MEDICAID GLOBAL WAIVER
DEVELOPMENTS FROM DECEMBER 2008-PRESENT
Update: February 5, 2009
At the end of December, Governor Carcieri forwarded the Proposed Global Medicaid Waiver to the House and Senate Finance Committees triggering a thirty day time limit for the House and Senate to revoke the waiver authority. The proposal included an unprecedented agreement to cap Medicaid spending over a five year period ($12.1 billion) in exchange for state flexibility in administering the program. The Congressional delegation communicated their concerns about the waiver proposal to the Governor.
The Committees held hearings on the proposal and decided to let the Governor accept the waiver, and proposed legislation to assure General Assembly oversight. The final version of the Global Consumer Choice Waiver was approved by the Centers for Medicare and Medicaid on January 16, 2009 and the Governor subsequently accepted the waiver. The legislation developed by House and Senate finance committees require General Assembly approval of any changes to the Medicaid Program. The legislation also provides some protections for beneficiaries and requires DHS to establish a community implementation task force. The House passed its version of the legislation (H-5112 SubAaa) on February 3. The Senate version (S-53 SubA), which differs slightly from the House, is scheduled for vote on February 11.
The Poverty Institute has provided analyses of the waiver and the proposed oversight legislation and worked with national and community partners to influence the outcome of the waiver decision and the subsequent legislation. The unprecedented waiver has also received national attention. After the waiver was forwarded to House and Senate finance committees, The Center on Budget and Policy Priorities and the Georgetown University Health Policy Institute Center for Children and Families published a report describing why the state should not accept the waiver, and the National Senior Citizens Law Center issued a statement critiquing the Long Term Care provisions of the waiver.
• Final version of the Waiver
• Letter to Governor from Congressional Delegation
• CBPP/CCF Report: Rhode Island's Medicaid Waiver: A bad deal for the state
• NSCL statement: Rhode Island LTC Plan Still Comes up Short
• Testimony H-5112, Linda Katz
• Testiomny S-0053, Linda Katz
• House Bill H5112Aaa
• Senate Bill S0053Aaa
Related Materials:
• PRESENTATION: "Mega Changes for Medicaid" (3.25.09)
Presented by Linda Katz at the Rhode Island State Nurses Assocation Annual Conference
• RI Lawmakers Adopt Strict Oversign of the Nation's First Global Medicaid Waiver (National Conference of State Legislatures State Health Notes 2.09)
Advocates are concerned that the cap "will sharply limit the number of poor and elderly people eligible for Medicaid coverage," said Linda Katz, policy director at the Poverty Institute. Advocates are particularly concerned that people who need long-term care will not receive it, either because new eligibility categories would deny them nursing home care, or because the number of home- and community-based services would be insufficient.
• RI may lack personnel to redo Medicaid (Providence Journal 2.2.09)
“It does raise concerns about the capacity to implement huge changes,” said Linda Katz, policy director of The Poverty Institute. “If you try calling in to the Department of Human Services, the workers’ mailboxes are full. We’re hearing people are having a hard time getting through to their workers already.”
• Waiver may cut share of stimulus (Providence Journal 1.29.09)
“That’s the problem with having a cap at all. You can’t predict things like this,” said Linda Katz, policy director at [The] Poverty Institute. “This is what we warned of. We’re on the brink of a new administration with clearly some federal fiscal relief coming to the states. Why would we want to tie our hands at this point?”
• Carcieri urges lawmakers to approvel Medicaid overhaul (WJAR 1.9.09)
Channel 10 interviews Linda Katz after day 1 of the Global Medicaid hearings. "It’s as if we have a business partner that is willing to match dollar for dollar what we put on the table and now that business partner is going to limit what they spend on this business."
• Governor wants Medicaid overhaul approved (WPRI 1.9.09)
Channel 12 interviews Linda Katz after day 1 of the Global Medicaid hearings. "We can achieve all of those changes without selling our soul in terms of capping federal dollars with existing authority that we have from the federal government."
• Sides line up over governor’s bid to cap Medicaid spending (Providence Journal 1.9.09)
The Poverty Institute's policy director Linda Katz said it’s a mistake to agree to a five-year spending cap without knowing what the state’s needs could be.“No one can see into the future,” she said.
• Lining up for a share of stimulus aid (Providence Business News 1.9.09)
Linda Katz, policy director of The Poverty Institute located at Rhode Island College, said the federal government probably would increase the share of the Medicaid budget that it pays for, with the potential to save the state hundreds of millions of dollars over the next year or two.
• Preview: Global Medicaid Waiver (WRNI 1.9.09)
WRNI's health care reporter Megan Hall speaks with Linda Katz, and sorts through what's known and not known about the global Medicaid waiver, as touted by Governor Carcieri in his address to the state Wednesday night.
• Medicaid pact heads to assembly (Providence Journal 12.23.08)
“In these volatile economic times, trying to predict what the cost of health-care coverage will be for the hundreds of thousands of Rhode Islanders who rely on Medicaid for their services or for long-term care is a really risky proposition,” said Linda Katz, policy director for Rhode Island’s Poverty Institute.
DEVELOPMENTS PRIOR TO DECEMBER 2008
• Medicaid Waiver May Fall Short (Providence Business News 12.2.08)
Linda Katz, co-founder and policy director of the Poverty Institute at Rhode Island College, said the risk that programs will have to be cut goes against the traditional purpose of seeking a Medicaid waiver, which is to expand coverage.
• National Senior Citizens Law Center Analysis of Long-Term Care Proposals in Rhode Island's Global Waiver Compact Proposal
• Letter from Senators Reed and Whitehouse to Secretary of U.S. Dept of Health and Human Services, Michael Leavitt
• Letter from members of the House Commerce and Energy Committee including Congressman Kennedy and Langevin
• “RI’s Medicaid Proposal Would Put Beneficiaries at Risk and Undermine the Federal-State Partnership", a report by the Center on Budget and Policy Priorities.
• Read coverage in the Washington Post.
• Read the Editorial in The New York Times, "Gambling with Medicaid."
• Click to see the waiver and related DHS/EOHHS documents.
• Joan Alker, Deputy Director of the Center for Children and Families, Georgetown University Health Policy Institute, presented testimony at the joint House and Senate finance committee hearing on the waiver held on August 5.
• The Poverty Institute provides an analysis of the waiver submission including a chart documenting that much of the $67 million proposed to be saved by the waiver can be achieved without the Global Capped waiver proposal.
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