Waiver of Medicaid Block Grant Endangers Equity and Access for Vulnerable People

  • Karen Camper is a member of the Tennessee House of Representatives and is also the National President of the National Organization of Elected Black Legislative Women (NOBEL Women).

At a time of growing awareness of the pervasive inequalities plaguing our country, federal regulators are threatening a program designed to provide health care to Tennessee’s most vulnerable communities. Unlike the Biden administration’s efforts to promote health equity and reduce racial disparities, the US Department of Health and Human Services could go ahead with a proposal that in fact reduces access for patients at TennCare, Tennessee’s Medicaid program. It is critical that the Centers for Medicare and Medicaid Services reverse the waiver and instead focus on strengthening a program that improves equity for Tennesseans who have no other health care options.

Known as TennCare III, the controversial Medicaid block grant waiver was approved just days before the Trump administration ended in January. The waiver rewrites the history of TennCare’s funding, limits access to prescription drugs, and gives the state unprecedented authority over how federal dollars are spent.

TennCare received approximately 1,800 comments from the public on its Medicaid block grant proposal, including this postcard.  Almost all of the comments were against the plan.

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Normally, the federal government will match funds with the state to cover health care costs for Medicaid recipients, but as part of the block grant, the state will receive an amount capped each year by the federal government under the form a lump sum, potentially limiting essential funds to the state for low-income patients. Not only that, but the state will also be allowed to make critical decisions about whether to spend Medicaid funds outside of health care.

Karen Camper will be the first African-American leader of the parliamentary minority in Tennessee.

A key part of the waiver that will affect all adults participating in the program is the adoption of a closed, commercial-style drug formulary that is disproportionately detrimental to members of black and brown communities who rely on Medicaid as their only means of access. medication and stay healthy. Under the waiver, TennCare could limit the options for these patients to one drug per class – something you would rarely see, even in closed commercial forms.

This creates an additional barrier for vulnerable people – including members of minority and underserved communities – in the state who already struggle to manage chronic disease. Research from 2019 shows that nearly 50% of the million Tennesséens covered by Medicaid were from African American or Latin American communities who historically struggle to access care for life-threatening conditions such as diabetes, hepatitis, l hypertension and HIV. This is unfair care.

Failure to reverse the waiver undermines President Joe Biden’s health equity agenda, and marginalized Tennesseans will be the first to feel its negative impact. Setting a precedent with a program that would not need to be renegotiated for 10 years is reckless and irresponsible. This waiver also leaves so many unanswered questions, particularly how many Tennesséens would suffer during this time, what health disparities would be exacerbated, and how many states would immediately follow.

The people of Tennessee have sounded the alarm bells locally and nationally about the harmful effects of this waiver. If CMS does not act to reverse the waiver, this will be a missed opportunity to address health equity in a concrete way for years to come. CMS should step up and reassure Tennesseans that they will continue to have access to the quality and affordable health care they need and deserve.

Karen Camper is a member of the Tennessee House of Representatives and is also the National President of the National Organization of Elected Black Legislative Women (NOBEL Women).

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