No TennCare funding can be used to pay for elective abortion procedures, but the waiver seeks to withhold Medicaid reimbursements for all services, like contraceptive services, screening for sexually transmitted diseases and routine gynecological exams, from providers that performed or operated a facility that performed more than 50 abortions in the previous year.
The state legislature voted in March to direct the state to apply for the waiver from the federal Centers for Medicare and Medicaid services establishing, according to the waiver, “it is the policy of the state of Tennessee to favor childbirth and family planning services that do not include elective abortions within the continuum of care or services, and to avoid the direct or indirect use of state funds to promote or support elective abortions.”
Dr. William Block, chair of the East Tennessee State University Quillen College of Medicine Department of Obstetrics and Gynecology, said the lawmaker’s actions could increase the number of abortions in the state, the opposite of their intended effect.
“The problem is, there may be unintended consequences, like the lack of contraception for women who need it,” he said. “If women don’t have access to those services anymore, there probably will be a rise in unintended pregnancies and an increase in demand for abortions.”
Block said there are very few facilities in Northeast Tennessee that provide elective abortion services. Elsewhere in the state, however, clinics do provide those services, along with other women’s health services. If the waiver is approved, those clinics could lose a significant portion of funding, and lower-income women on TennCare could lose options for where they can seek care.
Rep. Matthew Hill, R-Jonesborough, voted for the waiver requirement in committee and on the House floor this year. He said Friday he doesn’t believe Block’s claim that it could lead to more abortions in the state.
“I don’t think that it is a very valid argument, because you can go to any of the county health departments and get your contraception there,” Hill said. “You can go to any of the community clinics that aren’t doing abortions, and I think the argument that it’s somehow limiting that access — I don’t think there’s any weight to that argument.”
Texas filed a similar waiver request last year, but the federal department overseeing Medicaid funds has yet to rule on it, a sign some legal experts say may mean it’s unlikely to be approved.
Texas gave up tens of millions in annual federal Medicaid funding in 2011, when its legislature created a new state program, Healthy Texas Women, and barred women’s health provider Planned Parenthood from participating. The Obama administration said then that the state was in violation of a federal law that requires states to fund “any willing provider.”
In its waiver application, Texas requested to be paid the federal dollars that were withheld during the previous administration. It also noted that it has the highest pregnancy rate in the nation, one of the highest teen pregnancy rates and nearly a third of the women in the state who get pregnant do so unintentionally.
Texas and Tennessee are hoping the Trump administration, which has taken a different approach to funding abortion providers than its predecessor, may be willing to approve the waivers.
Last month, the federal Health and Human Services Department changed rules for providers who receive federal family planning funding through Title X, barring those providers from performing or promoting abortion as a method for family planning unless a woman states she has already decided to have an abortion.
Title X funding falls under a different section of federal law than Medicaid funding, however, and allowing states to exclude abortion providers would set a new precedent.
A public notice and comment period for Tennessee’s waiver started June 13 and will last until July 13. Two public hearings will be held this month in Nashville.
Comments may be sent by email to email@example.com or by mail to Dr. Wendy Long, Director; Division of TennCare; 310 Great Circle Road; Nashville, TN 37243.