PROVIDENCE, R.I. - One year after Governor Gina M. Raimondo established the Working Group to Reinvent Medicaid, Rhode Island is positioned to expand and improve access to quality care and reduce costs. The state is projected to achieve over $100 million of annual Medicaid savings without cutting eligibility or reducing benefits. These reforms protect and expand vital health services and shift the state's Medicaid system toward a structure that rewards better outcomes, better coordination and higher-quality care.
"While there is more work to do, Rhode Island is up to the challenge of expanding access to quality health care and controlling costs," Raimondo said. "We could have kicked the can down the road. Instead, we worked with the legislature to pass a comprehensive, progressive package of reforms that transforms our system to reward quality. Our reforms will ensure more Rhode Islanders have access to important health care services and will allow the state more flexibility to make vital investments in providing opportunities for every Rhode Islander."
In large part because of the state's participation in Medicaid expansion through the Affordable Care Act (ACA), Rhode Island has cut its uninsured rate in half since 2013. Ninety five percent of Rhode Islanders now have health insurance, including nearly 275,000 enrolled in Medicaid. While more Rhode Islanders are able to access coverage through the ACA and Medicaid expansion, Raimondo inherited a Medicaid program that was growing more rapidly than the rest of the state budget, which required immediate action.
With strong partnership from the General Assembly, working with leaders in the health care, business, and labor communities, and with laser focus from the Medicaid program team, the state passed the Reinventing Medicaid Act of 2015. The progressive, comprehensive package of reforms is projected to save approximately $75 million in state Medicaid spending this year without cutting eligibility and without reducing benefits. In out years, the savings associated with these initiatives are projected to be even larger, including nearly $120 million in projected savings in FY 2017 relative to projected costs without Reinventing Medicaid.
"Our Medicaid reforms are about more than costs," Health and Human Services Secretary Elizabeth Roberts said. "From the day Governor Raimondo established the Working Group, our top priority has been to provide Rhode Islanders with better care and achieve healthier outcomes for more people. Rhode Island's progressive Medicaid reforms provide parents of children with special needs with more choice, transition more Rhode Islanders with behavioral health needs into home and community-based settings where they can lead happier and healthier lives, and expand and strengthen waste and fraud protections."
The Reinventing Medicaid Act of 2015 included more than 40 individual initiatives designed to transform how the state pays for health care services. The initiatives include:
• Contracting with Accountable Care Entities that have a financial incentive to manage the total costs and quality of care for Medicaid beneficiaries. To date, five Accountable Care Entities have signed up for the program.
• A special Accountable Entity program designed to serve Rhode Islanders with serious mental illness, some of the most vulnerable and high-cost Medicaid clients.
• A program to address the needs of Rhode Islanders with substance use disorders so they are served better outside of the emergency room.
• A program to serve people who are at high risk of homelessness.
• Reforms to the Cedar program which offer parents of children special needs with more choices and flexibility.
• Better enforcement, through new electronic monitoring systems, of Medicaid rules around waste, fraud and abuse.
"Because of the Governor's leadership, the Working Group's focus and the determined work of the dedicated Medicaid staff, we have provided a national model for how states can bend the cost curve and expand access to high-quality health care services," Medicaid Director Anya Rader Wallack said. "We started this process from a place of strength and we've laid a foundation for future sustainable reforms that build healthier communities, foster a more vibrant economy and transform health care delivery to be more efficient and effective."
Other states have achieved savings by restricting access, cutting enrollment or cutting provider payments. The Reinventing Medicaid reforms position Rhode Island to bend the cost curve by reducing waste and increasing program efficiency and effectiveness, even while enrollment grows. Medicaid enrollment is projected to grow by more than 2.5 percent between 2015 and 2017, but state spending on the program is projected to decline over the same period of time. Without the Reinventing reforms, Medicaid spending would have grown by 13 percent over that two-year period.
"From the very beginning, our focus was on spending Medicaid dollars more thoughtfully and protecting the benefits for Rhode Island's most vulnerable residents," Working Group Co-Chair Ira Wilson, MD, MSc said. "Rhode Island's Medicaid members will reap the benefits of a better coordinated, more attentive Medicaid system for years to come. I commend Governor Raimondo, Secretary Roberts, Anya and the entire Medicaid workforce for implementing the comprehensive reforms we recommended and putting Medicaid on a path to providing higher-quality care and achieving better, healthier outcomes for more people."
"Rhode Island has shown that states can lead an inclusive, public process to drive health care transformation," Care New England CEO and Working Group Co-Chair Dennis Keefe said. "By focusing on better quality and better coordinated care, our state is well-positioned to bend the cost curve without cuts to eligibility or reductions in benefits. Governor Raimondo and her Medicaid team have done the tough work to implement one of the most comprehensive, forward-looking health reform packages I've ever seen. This will allow Rhode Island to make equally important investments in the state's economic future - investments that would not have been possible if the state had chosen an easier path of straight cuts or restrictions on eligibility."
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