CMS approves TennCare block grant waiver

The federal comment period for TennCare’s waiver to overhaul the state’s safety-net insurance program has ended with mostly negative feedback, leaving its dissenters hopeful the Biden Administration will repeal the approval granted by the previous administration during its last days in office. 

More than 1,100 comments were submitted during the month-long public comment period that was brought on by a lawsuit challenging the legal procedures — more specifically, the lack of a public comment period hosted by the federal government — leading up to the waiver’s seemingly rushed approval in early January.

Of the comments submitted, there was overwhelming opposition from national industry organizations, local nonprofits, patient advocacy groups and handfuls of physicians. Most of the the comments from individuals appeared to be based on form language disseminated by interest groups, or from people with first-hand experience utilizing TennCare — nearly all reviewed by the Post were against it. 

In letters written from national industry organizations including the American Cancer Society, The Coalition of Human Needs, The Annie E. Casey Foundation and the National Alliance on Mental Illness, their leaders criticized TennCare’s new per-capita financing structure and questioned the legal validity of a closed drug formulary, which grants the state authority to deny coverage of prescription drugs approved by the FDA.

Locally, U.S. Rep. Jim Cooper (D-Nashville), the Community Youth Builders of West Tennessee and swaths of physicians all signed different letters that, in summary, said the new TennCare structure would only work to erode the social safety-net. 

In addition, the Tennessee State Conference of the National Association for the Advancement of Colored People, National Urban League and the Nashville Health Disparities Coalition all wrote letters expressing concern that the changes would only enhance health disparities. In a letter written by NHDC Co-Chair Cynthia Jackson, she contends the waiver will only worsen the health of TennCare beneficiaries and exacerbate racial disparities. 

“As the overall population in Tennessee continues to become more diverse, these health disparities will become more significant in terms of the amount of people affected, as well as the overall costs and negative effects for communities and families,” she wrote. “TennCare III authorizes Tennessee to spend federal Medicaid funds for purposes not authorized by Congress, incentivizing the state to cut TennCare to fund other parts of the state’s budget.”

In contrast, TennCare Director Stephen Smith submitted a letter attempting to debunk those claims, saying the waiver "advances the objective of Medicaid" without significantly departing from policy established by the Centers for Medicare and Medicaid Services.

Smith continues on to say the new TennCare form will lead to enhanced services and benefits to members through shared-savings initiatives that would include postpartum coverage, dental benefits for pregnant women and added coverage for adopted children. He also notes that discontinuing the waiver, which is already being implemented, would result in “immediate and significant disruptions in coverage” for TennCare beneficiaries. 

Gov. Bill Lee also wrote a letter in support of the waiver, and reiterated his belief that TennCare III could be a model of innovation for the entire nation. 

“TennCare III provides Tennessee and CMS with new opportunities to enhance Medicaid coverage and benefits, including the very real possibility of serving more people in need," Lee said in the letter. "It does so by recognizing the value in providing states with the tools and flexibilities to innovate; increasing federal funding for health and healthcare reinvestment through 'shared savings' when states manage their Medicaid programs responsibly and effectively; and, at the same time, protecting the services and benefits that TennCare members receive today." 

The Tennessee Justice Center, a plaintiff in the procedural lawsuit filed against the Department of Health and Human Services over the TennCare waiver, said the lawsuit has been paused and the federal government will decide whether to approve the already-in-process overhaul. 

“Since the public and health experts have been overwhelmingly opposed to the waiver as a threat to both patients and our health care system, we expect the comments will reflect that opposition, and we hope federal officials will revoke their approval,” a spokesperson told the Post.