Advocates Express Concern About Rhode Island Medicaid Proposal

Senioradvocates and Rhode Islandlawmakers have expressed concern that a proposal by Gov. Donald Carcieri (R) tooverhaul RIte Care, the state's Medicaid program,could create a "catastrophe" for 186,000 state residents enrolled inthe program, the Providence Journal reports. Carcieri announced the planin January, saying it would save taxpayers an estimated $67 million. Under theproposal, the state would agree to a federal spending cap on Medicaid programsfor the next five years in exchange for the state having more flexibility fromthe federal government to change Medicaid programs.

According to the Journal, the changes "have yet to bedetermined in many cases." Likely changes include stricter criteria forelderly beneficiaries who want to move into nursing homes. Also, "a secondnew group of persons with lower care needs, who under today's standards wouldbe eligible for nursing home care, would now be limited to home and communitycare services, but they would only get services if funding is available,"Maureen Maigret, former director of the state Department of Elderly Affairs and current policy director for thestate Senior Agenda Coalition, said. If Medicaid costs exceededthe negotiated cap, the state would have to cut services for some beneficiariesor fund the additional programs using state money.

Some advocates have expressed concern that the proposal would lock Rhode Island intospending levels that are "based on unrealistic assumptions,"according to the Journal. Adelita Orefice, deputy secretary of thestate Department of Health and HumanServices, said,"We know that it's risky," adding, "One of the things we'retrying to do is find a way to minimize the risk." Gary Alexander, directorof the state Department of Human Services, said, "I understand the riskinvolved, and I understand the concerns of the community, but right now we arepast the risk point," adding, "We may be at a point where, just tobalance the budget, we'll be taking 30,000 to 40,000 people off our currentprograms for (fiscal year) 2010 because we don't have any more money."

According to the Journal, "There are still many questions asto how the Carcieri administration would execute the cost-saving plan," as"[d]etails are being ironed out behind closed doors between the stateDepartment of Human Services" and CMS. According to the Journal,"Vermontis the only state to have arranged something close to what the Carcieriadministration is seeking" (Peoples, Providence Journal,5/23).

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