State files controversial<br> CMS waiver application

PROVIDENCE – The state last week submitted a proposal dubbed the “Rhode Island Consumer Choice Global Compact Waiver Application” to the Centers for Medicare and Medicaid Services, aiming to get the flexibility needed to implement major Medicaid reforms.
In exchange, Rhode Island would agree to a fixed Medicaid grant of $12.4 billion over five years – a provision that advocates for the poor and many in the health care sector say could expose the state to major shortfalls in a bad economy and force it to cut crucial services.
Rhode Island is the first state to seek this kind of waiver.
In a news release, Gov. Donald L. Carcieri noted that health and human services is the single biggest spending category in the state budget, and rather than cut programs and reduce eligibility, he wants to implement reforms to protect the state Medicaid program’s “long-term viability.” He added that he is “encouraged by recent conversations with CMS in expediting the approval of the waiver, which is critical to achieving maximum budget cost savings.”
The reform plan includes three key points:
• “Rebalancing” the long-term care system by shifting the focus from nursing homes to home- and community-based programs.
• Implementing managed-care systems across all Medicaid populations – as is already done with RIte Care – and establishing “Healthy Choice Accounts” that reward wellness, prevention and healthy lifestyles.
• Giving the state a more aggressive role in organizing and purchasing services for Medicaid beneficiaries, with a more competitive system that ties reimbursement to performance and quality of care.
The waiver application can be viewed online at
www.eohhs.ri.gov or www.gov.ri.gov.