Rhode Island Lawmakers Debate Gov. Carcieri's 'Global Medicaid Waiver'

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Caregivers / Homecare;  Seniors / Aging;  Seniors / Aging
Article Date: 23 Jan 2009 - 3:00 PDT

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Rhode Island lawmakers are continuing to debate changes to the state's Medicaid program following a deal reached between Gov. Don Carcieri (R) and CMS, the AP/Boston Globe reports (AP/Boston Globe, 1/21).

Under 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, 1/16).

According to the New York Times, "One of the biggest fears about the spending cap is that it will sharply limit the number of elderly people eligible for nursing homes paid for by Medicaid" (Goodnough, New York Times, 1/22). While Carcieri has said he wants to reduce the state's use of nursing homes by expanding at-home care, the state Senate Finance Committee on Wednesday considered a bill that would guarantee that current nursing home residents do not have to move. Carcieri has said that nursing home residents would not be forced to leave against their will, but lawmakers want the promise to be legally binding, according to the AP/Globe. The state House Finance Committee on Tuesday considered similar legislation (AP/Boston Globe, 1/21).

In addition, "Critics say the plan is especially risky given that Medicaid rolls around the nation are swelling because of the recession," the Times reports. Under the plan, "Rhode Island will not be able to increase spending on Medicaid even if the number of recipients there shoots up," according to the Times. However, if "something catastrophic" should occur, such as a natural disaster or an epidemic, the deal could be ended immediately; otherwise, the deal would allow the state to end the experiment with six months' notice, according to Gary Alexander, director of the state Department of Human Services (New York Times, 1/22).

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