Rhode Island House Will Not Move To Block Gov. Carcieri's 'Global Medicaid Waiver'

Main Category: Medicare / Medicaid / SCHIP
Article Date: 19 Jan 2009 - 1:00 PDT

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Rhode Island state legislators will not vote to block Gov. Donald Carcieri's (R) "unprecedented" plan to overhaul the state Medicaid program, which will subsequently take effect Monday, state House Speaker William Murphy (D) said Wednesday, the Providence Journal reports (Peoples/Needham, Providence Journal, 1/15).

Under the deal, negotiated between the Carcieri administration and CMS acting Administrator Kerry Weems and known as the "global Medicaid waiver," the state will limit Medicaid spending to $12.4 billion through 2013. In exchange for capping spending, the state will receive broad authority to change services, such as nursing home care, subsidized transportation for the elderly and beneficiaries with disabilities, health insurance for low-income children and parents, and prescription drug coverage for seniors. State Department of Human Services Associate Director Murray Blitzer said that if the state runs out of its allotted funds before the five-year mark, it will lose matching federal funds, which would force the state to pay the program's full cost or cut services (Kaiser Daily Health Policy Report, 12/10/08).

The decision by the House not to vote eliminates the possibility of halting the plan. The plan could have been stopped if both the state House and Senate voted against the proposal by Thursday, a deadline that the lawmakers imposed for themselves last year (Needham, Providence Journal, 1/13).

Many officials say they remain unclear on how the plan will affect the state's Medicaid beneficiaries, the Journal reports. Carcieri "has repeatedly promised transparency and legislative oversight if the agreement takes effect," but "some lawmakers are reluctant to take the Carcieri administration at its word," according to the Journal (Providence Journal, 1/15).

State senators have proposed legislation requiring strict oversight of the overhaul. The bill states, "No changes in the state Medicaid program shall be made without the express approval by a legislative body." The bill also defines three categories of potential changes and requires legislative approval for all changes except those that do not affect "beneficiary eligibility, benefits, overall health care delivery systems, payment methodologies or cost sharing" (Peoples, "Projo 7 to 7 News Blog," Providence Journal, 1/15).

State Senate Finance Committee Chair Daniel DaPonte (D) said, "If they're going to make major changes to the Medicaid program, the legislature would have to sign off," adding, "We have an obligation, from a public policy perspective, to have substantial oversight" (Providence Journal, 1/15). Daponte said he wants both the House and Senate to adopt the measure this week. Although the House is working on a similar bill, House leaders have said they do not expect to vote on it this week ("Projo 7 to 7 News Blog," Providence Journal, 1/15).

Letter
Rhode Island's four federal representatives on Tuesday wrote a letter to Carcieri warning that the waiver "could pose serious risks to the Medicaid program, leading to unprecedented cuts" affecting both beneficiaries and health care providers. The letter, signed by U.S. Sens. Jack Reed (D) and Sheldon Whitehouse (D) and U.S. Reps. James Langevin (D) and Patrick Kennedy (D), reiterated concerns that details of the overhaul remain vague. "Despite numerous public briefings, ... a detailed plan and justification are still not public and accessible," the lawmakers wrote, noting that their own requests for specifics have not been answered. They added that the "state has not provided data on the impact on beneficiaries, nor has it provided projections of state spending, savings, or the assumptions and methodologies on which such projections are based."

The letter also stated that "from the information we have, one aspect of the waiver seems quite clear:" that the "aggregate cap on spending could leave the state up to $842 million short of its projected obligations over five years ... because the cap is based on national projections in the president's budget and does not factor in Rhode Island's specific circumstances -- including a significant aging population and skyrocketing unemployment." The lawmakers also expressed concern that "there are no protections to ensure that essential benefits are available to those for whom they are medically necessary, and the specific changes that the state will seek remain unknown" (Gregg, "Projo 7 to 7 News Blog," Providence Journal, 1/13).

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