NEW: State Saves Millions from Medicaid Reforms
Wednesday, December 14, 2011
Steven M. Costantino, Secretary of the Executive Office of Health and Human Services, today said that an independent evaluation of Rhode Island’s Global Consumer Choice Compact Waiver and its companion Real Choices Systems Transformation Grant shows that the state has achieved Medicaid reforms that reduce costs, improve access and expand choice.
The evaluation was prepared by The Lewin Group and funded through a federal Real Choices grant. Among key findings of the report is that the Global Waiver is empowering the state to meet its three program goals of rebalancing the long-term care system, ensuring that primary and acute care is managed and coordinated with other services and supports, and procuring Medicaid-funded services through cost-effective strategies.
“The Lewin Group’s evaluation affirms that we have taken steps toward achieving the stated goals of the Global Waiver,” Costantino said. “Inter-agency cooperation has improved. Major program reform has been implemented, and savings realized. Now in the third year of this five-year demonstration period, we continue our work to make the Medicaid delivery system more person-centered, to encourage and reward service quality and healthy outcomes, and to promote home and community alternatives over more restrictive and costly long-term care settings.”
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTUnder the Global Waiver, Rhode Island was granted additional federal funds for Costs Not Otherwise Matchable—known as CNOMs—that help to maintain state funded programs targeted at those who are at-risk of poor health and institutional placements. The state gained explicit authority from the Centers for Medicare & Medicaid Services (CMS) to claim these federal matching funds for services that are not traditionally eligible for federal Medicaid matches. Authority is based on the notion that the 1115 Waiver allows states to demonstrate there may be services or populations that CMS should consider including in the State Medicaid Plan.
The evaluation puts the cost savings for state fiscal years 2009-2011 under the Global Waiver at $22,944,288. CNOMs for that period totaled an additional $42,771,929, for a total of $65,716,217. Cost savings for program management provisions not subject to Global Waiver requirements came in at $22,892,894, with other provisions requiring additional CMS approval but not dependent on Global Waiver requirements totaling $9,396,325. Cost savings not dependent on the Global Waiver totaled $32,289,219.
The results of the state’s efforts to date, as assessed by The Lewin Group, are as follows.
- There has been a decline in the number of low-need persons entering or remaining in nursing homes. More of these Rhode Islanders are choosing to obtain the care they need at home or in community settings like assisted and shared living.
- The growth of nursing home costs has been stemmed as a result of improved program management and changes in how the state pays for all long-term care service options.
- All Medicaid beneficiaries, except for those with some additional coverage such as Medicare or private insurance, have a medical home that provides care management and coordination.
- The state is becoming more of a “smart purchaser,” striving to make sure that every health care dollar Rhode Island spends achieves a better outcome.
The Global Consumer Choice Compact Waiver is not a block grant but rather an 1115 demonstration waiver that incorporates 11 different waiver authorities and accompanying reporting and administrative requirements into one waiver. While traditional budget neutrality allows expenditures on both the state and federal sides to grow each year, Rhode Island can draw down federal funds up to an aggregate budget cap of $12.1 billion over the Global Waiver’s five-year demonstration period. Rhode Island is in no danger of spending to the aggregate budget cap, as this would require a dramatic increase in state expenditures.
While the impact of maintenance of effort requirements in the American Recovery and Reinvestment Act and in the Affordable Care Act have negatively impacted the amount of flexibility anticipated under the Global Waiver, these are the same restraints faced by all states and do not diminish quality and service delivery.
Medicaid serves approximately 216,000 Rhode Island residents, or 21 percent of the state’s population.
