Medicaid Waivers


17 million people who gained coverage through Medicaid expansion could lose coverage and access to vital services.
On January 30 CMS Administrator Seema Verma of the Centers for Medicare and Medicaid Services (CMS) announced a plan that would allow states to use the Medicaid waiver process to fundamentally alter Medicaid as we know it. The CMS proposal would make sweeping, detrimental changes in eligibility, health benefits, drug coverage, and premium costs for people who now receive Medicaid healthcare coverage as part of the program’s expansion which occurred under the Affordable Care Act.

CMS should NOT use the waiver process to remove coverage for so many vulnerable people in America who now are covered. Doing so directly threatens access to vital services – including treatment for behavioral health issues and substance abuse – for millions of people in our nation.

Under the CMS proposal, states would be able to use the waiver process to make dramatic changes to their Medicaid programs which have the frightening potential to strip coverage from the many millions of people who currently have it. Specifically, proposed changes would jeopardize the health and health coverage of the over 17 million people under age 65 in 37 states who currently are covered under Medicaid expansion.

Additionally, given Administrator Verma’s expressed interest in continuing to expand the use of the waiver process to make dramatic changes to Medicaid, her January 30th announcement may well be just a first step toward broader changes affecting all of Medicaid as the Administration tests how it can reshape the Medicaid program and its financing.

We must collectively work to ensure that Medicaid remains a guaranteed benefit to adults in need, seniors, children, and people with disabilities. Together, our joint efforts made a critical difference to #SaveMedicaid in 2017. We successfully defeated legislation that included plans to fund Medicaid via capped block grants, which would have cut federal Medicaid spending by $772 billion over ten years. We hope you’ll join us again now in contacting lawmakers to prevent CMS from making harmful changes to Medicaid.

Ways You Can Take Action:
As part of our continuing efforts to safeguard Medicaid and ensure it provides coverage that is affordable, accessible and adequate for vulnerable individuals nationwide, we suggest below several actions you can take to influence decision makers’ opinions both at the federal and state level:
  • Option 1: Lutheran Services in America sent a letter to Administrator Verma on January 31, 2020 expressing our continued opposition to proposed policies that would cut coverage for Medicaid beneficiaries. Feel free to draw any messaging from this correspondence which would be helpful to you as you reach out to any of the officials mentioned below.
    • Contact key officials in your state and make your voice heard:  Reach out to state officials including your state’s health agency and Governor. These key stakeholders soon will be in a position to decide whether to submit a waiver request under this new proposal. If you need assistance identifying or contacting your state officials, please let us know and we will be glad to help.
    • Contact your elected Federal officials: While Congress does not have direct decision-making authority on this issue at this time, dozens of lawmakers contacted CMS on January 29 to express their disapproval. These lawmakers are in a position to use their oversight and appropriations powers to safeguard Medicaid coverage going forward. As such, we urge you to contact U.S. Senators from your state and your U.S. Representative.
  • Option 2: Write to your Representative and Senators through our advocacy tool where we provide suggested language, emphasizing the need to safeguard Medicaid from harmful cuts or caps in funding. You may wish to add a personalized message about how Medicaid cuts would impact your organization.
  • Option 3: Contact your lawmakers by phone using the suggested talking points below. You can find your lawmakers and their phone numbers here. Suggested messaging you may wish to use during your call:
    • “Given our commitment to working with so many of our state’s most vulnerable people, our organization urges lawmakers to urge CMS to NOT use waivers to cut Medicaid or remove so many people in America from Medicaid as CMS officials currently propose. This change will have the power to dramatically affect the health and lives of the over 17 million people in 37 states covered under Medicaid expansion. People in our state deserve better.”
  • Option 4: Since lawmakers’ staff consistently monitor their social media pages, reaching out via their Twitter pages is also useful.
    • You can find your lawmakers and their twitter handles here.
    • Two suggested tweets:
      • [Insert your lawmaker’s Twitter handle here] I urge you to tell CMS not to use the waiver process to cut #Medicaid coverage for vulnerable people.
      • [Insert your lawmaker’s Twitter handle here] Congress should reject proposals to use the waiver process to remove people from #Medicaid.
  • Option 5: If you are able to do in-person meetings either in your Federal Representative’s and/or Federal Senators’ local offices in your state – or in DC while Congress is in session – these can also prove invaluable. We are eager to assist you in requesting and arranging these meetings. We encourage you to take advantage of this option and of our Capitol Hill presence, not only on the critically important issue of Medicaid waivers, but on any federal issues of importance to you and your organization at any time.

Be assured that we are continuing our outreach to CMS, the rest of the Administration, and lawmakers to urge them not to use the waiver process to cut Medicaid coverage for vulnerable people. We are closely monitoring this situation and will keep you informed in the days ahead and will continue to share additional messaging and action items.

Need more information? Please contact Sarah Dobson, Director of Public Policy and Advocacy, at or 202-499-5832.





On May 2, the Tennessee state legislature approved legislation supported by Governor Bill Lee requiring Tennessee to submit a Medicaid block grant plan to the federal government using the 1115 waiver program within six months. Such a plan would request the federal portion of the funding for the state’s Medicaid program (currently about two-thirds of the total cost) in a lump sum in exchange for “greater flexibility” in administering the program’s healthcare coverage for children, pregnant women, seniors in nursing homes and people with disabilities. This lump sum would not increase if program enrollment increases, and would make Tennessee the first state to ask the Trump Administration for lump sum Medicaid funding. 

Lutheran Services in America is deeply concerned that such a move could mean eventual slashed eligibility or services for many in the state. This is critically important given that six in 10 seniors in nursing homes rely on Medicaid, nearly 40% of children receive health coverage through this vital program, and over 10 million people with disabilities rely on Medicaid for care. While we agree that, as with any health system, Medicaid is not perfect and can be improved, changing the fundamental payment structure and access to this vital program is not in the best interests of those we serve in the Lutheran Services in America network.

The legislation was developed following ongoing indications from Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma that she wants to approve waiver applications from states seeking block grant funding for their Medicaid programs. However, CMS legal staff have not yet determined a way for the agency to legally approve such waivers under the parameters of existing Medicaid law. Therefore, much like with Medicaid work requirements, block grant waiver approval is likely to face lengthy legal opposition before it could become legally binding. Nevertheless, given that Tennessee’s actions could become a “test case” for other states that have indicated they’re considering requesting similar block grant waivers, we wanted to provide you with this update now so you are aware of this effort to block grant Medicaid.


While timing on this issue is still early, you may wish to gauge whether similar actions could potentially occur in your state by contacting your state legislature, your state’s agency that administers Medicaid, or any non-governmental state-wide organization for Medicaid stakeholders in your area. In addition, we have provided suggested talking points below, should you be asked by contacts or reporters in your state about this issue.

From a federal perspective, Lutheran Services in America will continue to meet with our Capitol Hill and federal agency contacts on this issue, to be part of ongoing conversations and help shape this issue’s direction moving forward. We will be voicing our strong opposition to changing the basic structure of traditional Medicaid or weakening this vital program’s support of America’s most vulnerable people. Additionally, we will closely monitor this issue and keep you informed as related actions occur. Please feel free to contact Sarah Dobson or Dania Douglas with any related questions.



  • “Given our commitment to working with our state’s most vulnerable people, we are closely monitoring this Medicaid news from Tennessee. We have serious concerns that should the Medicaid block grant move forward in Tennessee, other states may follow suit.”
  • “We are gravely concerned that changing Medicaid’s payment structure would harm the six in 10 seniors in nursing homes who rely on Medicaid, the nearly 40% of children receiving health coverage through this vital program, and the over 10 million people with disabilities relying on Medicaid for care.”
  • “While it is unclear whether the Administration can legally restructure how the Medicaid program is financed, the potential of Tennessee’s Medicaid block grant request being approved sets a precedent to further reduce the Medicaid program.”
  • “In the United States, Medicaid is the only real coverage available for seniors in nursing homes and people with disabilities. A major concern about Tennessee’s block grant request is that the state would receive considerably fewer federal dollars to care for its most vulnerable populations. This could force the state to dramatically cut the number of people receiving services through Medicaid, while also severely curtailing many of the types of services it provides to seniors, children, youth and families, and people with disabilities.”