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Joe Biden is now rescinding that guidance, meaning that previously approved demonstration projects or waivers could be withdrawn at any time.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.