Sep 18, 2019

Tennessee block grant plan faces uphill battle

Illustration: Sarah Grillo/Axios

Tennessee's proposal to convert its state Medicaid financing into a block grant could become a landmark restructuring of the program.

The big picture: We don't yet know whether the Trump administration will approve the proposal, whether it'll hold up in court or what outcome it'd have on enrollees — but advocates are warning it‘s probably going to lead to benefit cuts.

Driving the news: Tennessee released its proposal yesterday, becoming the first state in the nation to put forward a block grant waiver plan.

  • Medicaid block grants have long been a conservative goal, but Republicans haven't been able to pass them into federal law. They most recently tried and failed during the 2017 effort to repeal the Affordable Care Act.
  • The Tennessee plan would create a cap on federal funding for medical services, although it would increase with price inflation and if enrollment grows. It'd also give the state additional flexibilities over the program's benefits.

What they're saying: "They want to have carte blanche to cut benefits going forward, without having to ask the federal government or letting anybody know they’re doing it," said Joan Alker, the executive director of Georgetown's Center for Children and Families.

  • The state, however, writes that the proposal includes "no reductions in who is eligible for or what benefits are currently provided."

Medicaid funding is typically open-ended and split between the federal government and the state. The proposal asks for Tennessee to instead receive a fixed amount of federal dollars.

  • If Tennessee spends less than it's projected to under the traditional system, the savings would be split 50-50 between the state and the federal government.
  • Some costs — like prescription drugs and administrative spending — would be excluded from the block grant and funded using the traditional method.

Yes, but: This shift in the relationship between state and federal Medicaid funding may be illegal, Nicholas Bagley, a law professor at the University of Michigan, writes in The Incidental Economist.

  • "You can’t use Medicaid waivers to change Medicaid’s financing structure. And that’s exactly what Tennessee is proposing to do," Bagley writes.
  • Not everyone agrees. "The legal aspect isn’t the problem because...they're not doing anything that’s so much different from what's already been done in other states," said Matt Salo, executive director of the National Association of Medicaid Directors.

What we're watching: The proposal is open for public comment until mid-October, and the state must submit the plan to the Centers for Medicare and Medicaid Services by late November, per WashPost.

  • “CMS supports efforts to improve accountability for cost and outcomes in Medicaid, and we look forward to working with Tennessee once they submit their proposal to help them achieve these goals as effectively as possible within our statutory authority," said CMS spokesperson Johnathan Monroe.

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Federal Election Commission commissioner Ellen Weintraub posted an extensive fact-checking thread to Twitter late Wednesday refuting claims by President Trump and some Republicans that mail-in voting can lead to fraud.

Why it matters: Weintraub weighed in after Trump threatened to take action against Twitter for fact-checking him on his earlier unsubstantiated posts claiming mail-in ballots in November's election would be fraudulent, and she directly addressed Twitter's fact-checkin of the president in her post.

Minneapolis unrest as hundreds protest death of George Floyd

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Minneapolis police clashed for a second night with protesters demonstrating the death of George Floyd, an African American man who died in police custody.

The latest: Minnesota Gov. Tim Walz tweeted late Wednesday that the situation where the clashes were taking place was "extremely dangerous" as he urged people to leave the area. There were multiple news reports of police firing tear gas at protesters and of some people looting a Target store.

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 1:30 a.m. ET: 5,695,155 — Total deaths: 355,688 — Total recoveries — 2,351,177Map.
  2. U.S.: Total confirmed cases as of 1:30 a.m. ET: 1,699,933 — Total deaths: 100,442 — Total recoveries: 391,508 — Total tested: 15,192,481Map.
  3. Public health: CDC issues guidelines for reopening officesFauci says data is "really quite evident" against hydroxychloroquine.
  4. States: California hospitals strained by patients in MexicoTexas Supreme Court blocks mail-in expansion to state voters.
  5. Business: MGM plans to reopen major Las Vegas resorts in June — African American business owners have seen less relief from PPP, Goldman Sachs says.
  6. Tech: AI will help in the pandemic — but it might not be in time for this one.
  7. World: EU proposes a massive pandemic rescue package.
  8. 1 🎶 thing: Local music venues get rocked by coronavirus.
  9. 🎧 Podcast: Trump vs. Twitter ... vs. Trump.
  10. What should I do? When you can be around others after contracting the coronavirus — Traveling, asthma, dishes, disinfectants and being contagiousMasks, lending books and self-isolatingExercise, laundry, what counts as soap — Pets, moving and personal healthAnswers about the virus from Axios expertsWhat to know about social distancingHow to minimize your risk.
  11. Other resources: CDC on how to avoid the virus, what to do if you get it, the right mask to wear.

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Updated 1 hour ago - Politics & Policy