For decades, Republicans have been plotting to make Medicaid, the federal-state joint program that provides medical coverage for tens of millions of low-income adults and children—72,227,695 individuals as of June 2019—into a block grant program. Medicaid is designed to respond to need in the states, and spending expands and contracts in response to the number of people who require coverage. Turning it into a block grant would mean states get a lump sum every year, and that’s it—once the money is used up, that’s it until the next year. That would mean no new enrollees, and potentially no further care for the people already signed up.
Tennessee, which as of June had 1,455,253 people on Medicaid, including 52,836 children receiving coverage through CHIP, wants to be the first state to take the Trump administration up on its willingness to push the legal boundaries and block grant the program. The state’s draft proposal would affect more than 1 million of those people.
Michele Johnson, executive director of the Tennessee Justice Center, says the proposed changes would be “devastating for our health infrastructure, for the Tennessee economy, and for our communities.” Half of the children of Tennessee depend on TennCare, the state’s Medicaid program. Johnson says no matter how the state and White House are trying to spin the idea of “flexibility,” for the state “The downside is, we are going to have less money in a state that is incredibly poor. Both Gov. Lee and President Trump are treating Medicaid as a piggy bank, and half the kids in our state are relying on this piggy bank.”
The proposed waiver for Medicaid rules still has not actually been cleared by the administration, partly because it’s not a particularly legal thing they can do under the current Medicaid statute. The structure of payments from the federal government to the states is one part of the law that can’t be waived. If the administration tries to allow these waivers and if Tennessee gets approval, it’s going to court. “If the block grant is approved in a way that violates the law,” Johnson said, “there is no question there would be a lawsuit.”