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Tennessee nursing home resident advocates are slamming the state’s bid to move its Medicaid program to a capped block grant system to limit spending growth.

Gov. Mike Lee (R) is poised to sign the policy change, which would make Tennessee first in the nation to ask the federal government for its Medicaid funds in a lump sum. This change has been long-coveted by Republicans and President Trump as a way to cap spending growth for nursing homes’ largest funding source, and it has been dreaded by providers and consumers alike. Watchers note, however, that its review could take months and may be challenged in court.

Resident advocates blasted Tennessee’s actions this week, concerned that they would only make skilled care less attainable for the poor. Medicaid covers 61% of nursing home care in the Volunteer State, noted Grace Smith, executive director of the Council on Aging in Middle Tennessee. TennCare is projected to spend about $1.07 billion this fiscal year on nursing home care for 24,000 individuals, one of the most costly services under the program.

The Tennessee Health Care Association declined to comment on the bill this week, and the head of LeadingAge Tennessee did not respond to a McKnight’s request for comment Thursday. In the past, national nursing home industry trade groups have expressed opposition to moving Medicaid into a block grant system.

Tennessee lawmakers first approved the legislation last Thursday and the governor is expected to sign it soon. After that, Tennessee will have 180 days to submit the waiver to CMS. Politico noted that if approved by the Trump administration, it could take months to review, and litigation is likely. Other states, such as Alaska and Georgia, have similarly expressed interest in transitioning their Medicaid programs to block grants.