WASHINGTON, D.C. – The approval of Tennessee’s Medicaid 1115 Research and Demonstration waiver by the Centers for Medicare and Medicaid Services (CMS) today is the latest in a wave of approvals in the last few months of waivers that all weaken the state programs. The approval of Tennessee’s 1115 waiver will allow for a capped funding arrangement, also known as a “block grant,” in the TennCare program, which is designed to limit the amount of federal funding provided to the state, essentially leading to funding cuts to the program. Additionally, the waiver approval authorizes the state to establish a closed prescription drug formulary which limits the prescription drugs available to treat complex conditions like cancer. The authorities granted through this waiver will likely result in a reduction in enrollment, limiting of benefits and services and other changes that will decrease access to care for some of Tennessee’s most vulnerable residents.
In October 2020, CMS approved 1115 Research and Demonstration waivers for Georgia, Nebraska and Indiana, all of which included burdensome administrative reporting requirements that condition eligibility or enrollment on employment or community engagement activities.
The following is a statement from Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN).
“The 1115 waivers approved by CMS in the last few months of this administration do not promote the objectives of the Medicaid program. Instead, amid a pandemic creating greater need for this program, these waivers erect additional barriers to health insurance coverage and lifesaving therapies critical to individuals and their families with lower incomes, including those with cancer, cancer survivors and those who will be diagnosed with the disease.
“These waivers add unnecessary bureaucratic red tape to the enrollment and eligibility process and reduce funding for the program that will result in coverage losses and poorer health outcomes. It’s a move that’s not only irresponsible and contrary to the Medicaid statute, it could also be deadly to those who lose their coverage or are now unable to gain coverage.
“The COVID-19 pandemic has illustrated the absolute importance of timely access to comprehensive health care. Our lawmakers at every level of government should be working to increase investment in the program and improve access to health insurance for as many individuals as possible, not enacting changes that will ultimately increase the number of uninsured Americans.
“Research shows individuals without health insurance are more likely than those with insurance to be diagnosed with cancer at a later stage, when it is more costly to treat, and individuals are less likely to survive. We’ve seen this play out in states that have fully increased access to Medicaid. According to American Cancer Society (ACS) research, uninsured rates in Medicaid expansion states fell from nearly 10 to about 3.5 percent between 2011-2014. This decline in the number of uninsured also resulted in a statistically significant shift toward early stage diagnosis in common cancers like, lung, breast and colon. ACS studies have found, for instance, low-income women were 25% more likely to adhere to screening guidelines in expansion states than in non-expansion states.
“At a time when unemployment rates are skyrocketing and amid a public health crisis, the fact that states are teaming up with the federal government to limit access to benefits, services and coverage through Medicaid is unconscionable. We call on CMS to halt these sub-par Medicaid waivers immediately and urge the incoming administration and Congress to restore and strengthen this lifesaving program, especially as we continue to battle a global pandemic. ACS CAN will continue to work with state lawmakers to do the right thing for their residents and make access to health insurance more accessible, not more restrictive.”