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

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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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Jim_Donahue

The Don paid his friend $350,000 without a contract or anything in writing for his 'volunteer' efforts.

Where can I sign up to volunteer'?

Wednesday, December 14, 2011 | Report this
Anita

The OUTRAGE in this story - which the reporters have so far missed - is that apparently $15M of the savings came directly from reducing payments to nursing homes - or more accurately - the care for their aged residents.

This story shows just how far women have really come when they reach the end of their lives: About 90% of the residents of nursing homes are elderly women. So - after spending their lives caring for their parents, children, spouses, they get to spend their last years or months sitting in their own waste, being cared for largely by Certified Nursing Assistants (CNAs) - a job held largely by former welfare recipients and immigrant women who have few other job options. (CNAs have very high rates of on-the-job injury and many do not remain in the field for more than a few years due to the physical strain.)

Many CNAs also do not speak English well, or are unfamiliar w/American culture, causing further issues and/or discomfort for the people in their care.

Creating "savings" on the backs on these 2 classes of vulnerable women is, in my opinion, a sin, if not a criminal act. Let us recall that the Carcieris liked to sing the "life is sacred" song - but that only applied to those not-yet-persons still in the womb. Once you've spent a lifetime in the world, you're not entitled to even spending your last months or dying with dignity.

What a world!

Wednesday, December 14, 2011 | Report this
WWjayceesKC@aol.com

MEDICAID is a complicated, joint program (Federal / State) that looks at Elder Care (nursing homes), Children with low-income parents (Welfare) and Disabled Citizens (not SSDI qualified).

The government should AMEND the long, overdue, archaic ceilings it has for resource possession (Asset Ownerships) and allow recipients, families and care givers to assist and provide more dollar allocations for such care.

The allowance for example, of a paltry $2,000.00 cut-off (that whacks and besmirches good and decent peoples' integrity and personal respect) versus some modest indexing or gradual increasing [no such increase has taken place in over 20 + years!!!]is on face value, insulting. Further, a mere elevation in such resource restrictions is totally budgetary neutral, allows a miniscule increase of independence and confidence and provides a proportionate expenditure directly into our economy.

The whole health care issue must be aired-out across the country, possibly through a Commission-appointed, inclusive panel (medical, insurance, consumers) for a regional set of conferences / hearings in gathering information to Congress and report to the President for a proper disposition.

This is the only credible way (ala Base-Closing model[s]) and open manner that the full impact of any changes / modifications to the ever-present, humanly-needed and outstanding economic tool that 'heath care costs' reverberate throughout our financial and familial systems, can conceivably be implemented in a truly fair, comprehensive and cost-effective manner.

Our mostly young and youthful (today's) 'Occupiers' citizens are right to demonstrate their fears, frustrations and frank opinions about the so-called 1%ers versus the 99, but after such substantive theatrics is aptly noted, they -- and others -- should bear down, focus on the immediate issues of need and purpose and generate the transparency of public policy, its effect on private transactions and activate the stream of societal regurgitation (diverse dialogue) to select the pathway in meeting our significant public goals and individual requirements in making America a healthier, safer and (and once again a reasonably), prosperous nation for all.

Blessed Holidays!

Thursday, December 22, 2011 | Report this
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