different From Tennessee’s

The Trump administration’s long-awaited guidance on Medicaid block grants looks a lot different from what Tennessee has asked for. The Centers for Medicare and Medicaid Services has sent a letter to state directors outlining how to approach future requests.

Tennessee was the first and only state to apply for a block grant to fund Medicaid, known as TennCare here. TennCare officials saw an opportunity to ask for much more flexibility to treat its existing patients and money to potentially cover more people.

But the Trump administration is thinking a bit more narrowly, using these block grants to cover only able-bodied adults. They don’t make up a big part of the program in Tennessee, which never expanded Medicaid to cover the working poor.

GOP leadership in the legislature, which asked TennCare to pursue the block grant, say they always expected “a negotiation process.”

“The governor and the legislature have consistently said that if the deal on the table is not the best for the state then Tennessee would walk away. That remains the case,” a spokesman for Senate Speaker Randy McNally said in a written statement.

Democrats have been against block grants from the start, and Sen. Jeff Yarbro, D-Nashville, says it appears to have been a waste of time.

“If we’re going to be serious about health care, it looks like we’re going to have to go back to the drawing board, start over, and figure out what we’re going to do that’s actually going to make health care better in Tennessee,” he said.

Democrats have suggested starting with Medicaid expansion, which is being pursued by other GOP-led states. However, it’s remained a nonstarter with most Tennessee Republicans.

TennCare officials say, however, they don’t need to start over and still expect to work with the administration on the existing request, which they say will reward the state for improving the health of residents.

“Specifically, it is encouraging that CMS recognizes that states should have the opportunity to earn shared savings through quality-based performance that can then be reinvested in their Medicaid programs and the health (not just health care) of their Medicaid members,” TennCare spokesperson Sarah Tanksley said in a written statement. “We look forward to future discussions with CMS.”

So far, CMS has not commented on the substance of Tennessee’s request, but on Thursday, administrator Seema Verma was asked about the proposal and said it was broader than what is outlined in the guidance.