"Democracy means paying attention" John Dewey.
Q. Why all the fuss about this "Medicaid Waiver" ? Medicaid provides acute and long-term care medical services to 180,000 Rhode Islanders, including long-term care for 18,000 seniors and 27,000 disabled adults. Funded by federal and state dollars, Medicaid is the ultimate "safety net" that pays for home and community-based services ranging from home health aides to assisted living and residential nursing home services for low-income seniors. The state just entered a five-year agreement, called the global Medicaid waiver, that will allow the state to make major changes in how it provides these and other services.
Q. Why is it called a "global" waiver? Because it will bring under one contract for five years all Medicaid-funded services to all covered populations: children and families, persons with developmental disabilities or mental retardation, and seniors and disabled adults.
Q. Why is the State of Rhode Island doing this? Primarily, to save money . RI Department of Human Services believes it can reduce the rate of increase in Medicaid spending and increase the quality of Medicaid-funded services at the same time. For example, it expects that the waiver will give it greater flexibility in "rebalancing" long-term care for seniors and disabled adults by serving more of them at less cost in the community and fewer of them in more expensive nursing homes.
Q. How will the waiver affect Medicaid-funded long-term care for seniors? The biggest immediate change will be that the state shifts from a single "level of care" definition for entitlement to long-term care, to three levels of care-highest, high, and preventive. Only meeting the "highest" level will entitle a senior to these services. Moreover, this "highest" level is defined more restrictively. It demands that eligible individuals "require extensive assistance or total dependence with at least one Activity of Daily Living (ADL):e.g. bathing, toilet use, bed mobility, eating, or transferring, and require at least limited assistance with any other ADL. Depending on available funds, seniors not eligible at the "highest" level may end up on a waiting list for services.
Q. What are the waiver's potential benefits for seniors? It should make it easier for seniors to qualify for home and community-based care programs that are currently "capped" in the numbers of people they can serve. Seniors may be more options for selecting caregivers, including contracting with relatives. Some seniors who are currently just above the Medicaid income limit may receive services that will help keep them out of nursing homes.
Q. With these benefits, why are there concerns about this waiver? There are two major areas of concern. One is a lack of details on how the waiver will be implemented. The waiver document is not specific about how the "new RI Medicaid program" will work. Public hearings haven't gotten into specifics, either. The second, and perhaps more serious concern, is about the ability of Rhode Island 's state agencies, that have lost hundreds of experienced staff through retirement, to implement such a complex restructuring. Rhode Island 's acting Medicaid Director retired in September. The long-term care unit of the RI Department of Human Services has 22 of 87 direct service positions open.
Q. What happens next? The global Medicaid waiver took effect January 16, 2009. The General Assembly is in the process of passing legislation that will require the Assembly's approval of any major changes made via the waiver. This is a major protection that the Senior Agenda and other groups recommended. The General Assembly by law has established a 12-member Joint Legislative Committee for oversight of the waiver. Senior consumers, advocacy groups, and providers will need to remain vigilant in monitoring the waiver's implementation and make their voices heard concerning