Reform often comes first from the local level, rather than being handed down from above. President William J. Clinton recognized this when he signed the Personal Responsibilities and Work Opportunities Reconciliation Act of 1996, which shifted control of welfare away from Washington bureaucrats and returned it to local control. The success of welfare reform since that time has been historic.

So why do some people now say that the sky is falling just because a similar reform is slated for Medicaid in Rhode Island?

Just like welfare reform, the Global Medicaid Waiver proposed by the R.I. Department of Human Services will essentially provide a block grant to the state in exchange for greater flexibility when deciding how best to ensure health care for our most vulnerable citizens.

One of the most significant changes proposed would take some control out of the hands of bureaucrats and place it with recipients, treating them as consumers and equal citizens rather than wards of the state.

If Medicaid recipients were given both the responsibility to shop for their own health care and the funds to buy it with, you can bet they would find the absolute best care at the absolute lowest cost.

Our current health care marketplace already provides low-cost choices to citizens who pay for their own care or have employer-provided insurance. The goal of the global waiver is to release the free market to give Medicaid recipients the same choices, while eliminating some of the costly practices enshrined in the current system.

Because of price controls imposed on doctors for treating Medicaid patients, it is often difficult for many recipients to get an appointment with a doctor. This leads many to seek treatment at emergency rooms. The modernization of Rhode Island’s Medicaid system will help to prevent this unnecessary and expensive practice.

Walk-in clinics for run-of-the-mill ailments and injuries provide immediate health care at a far lower cost than emergency rooms, and many states have cash-only doctors that provide high-quality medical services at a low cost and without bureaucratic hassles. These and other options would give the same choices to Medicaid recipients that other citizens enjoy.

The global waiver proposes to list all rates, services and goods on the Web to help consumers choose the best providers for them, and social workers can provide valuable information to their clients as well.

Another key component of modernizing Medicaid is to allow patients receiving long-term care, primarily the elderly and disabled, to be treated in non institutional settings, such as their own home or facilities in their local community. This would provide the needed services while respecting the dignity and wishes of patients, and potentially save significant taxpayer dollars as well.

Written into the waiver is an agreement that all mandatory populations will continue to receive necessary services.

The growth of Medicaid spending in Rhode Island is like a runaway train, more than 7 percent a year while state revenue only grows at 2 to 3 percent.

With the federal government providing a fixed amount of funds, the global waiver provides predictable funding and the freedom to modernize Medicaid so it provides needed care to our most vulnerable citizens while saving money for taxpayers.

Rhode Island lagged behind the rest of the nation in reforming welfare, only modernizing our system last year. This time, the Ocean State can lead the charge for Medicaid modernization that the rest of the country can follow. •

William Felkner is president and CEO of the Ocean State Policy Research Institute.