Questions regarding the RI Medicaid Global Compact Waiver Proposal

• 1. Are the three "silos" in Figure 2.1: LTC Proposed Level of Care and Service Option Matrix: nursing homes; hospital; and intermediate care facilities for the mentally retarded, how the "person centered" system will actually operate; by industry grouping?
• 2. Are "levels of care determinations" made using a universal functional criteria or with three separate criteria: one for nursing homes; a second for hospitals; and a third for ICFMR?
• 3. Are the "levels of care determinations" made by the Assessment and Coordination Organization (ACO) appeal-able?
• a. If so, what is the appeal mechanism?
• 4. Are the current long term care beneficiaries "held harmless", or is it possible that some may lose all long term care services if the levels of care determinations place them in the preventive category, even if there is no change in their ability to perform activities of daily livings (ADLs)?
• 5. Will any of the Medicaid transportation change?
• a. To oncology treatment?
• b. To renal (dialysis)?
• c. To doctors offices?
• d. To physical or occupational therapy?
• e. Will the behavior health/substance abuse users be included in RIde or will Medicaid be using ambulances?
• f. Will Medicaid continue to purchase from RIPTA the 10 trip tickets for use?
• 6. Will "Expanding Capacity" include efforts to merge existing disability specific "silo" agencies (I.E. developmental disabilities, mental health, substance abuse, etc.)?
• a. If not why not?
• 7. Will all long term funding follow the person, or will existing providers directly receive a minimum level of funding, during a transition period?
• 8. Will long term care beneficiaries participate in the Healthy Choices "incentives and rewards for healthy behaviors"?
• a. If not, why not?
• b. If yes, will the target behaviors be the same as the general Medicaid populations?
• 9. Will there be a "medically necessary" exemption from the Psychiatric Preferred Drug List?
• 10. With providers and health plans become responsible and accountable for quality assurance monitoring, etc. how will the state ensure problems are not "buried"?
• a. What roles will the Office of the Child Advocate, Mental Health Advocate and Long Term Care Ombudsperson play in quality assurance?

Global Waiver proposals discussions continue in September and significant changes may occur for some of the people in RI who need the assistance of medicaid support.

Director Alexander will continue to host the Stakeholder Meetings as
forum to provide updates on the status of the Global Consumer Choice
Compact to Health wavier process and to obtain stakeholder feedback.

The meetings will be held every other Friday from 10:30 - 12:00,
beginning on September 19, 2008.

The first two meeting will be held at the Department of Labor and
Training, 1st Floor Conference Room 1511 Pontiac Avenue Cranston, RI
02920.

Thereafter, the meetings will be held at the Department of Human
Services 600 New London Avenue Forand Building #038, 1st Floor Staff
Development Training Room Cranston, RI 02920.

The meeting schedule is as follows:

Friday 09/19 10:30 -12:00 Dept of Labor and Training, 1st Floor
Conference Room
Friday 10/03 10:30 - 12:00 Dept of Labor and Training, 1st Floor
Conference Room

Friday 10/17 10:30- 12:00 Dept of Human Services Forand Building 1st
Floor Staff Dev. Conference Room
Friday 10/31 10:30- 12:00 Dept of Human Services Forand Building 1st
Floor Staff Dev. Conference Room
Friday 11/14 10:30- 12:00 Dept of Human Services Forand Building 1st
Floor Staff Dev. Conference Room
Friday 11/28 10:30- 12:00 Dept of Human Services Forand Building 1st
Floor Staff Dev. Conference Room
Friday 12/12 10:30- 12:00 Dept of Human Services Forand Building 1st
Floor Staff Dev. Conference Room

Gambling With Medicaid

Published: September 14, 2008 Rhode Island is seeking a federal waiver to change much of its Medicaid program from an open-ended entitlement with no limit on spending to a capped budget with fixed expenditure limits. Skip to next paragraph

The Board Blog

Additional commentary, background information and other items by Times editorial writers.Go to The Board » Gov. Donald Carcieri, a Republican, is hoping to close his state's looming budget deficits and curb rising Medicaid costs, two problems that are bedeviling many states. But prudent leaders would be wise to watch what happens - and especially what happens to Rhode Island's poorest residents - before following this path. Medicaid has traditionally been an "entitlement program" that pays the medical bills of all residents whose incomes are sufficiently low to qualify for coverage. There is no limit on how many people can enroll or on how much the state and federal governments must spend to provide services. In the current fiscal year, Rhode Island's Medicaid program is costing about $1.9 billion - with slightly more than half paid by the federal government and the rest by the state. Under the proposed waiver, the federal government would contribute a fixed annual amount for the next five years (roughly what it was projected to spend anyway), but Rhode Island would limit its contribution to 23 percent of its general revenue budget. That would mean substantially less money for Medicaid. An analysis by the Center on Budget and Policy Priorities estimates that if the waiver is granted, the state's Medicaid budget will fall $231 million short of the projected $2.07 billion needed next year - with the gap increasing every year. The state is hoping to make up the difference, without harming patients, by providing health care more cheaply. It wants to require most long-term care patients to get treatment at home or from community-based services rather than in expensive nursing homes and would put virtually all beneficiaries in managed care. If that isn't enough, it wants flexibility to charge higher co-payments, put people on waiting lists for treatment, and limit the duration and scope of services. States already have great leeway when it comes to Medicaid, so it may be reasonable to give Rhode Island the flexibility to try something new. This is still a risky path. If costs escalate more rapidly than expected and savings don't materialize, the state might feel obliged to cut Medicaid spending even more drastically. Rhode Island's most vulnerable citizens would pay the price.