Tennessee wants federal permission to exclude abortion providers from its Medicaid networks.
The state posted a waiver request Wednesday to exclude providers that performed, operated or maintained a facility that performed more than 50 abortions in the previous year from its Medicaid program, known as TennCare.
The state's Legislature earlier this year passed a bill requiring Tennessee's Medicaid agency to submit the waiver request. Comments are due July 13.
The request comes just weeks after HHS proposed new funding changes to the Title X program, which provides grants to programs in family planning, STD screening and breast and cervical cancer screenings.
The proposed rule would prohibit federal funds from going to facilities that perform abortions or refer clients to abortion facilities.
Clinicians in Tennessee are worried that the waiver will imperil access to care in rural parts of the state.
In northeast Tennessee, there is a clinic whose providers will no longer be able to accept Medicaid, leading to a loss of medical services in the region, according to Dr. William Block, chair of the OB-GYN department at East Tennessee State University.
"This is a significant loss for the women of the region as politics are controlling access to healthcare," Block said.
Texas submitted a similar 1115 request last year, and the CMS has yet to announce a decision on that request.
A CMS spokesman said the agency doesn't comment on waivers under review. However, policy insiders expect the agency to decline both of these requests.
They "go beyond what courts have found allowable by excluding qualified providers because they include abortion in the services they cover," said Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities. Title X is regulated under a different federal law than Medicaid.
Medicaid agencies can only exclude providers on the grounds of quality of care for medical services they pay for, according to Susan Berke Fogel, director of reproductive health at the National Health Law Program.
Federal law bans using any federal funds for abortion, with exceptions for pregnancies that endanger the life of the woman, or that result from rape or incest.
Providing abortion services in and of itself does not disqualify a provider from offering other care services covered by Medicaid, Fogel said.
But Texas Attorney General Ken Paxton disagrees. He said federal law gives states the authority to choose qualified providers for their programs. He urged the CMS last month to approve his state's request for its family planning program, known as Healthy Texas Women.
The Obama administration cut Medicaid funding from Healthy Texas Woman
The program was cut off from Medicaid funding in 2012 after the state Legislature enacted a law preventing taxpayer money from going to abortion providers. If the CMS approved Texas' request, the state would draw in an additional $30 million a year in federal dollars.
"Texas and the Healthy Texas Women program should not be penalized through the continued withholding of federal funds merely because Texas has exercised the authority that federal law has granted to it—namely, the authority to refuse to be a conduit for channeling taxpayer funds to abortion providers pursuant to state law," Paxton said in a statement.
However, some conservatives doubt the waiver will be granted since the CMS has sat on it for nearly a year.
"CMS might think that they've reached the limit of flexibility they can offer," said Yevgeniy Feyman, a Republican analyst.
