Advocates Express Concern About Rhode Island Medicaid Proposal

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

According to the Journal, the changes "have yet to be determined in many cases." Likely changes include stricter criteria for elderly beneficiaries who want to move into nursing homes. Also, "a second new group of persons with lower care needs, who under today's standards would be eligible for nursing home care, would now be limited to home and community care 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 the state Senior Agenda Coalition, said. If Medicaid costs exceeded the negotiated cap, the state would have to cut services for some beneficiaries or fund the additional programs using state money.

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

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