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Report on R.I’s Global Medicaid Waiver finds $22M in savings

THE long-awaited report by the Lewin Group on Rhode Island’s Global Medicaid Waiver was released on Dec. 13, finding that some $22.9 million in savings had been created over three years, far below the $100 million in savings claimed by Gary Alexander, former Secretary of the R.I. Office of Health and Human Services under former Gov. Donald L. Carcieri’s administration.
Posted 12/13/11

PROVIDENCE – The long-awaited report by the Lewin Group on Rhode Island’s Global Medicaid Waiver was released on Dec. 13, finding that some $22.9 million in savings had been created over three years, far below the $100 million in savings claimed by Gary Alexander, former Secretary of the R.I. Office of Health and Human Services under former Gov. Donald L. Carcieri’s administration.

Alexander’s claims of savings became a political football during 2011, which were championed by Alexander in a report published by The Galen Institute, a free-market conservative think tank opposed to health care reform. Rhode Island’s Global Medicaid Waiver was positioned as something that other states should emulate, comparing it to a block grant.

However, the Lewin Group report explicitly found that Rhode Island’s Global Medicaid Waiver was not a model for a block grant, nor did it function as a block grant, because expenditures under the waiver still required federal oversight and approval. Further, the flexibility and savings that the Rhode Island received through the waiver was primarily in the long-term care arena, according to the report.

The report also found that the waiver had served as a positive force in helping Rhode Island redirect its strategic policies so that Medicaid recipients “had the right services, at the right time, in the right setting.”

Linda Katz, the policy director at The Poverty Institute, said the Lewin Group report supported what advocates had been saying about the Global Waiver from the beginning.

“Most everything that the waiver purported to bring about could have been done without the Global Waiver,” Katz said. “The trend moving seniors and people with disabilities to provide more options in the community instead of nursing facilities was something that was underway before the Global Waiver was announced.”

While the report looks more at the financial implications, Katz said, it would have be helpful “to have an evaluation from the consumers’ perspective about their experiences, across all the populations, that received Medicaid-funded long-term care services.”

The was some confusion regarding the release of the report, which was dated Dec. 6, but was posted Tuesday afternoon on the R.I. Executive Office of Health and Human Services website, without any accompanying news release.

Elena Nicolella, the director of Rhode Island’s Medicaid program, had not been briefed about the timing of the release. In addition, the Lewin Group had not yet posted the report on its website.

Budget documents are now being prepared by agencies for Gov. Lincoln D. Chafee’s fiscal 2013 budget proposal, but how the Lewin Group report will affect the budget is unclear.

Neither Steven M. Costantino, the current Secretary of the Executive Office of Health and Human Services, nor Beryl Kenyon, the agency’s spokeswoman, returned numerous phone calls or emails asking for a comment.

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