Rhode Island Submits Consumer Choice Global Compact WaiverApplication To Centers For Medicare And Medicaid Services

08-08-2008

Governor Donald L. Carcieri announced that the Rhode Island Executive Office on Health and Human Services and the Rhode Island Department of Human Services submitted the Rhode Island Consumer Choice Global Compact Waiver Application to the federal Centers for Medicare and Medicaid Services (CMS) for review and approval. Rhode Island is the first state to seek this new State-federal compact, which allows the state greater flexibility while assuring federal funding certainty for Medicaid programs for a five-year period.

“Rhode Island is already feeling the pressures of the national economic downward spiral, with increased unemployment and decreasing general revenues. The single largest expenditure of the state’s budget is health and human services, and the simplest way to balance the budget would be to eliminate programs and reduce eligibility. That may save a few dollars in the short run, but it does not address the problems that only systemic change can solve,” said Governor Donald L. Carcieri. “Fiscal pressures, service demand and institutional bias have colluded to push Rhode Island further down the path toward comprehensive Medicaid reform. The Global Medicaid Waiver allows the state to implement reforms to protect the long-term viability of the program. I am encouraged by recent conversations with CMS in expediting the approval of the waiver, which is critical to achieving maximum budget cost savings.”

The Waiver recognizes that individuals need different levels of care throughout their lives and seeks to re-shape the system so that people can receive services in their homes and community as long as possible, delaying entry into higher cost, more restrictive settings. The State’s plan for Medicaid reform focuses on three key components:

1. Rebalance the long term care system, enhancing access and availability of services including home- and community-based programs as an alternative to more restrictive and institutional settings.
2. Manage care across all Medicaid populations building on existing programs including Rite Care, ConnectCare Choice, PACE, Rhody Health Partners to ensure coordinated and accessible care for all Medicaid enrollees, as well as establish Healthy Choice Accounts that reward wellness, prevention and healthy lifestyles.
3. Complete the transition from payor of bills to organizer and purchaser of services for all Medicaid consumers, creating a more competitive system that ties reimbursement to the performance and quality of care and allows the Agency to purchase selected health care services interdepartmentally at the best price.

As budget forecasts worsened last fall and the need to address comprehensive Medicaid reform lingered, the State entered into conversations with CMS to reform the Medicaid Program. Rhode Island is the first state in the nation to request an 1115(a) demonstration waiver to use global budgeting as a financing mechanism for all Medicaid populations and settings. If approved, the state will be the first to have the flexibility to organize and deliver services across populations with a greater emphasis on home and community based settings.

“We are optimistic that we will get a favorable response from CMS that will allow us to delve into the detailed planning of how best to deliver the services that Medicaid supports,” said Adelita Orefice, Deputy Secretary of the Executive Office of Health and Human Services. “This will be done in cooperation with stakeholders, in compliance with statutory obligations, and with oversight from the legislature.”

CMS will assemble a team to review the waiver with broad representation from CMS, Office of Management and Budget, and other federal departments. As part of the negotiation process, CMS may request additional information and ask clarifying questions regarding the State’s application. CMS’ final approval of the waiver takes the form of “Terms and Conditions” including programmatic and financial terms.

The Rhode Island Global Consumer Choice Compact Waiver can be viewed online at www.eohhs.ri.gov or www.gov.ri.gov.