Feds rescind effort to lock in Medicaid changes made by Trump administration

Gov. Bill Lee speaks to reporters following his address to a joint convention of the General Assembly on Jan. 19, 2021. (Erik Schelzig, Tennessee Journal)

A little over two weeks before President Donald Trump left office, the Republican administration sent out a letter to states like Tennessee to declare it was locking in any approved changes to Medicaid programs for a period of at least nine months. Democratic President Joe Biden is now rescinding that guidance, meaning that previously approved demonstration projects or waivers could be withdrawn at any time.

The most immediate effect of the move could be a cancellation of work requirements for Medicaid recipients that had been approved in several states. But Tennessee’s first-in-the-nation block grant could also be on the chopping block.

“We’re the first state in America that just got a federal waiver for Medicaid that allows us to share savings with the federal government,” Gov. Bill Lee told the Nashville Area Chamber of Commerce on Tuesday. “There’s a lot of partisan squabbling about that, but that was a business deal that was negotiated over a year-and-a-half that will allow Tennessee to have more money to spend on its Medicaid population than it would have underer a traditional Medicaid agreement.”

Read the full letter from the Centers for Medicare and Medicaid Services to TennCare Director Stephen Smith below.

Dear Mr. Smith:

On January 4, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a letter to individual State Medicaid Directors that concerned procedural issues for states that operate a section 1115 demonstration. Specifically, an attachment to the January 4, 2021 letter proposed to delineate certain additional procedures for a preliminary hearing process, yet to be developed by CMS, that would be implemented in the event that CMS determines that it will either suspend or terminate a demonstration, in whole or in part, for material non-compliance with the terms of the demonstration project or based on a finding that the demonstration project is not likely to achieve the statutory purposes (see 42 C.F.R. § 431.420(d)(1)–(2)).

Consistent with federal regulations, the approved special terms and conditions (STCs) governing each demonstration project under section 1115 of the Social Security Act (Act) already generally specify procedures that CMS would use, in the event it suspends or terminates a demonstration project, in whole or in part, for material non-compliance or based on a finding that the demonstration project is not likely to achieve statutory purposes. As the attachment to the January 4, 2021 letter noted, the terms and conditions of the demonstrations at issue typically provide that “CMS will promptly notify the State in writing of the determination and the reasons for the amendment and withdrawal, together with the effective date, and afford the State an opportunity to request a hearing to challenge CMS’ determination prior to the effective date.” See 42 C.F.R. § 431.420(d)(3) (providing that “[t]he terms and conditions for [a] demonstration will detail any notice and appeal rights for the State for a termination, suspension, or withdrawal of waivers or expenditure authorities”).

By proposing to delineate additional procedures for the withdrawal or suspension of a demonstration approval—particularly by purporting to require that the effective date of such a withdrawal or suspension be at least nine months after CMS transmits its withdrawal determination to a State—the January 4, 2021 letter did not address CMS’s need for flexibility to make and effectuate determinations under 42 C.F.R. 431.420(d)(1)-(2). The current COVID-19 pandemic and economic environment, along with an ongoing need for general CMS oversight of section 1115 demonstrations, necessitate that CMS maintain the regulatory flexibility to respond appropriately to current or changed circumstances by adjusting, suspending, or terminating an existing demonstration and associated authorities in whole or in part.

CMS needs to remain able to exercise its authority under the Act and implementing regulations to maintain continued oversight of demonstrations in order to ensure that they remain likely to achieve the statutory purposes. (see 42 U.S.C. 1315(d)(2)(E); 42 C.F.R. 431.420(d)(2)) Therefore, CMS is rescinding the January 4, 2021 letters, along with the specific provisions in the attachments to those letters, including those signed by states, and will not accept signed attachments from states based on those letters. Instead, CMS will adhere to the regulations and STCs, which generally provide that States will receive notice and an opportunity to request a hearing before a determination to suspend, modify, or withdraw a demonstration project becomes effective.

CMS remains committed to the state and federal partnership centered on meeting the diverse healthcare needs of the millions of beneficiaries served by Medicaid. States should continue to look to the approved STCs that govern their section 1115 demonstrations and reach out to their section 1115 demonstration project officer with any questions.

Sincerely,

Elizabeth Richter

Acting Administrator

49 Responses to Feds rescind effort to lock in Medicaid changes made by Trump administration

  • Avatar
    steve cates says:

    All Lee and his republican cronies in the TN house and senate need to do is accept the federal medicaid expansion, which has been available to TN for ten years!! TN remains only one of 12 states still refusing to accept this money, which, in TN’s case, could provide insurance for about 300,000 of our fellow Tennesseans. It could also help stop the closing of hospitals. Because of the closings already, we have fellow Tennesseans who are as much as an hour from an emergency room. The total hypocrisy of these republicans, who have good insurance, refusing to accept this for Tennesseans is alarming, disgusting, and near-unbelievable.

    • Avatar
      Cryan says:

      Stuart’s Daddy, Minute Man Casada, doesn’t want medicaid expansion. Hot chicken and promiscuous staff on the other hand…

    • Avatar
      Taxpayer #314 says:

      Steve Cates pinpoints the problem and solution in one short paragraph. Our verbal conservative machine that spews nonsense, Stuart will no doubt spew more lies and accusations in the comments below but you already have the precise explaination. Now scroll down and read Stuarts’ nonsense.

    • Avatar
      Michael Lottman says:

      Mr. Cates is absolutely right. The combination of turning down essentially free Medicaid expansion money, stuffing millions of dollars in various trust funds and reserves, hiding hundreds of millions intended for aid to children and families, and putting Medicaid/TNCare funding at risk for everyone will have a disastrous effect that the next governor, who can’t come soon enough, will have to struggle with. He/she will have to face the coronavirus’ continuing effects, possibly other pandemics, and worsening symptoms of climate change, plus continuing needs in public education, infrastructure, and other human services without access to additional sources of revenue. And thanks to our heroic “leaders,” voters are now conditioned to opposing additional levies whatever the need may be.

      • Avatar
        Stuart I. Anderson says:

        I don’t know about anyone else but you’ve certainly scared the hell out of me Michael. Why anyone ventures out of bed in the morning I can’t imagine. No problem Michael, in six short years we hopefully will elect a Republican Governor even more conservative than Lee.

  • Avatar
    David Collins says:

    If Lee and his caucus were really interested in Medicaid expansion, they could have already done so years ago. My suspicious mind tells me they have come up with some way to scam the system (ala Rick Scott) which means one of their cronies will get rich and the poor will get nothing in terms of expansion of health care.

  • Avatar
    Stuart I. Anderson says:

    Those on the dole are a very important part of the Democratic Party’s constituency, so the Democrats want to keep them that way. If we impose work requirements then some of the dole recipients might get the idea that they are capable of working for a living and they might even get to prefer that to being on the dole and poof there goes a valued member of the Democratic constituency. Can’t have that by golly!

    Another thing we can’t have is subsidiarity so that power is returned to the lowest strata of government closest to the people. The whole idea of leftist government is command and control through government power to satisfy the leftist control freaks that form another important part of the Democratic Party constituency. That’s what the American voters chose last November. Enjoy!

    • Avatar
      Cryan says:

      You’re a damn fool. How much money does the average medicare recipient receive versus the millions in farm subsidies dipshit Stephen Fincher gets for NOT planting cotton?

    • Avatar
      Taxpayer #314 says:

      Stuart with HIS conservative diversions, always an explaination that accuses the Dems for any and all trouble. He wishes we could all have a government like Texas and be as organized and living in total bliss like his hero, Ted Cruiser.

      • Avatar
        Cryan says:

        Donald Trump hinted Ted Cruz might be a closeted gay. I wonder if that would explain Stuart’s fascination with Cruz, Casada, and Cothern.

    • Avatar
      JuJu says:

      Stuart I,
      I’ve taught those ‘on the dole’ as you put it, which is terribly crass of you. I’m sure you’ve never known from whence these citizens came, their condition at birth, how they live or how they’ve been treated. In retirement, I continue to volunteer with foundations who serve these clients. I’m pretty sure you’d complain about your service if most of these ‘on the ‘dolers’’ had a work requirement.
      You seem a little unhappy that the US has returned to, well…at least we on the road to recovery. Toodles!

      • Avatar
        Stuart I. Anderson says:

        Nothing crass about being “on the dole” JuJu it’s simply a sad fact of life. Another fact of life is that people with all kinds of limitations that would prevent them from adequately raising a child still can, and do, have children. We must as a society take life as we find it and make the best of whatever situation with which we are confronted. People who are able to work should work, it’s no more complicated than that. Children in school should be socialized for work at the youngest ages. Those who don’t work should have a lower standard of living than those who do work. This is America, everyone should be expected to rise above whatever undesirable circumstance that they came from in order to be a self-supporting law abiding citizen. That’s not a particularly tough standard to meet and we should tone down the excuses for not meeting that standard. These are a few basic rules we should follow so that we keep the underclass as small as possible.

        We haven’t returned to anything JuJu. This country is in decline, politically, socially, and spiritually. When the left is in power that decline accelerates. When the Republicans are in power they tap the brakes a bit to slow the decline down. Indeed, western civilization isn’t doing too well either as every European is in even sharper decline than this country. It’s OK JuJu, I’m a childless only child so if what’s going on in this country is OK with those who brag about their kid and grandkids all I need is a little more brake tapping and it certainly will be OK with me too.

  • Avatar
    Cannoneer2 says:

    Stuart might complain about Bill Lee’s lack of Republican credentials, but he sure has one portion of it down, the ability to line crony pockets with cash!

    • Avatar
      Stuart I. Anderson says:

      Has our own Inspector Clouseau of the French Surete made you a junior or assistant Inspector Cannoneer? If so congratulations. Do you suspect Lee is engaging in some illegality “lin[ing] crony pockets with cash? If so, as a conservative I hope the two of you get ’em and they are given significant penalties. Or is this simply the case of funneling government money to favored constituents like the liberals do with various members of the renewable energy industry for one expensive boondoggle after another or to teachers for not teaching etc. etc.

      • Avatar
        MARLE says:

        Cronyism is not illegal. Why are you acting as though a charge of cronyism is a charge of illegality? The problem with it is in the fact that pocket lining through initiatives, regulations, waivers, legislation etc is Unfortunately an integral part of our evolving capitalism.

        • Avatar
          Stuart I. Anderson says:

          You are correct MARLE but David Collins set the tone of what was to follow by conjuring up something or other where Lee and his cronies “. . .have come up with some way to scam the system” which may very well be illegal. As a law and order conservative I simply wished Inspector Clouseau, who I am sure we will soon be hearing from considering it’s Republicans we are talking about, and his Assistant the best of luck in apprehending any law breakers.

        • Avatar
          Cannoneer2 says:

          He can line crony pockets with his own money, not my tax dollars.

      • Avatar
        Cannoneer2 says:

        It’s fine to use friends with needed skills or businesses. However, Tennesseans are paying top dollar and then some for people with marginal capabilities that Lee brought in and out of state companies with less than outstanding credentials for the job that Tennessee hired them to do. After last year, we supposedly are short on funds, aren’t we? Are we getting our money’s worth? Lee’s form of crony capitalism might not be illegal, but that doesn’t mean it is the right thing to do.

    • Avatar
      Stuart I. Anderson says:

      Oh and BTW whatever Lee is doing, if you the Inspector don’t put a stop to it he will be doing it for another six years!

      • Avatar
        Cryan says:

        Andy Ogles will make Bill Lee a one-termer. You are so bad at politics, boomer.

        • Avatar
          Donna Locke says:

          Andy Ogles is a joke and an impostor. Chaz Molder might have a chance, though. I’d vote for Chaz even though he is a Democrat. He would be better than what we’ve got.

  • Avatar
    Beatrice Shaw says:

    This Governor sure seems to fail at every large initiative he tries. It benefits me though, so I am ok with it. It’s almost like he is an undercover Democrat. That would make a great movie!!!

    • Avatar
      Cryan says:

      Bill Lee is not a closeted Democrat. Maybe closeted but not a Democrat. His problem, much to the bemusement of establishment, anti-Trump Republicans like Stuart I. Anderson, is his incompetency.

  • Avatar
    Paul says:

    A few things you can bet on:

    – If Bill Lee is involved in a “major initiative”, it will be a debacle.
    – If Bill Lee’s “major initiative” is said to be efficient, increase choice, promote freedom, whatever, it will be a debacle. It will likely increase costs and decrease services provided at more cost to the taxpayer.
    – If Bill Lee says he is “helping Tennesseans” in some regard, it will be a debacle. He will be helping his cronies and contributors.

    Finally, if Bill Lee is involved in a “major initiative”, he and his legislative pals and enablers will claim victory despite all evidence to the contrary.

  • Avatar
    Stuart I. Anderson says:

    Bill Lee has all the money in the world and the personal story and photogenic appearance that served him so well in 2018 capped off by the fact that Tennesseans are very slow to throw incumbents out of office absent some compelling reason. Why so many of you are even thinking in terms of Lee being a one termer is a mystery to me.
    ________________________
    Now if you want to do something productive how about finding an arch conservative to run for the U.S. Senate in Georgia now that David Perdue (Hertage-74%) has decided not to run for his old seat. The word is that Trump wouldn’t support him so Perdue decided to bow out. No loss, 74% from Georgia is nowhere good enough. Now Doug Collins (Heritage-81%) would represent an improvement but can’t we do better still? Stay tuned.

    • Avatar
      Taxpayer #314 says:

      Some people are not impressed in the least by politicians that have, “all the money in the world” and the rest of the attributes you attach to Lee are just fantasy. Some people want leadership and good will and hard work from their leaders and OH yeah, Truth and moral conviction. None of that has shown itself in the GOP or your conservative corner of the world. That might be why so many people plan on and hope for a “one term” politician. Here is an idea, why not let the folks in GA decide who they want to vote for? They may have a surprise for you with all the GOP voters abandoning the party these days.

      • Avatar
        Stuart I. Anderson says:

        As you do so often Taxpayer you miss the point which is to move the GOP from being the political arm of the U.S. Chamber of Commerce to being a real political party with a serious conservative ideology, just like the Democratic Party has a serious liberal/left ideology . I understand Taxpayer that as a leftist you much rather the Republican Party simply be a Democratic piñata that represents as little difference from the Democratic leftists as possible but please try to understand that hasn’t been acceptable to those of us on the right for decades and it will never be.

        So once again I repeat, the game plan for those of us on the right is for the Republican Party to nominate the most conservative candidate possible for each and every office up for election. Give the people a choice, not an echo, as the old campaign slogan admonished us. Then, of course, let the people choose. If the American people are no longer up for the prosperity and freedom that comes with a capitalistic, market based economy with limited government and prefer a command and control democratic socialist country instead so be it, but they should have a choice regarding such a grave matter.

        • Avatar
          Taxpayer #314 says:

          Is Texas part of your current shining example of “prosperity and freedom that comes with a capitalistic, market based economy with limited government.” Stuart, you talk a good line and even think you have made your point so well when in reality, those with any intelligence see through your rambling attempts to pass off this conservative hocus pocus crap as somehow being good, just like the Texans do. Those piles of BS ARE Bigger in Texas.

      • Avatar
        Jane says:

        Who do we have to run against Lee in 2022? He has to go. We need a moderate Republican preferably a woman, to run against him as an Independent.

        • Avatar
          Stuart I. Anderson says:

          I wouldn’t think you have anyone Jane, and certainly no one who wants to waste her time on a Kamikaze mission running as an Independent. In case you do find someone who wants to make her final toast with a little shot of sake after writing her last political will and donning the ceremonial scarf before flying off, please be sure the markings on her plane identify her as a “moderate” so no poor unsuspecting voter who wants good solid conservative government boards the plane with her.

    • Avatar
      MARLE says:

      Re: Perdue…..TRump didn’t support him This time nor his blonde twin.

      • Avatar
        Stuart I. Anderson says:

        Kelly Loeffler (Heritage-82%) seems particularly uninspiring, though she did beat Collins in the primary last November. Collins is more the glib politician who I find preferable from a marketing standpoint. Happily, either one is an improvement over the tepid conservative Perdue.

        • Avatar
          MARLE says:

          In Nov Perdue beat Ossoff by 2 points. Another conservative also on the Nov ballot got 2 points. Perdue should have beaten Ossoff by 4 in the Jan runoff. But thanks to Trump and his 3 month long antics against the GA republican establishment …..Perdue lost. Hard to imagine. And all thanks to Trump and his non-stop agitation. FACTS which are the opposite of derrangement.

          • Avatar
            Stuart I. Anderson says:

            I only hope that in the end Trump decides not to run in 2024. Trump is a destructive force in the Republican Party, I believed that 2016, I believe it now. If he decides to run in 2024 as things now stand, however, I don’t think he will seriously be challenged by anyone other than a centrist Republican in which case I will have to vote for Trump.

          • Avatar
            Cryan says:

            See LeeAnne. Stuart is a slimy establishment Never Trump RINO. I wouldn’t be surprised to find out he financially backed the Lincoln Project.

          • Avatar
            Taxpayer #314 says:

            Trump is a destructive force, period, not just in the republican party.

  • Avatar
    Susan G says:

    Democrats in the Swamp have no respect for or concern for taxpayers! Spend, spend, spend like there is no tomorrow!

    • Avatar
      Perry Aubric says:

      Oh, please. After four years of totally ignoring the deficit and running the government into debt, and now you rediscover fiscal responsibility and pretend that only democrats believe in government spending? What a damn hypocrite you are, Susan.

      • Avatar
        Cryan says:

        Same old song and dance. Reagan, Bush, Trump, Haslam, Lee etc. spend us all to death AND cut taxes. Everybody loves to spend but only one party is fiscally responsible enough to keep tax revenue coming in and balance budgets. It ain’t the cop killing GOP Q-ANON lovers.

      • Avatar
        mike swafford says:

        Susan, Perry is right you are dam fool. And there’s no way you are Tennessee Born

      • Avatar
        James White says:

        The debt goes UP every year, republican or democrat. Period.

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  • Avatar
    Taxpayer #314 says:

    With Texas as a shining example of stupid decisions being made in the past by conservative republicans coming back to haunt the public, when they realize that these conservatives just flat out lied to them and did not at all do what they said they would do. The republican party is a master at one particular task….raising money! Especially the kind that does not have to be reported and/or can’t be tracked. Trump has never answered yet about the millions that evaporated in thin air during his inaugural celebration. They always love to cut the taxes for the upper class but they never can explain where all that tax money actually went.

  • Avatar
    Kosh III says:

    TennCare Medicaid is open only to children, pregnant women and a few thousand caretakers of minors.
    So Lee wants child labor to be reinstated?

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