KNOXVILLE, Tenn. (WATE) – A big change was made to Tennessee’s TennCare program Friday.

Gov. Bill Lee officially signed off on the Medicaid block grant waiver, which also passed the state House and Senate. Prior to state approval, the Trump administration approved the deal late last week, which made Tennessee the first in the country to be approved.

It means the state will receive a lump sump payment from the federal government to find the state’s Medicaid program, TennCare, instead of the 65% reimbursement the state has received for decades. Currently, the federal government pays about 65% of the state’s Medicaid costs, which is about $7.5 billion.

Many Republicans bill the change as having more flexibility and more services.

“Under this block grant, our state will be rewarded for our strong financially management of the TennCare program and we’ll gain additional funding from the federal government through shared savings,” Lee said in a video about the grant. “We can work toward improving maternal health coverage, clearing the waiting list for intellectual and developmental disability services, and reaching more needy populations through targeted interventions.”

Michael Holtz, a cancer survivor who now advocates for others, is concerned the waiver will give the state so much flexibility that it could limit the number of medications a person can receive per diagnosis.

“I had four medications that were used to treat just the cancer, never mind the side effects,” he said. “Reducing that, in the middle of a global pandemic, seems counterintuitive.”

Michele Johnson, executive director of the Tennessee Justice Center, calls the move dangerous and believes the lump sum plan will limit the number of people able to enroll.

“It’s it’s going to be costly to the whole state, and it’s going to be particularly costly to the children who we represent. … It’s hard to understand what it is they were getting from this deal if it’s not the freedom to make cuts,” she said.

TennCare offers health coverage to low-income and disabled Tennesseans through federal and state dollars. In December, 1.5 million were enrolled in the state, that includes 83,000 in Knox County, 23,000 in Blount County, 22,000 in Sevier County, and 17,500 in Blount County.

The state’s website shows if Tennessee has an uptick in enrollment of more than 1%, their lump sum amount would be increased. A graphic also shows the state traditionally spends fewer dollars than the federal government budgets. The waiver, according to the state, allows half of those savings to go to the state to go toward other TennCare programs and services.

President-Elect Joe Biden opposes block grants and could rescind the move.