Global Waiver Has Benefits & Risks
Source: AARP.org
Rhode Island has obtained approval from the Center for Medicaid/Medicare Services (CMS) for an unprecedented 5-year Global Waiver with the state’s Medicaid program, currently serving the medical needs of nearly 1 in every 6 Rhode Islanders, including most of the state’s approximately 8,000 nursing home residents.
To obtain greater flexibility in how Medicaid funds can be used to meet individual needs, the State has agreed to a $12.1 billion “cap” or limit on the 5 year amount of funds which will be available, an agreement no other state has made.
Current Medicaid law requires that state fund long-term care primarily in nursing home settings. The waiver will allow Rhode Island to more easily fund home and community based long-term care services. An AARP Survey on Long Term Care in R.I. indicated that 86% of respondents preferred to receive long term care services in their home and community. The State is currently spending nearly 90% of Medicaid long-term care funds for care in nursing homes, one of the highest percentages among all the states.
An area of concern is that no further funds will be available to the state unless the state withdraws from the waiver.
The details of implementation remained sketchy even as both the federal and state officials signed the waiver. The agreement permits the state to increase cost sharing (co-payment) and requires most Medicaid participants be enrolled in managed care.
The agreement allows either the State or the federal Government to withdraw and cancel the agreement at any time. The Carcieri administration has repeatedly voiced its intention to utilize the waiver to reconfigure the state’s long-term care system away from the current nursing home model to allow increased numbers of those who choose to remain in their homes and receive services.
The State’s General Assembly quickly enacted legislation requiring their oversight and prior approval for many of the changes in eligibility and benefits proposed in the compact. In addition to oversight and prior approval, the legislation requires the implementation of an up-to-45 person advisory “Demonstration Implementation Task Force”, appointed by the Director of the Department of Human Services. The task force will consist primarily of program beneficiaries or their families and providers.
“AARP has long advocated for a better balance in the long term care system, ” said AARP RI State Director Kathleen Connell, “but we remain concerned at the inherent risk in the limited funding for undetermined future medical needs in these troubled economic times.”
Other Resources:
www.dhs.state.ri.us
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