An 11th-Hour Approval for Major Changes to Medicaid in Tennessee

With 12 days to go, the Trump administration on Friday approved a long-held conservative goal: to issue a state’s Medicaid funding as a spending-capped block grant.

The structural experiment in Tennessee, which would become effective once approved by the state legislature, would last for 10 years. Block grants for Medicaid have been a priority for Seema Verma, the administrator for the Centers for Medicare and Medicaid Services and a former consultant who helped states write waiver requests.

“What we tried to do was take some of what we thought were some of the wins, some of the positive things about block grants people have talked about for years,” Ms. Verma said. “And we tried to go through and address some of the criticisms.”

Patient advocates in Tennessee, who fear the new structure would cause poor people to lose access to health care, say they plan a court challenge, and the Biden administration will almost certainly seek to reverse it when it takes over the Department of Health and Human Services.

But in the last week, the Trump administration has tried to slow the reversal of its Medicaid experiments. Traditionally, such waivers are agreements between H.H.S. and states that can be