Projo 7 to 7 News Blog

More than three dozen people have signed up to testify about the proposed Medicaid waiver sought by Governor Carcieri to save a promised $67 million this year alone. Carl was the first member of the public to testify, and his ardent plea to the legislators to reject the waiver proposal followed hours of testimony by Gary Alexander, director of the Department of Human Services, and others.

Carcieri himself made a personal appearance to promote the waiver proposal would give Rhode Island unprecedented freedom to redesign the state's Medicaid program -- and set new rules, for example, on who is eligible for nursing home placement and which doctors and pharmacies a patient can use -- in exchange for agreeing to live within a five-year, $12.1 billion spending cap. (Correction: A previous version of this post gave an incorrect figure for the spending cap.)

The federally approved waiver request clearly allows waiting lists for services. It states, for example: "Should a waiting list for long-term care services develop, the state must provide services for individuals classified in higher levels of care categories.'' Alexander and others tried to play down the likelihood of that happening.

But Carl urged skepticism. He said the state has "maintained a waiting list illegally for the last several years,'' raising questions about how many home-based and community services are available now to people who would no longer be eligible for placement in nursing homes and other institutional settings. "It is clear to me they do not have their act together now,'' he said.

Earlier today, Carcieri told the lawmakers:"I think the federal government has given us an enormous opportunity. . . I want to make this a better program that we can sustain because right now we are struggling, and you know that."

Carcieri said he wants to set up an advisory council "to put to rest a lot of the fear that's out there that, somehow, we are dramatically changing ... the level of care." Carcieri said he wants to do so with input from the legislature.

The lawmakers are working under a tight self-imposed deadline to reject, amend or let the waiver proposal take effect without any further action at the start of next week. The tight deadline -- 30 days after approval by the Centers for Medicare and Medicaid Services -- was built into the state budget passed last June, that also contained $67 million in promised savings from the Medicaid overhaul. Since the approval came down on Dec. 19, the lawmakers believe they have until a week from Sunday to act.

Today's hearing marked the first time the public has had a chance to comment, though hearings will continue in the House and Senate next week.

Among those lined up to testify was Cynthia Conant-Arp, speaking as the executive director of the Hope Alzheimer's Center, president of the Rhode Island Adult Day Services Association, vice president of the Rhode Island Association of Facilities and Services for the Aging and as a "provider of dementia-specific adult day services.''

She lauded the goal of providing care in the "least-restrictive, cost-effective settting,'' and said the waiver could provide welcome new opportunities. But in written testimony she brought with her to the State House today, she raised a litany of concerns, among them: that " the current plan for expedited services...may provide too-few hours or days of home care or adult day care services to ensure the safety and quality of care for a newly discharged hospital or rehabilitation patient.''

"Moreover, as acuity levels rise in every part of the service continuum from nursing homes to senior centers, we are concerned,'' she said, that sufficient financial resources'' be available "to support the levels of skilled personnel and technology...necessary to provide more intensive services.''

Waiting alongside her to testify was James P.Nyberg, director of the Rhode Island Association of Facilities & Services for the Aging, who expanded on her concerns. In principle, he said the group - which represents a mix of nursing homes, assisted living facilities, adult day-care and elderly housing providers - supports a "rebalancing'' of the long-term care system.

But he said more clarity is needed on how people will be categorized under the broadly-sketched new "eligibility process,'' such as "the role of the patient's physician.'' He said speedy approval for long-term care placements is critical; the current review process is already slow, exacerbated by the recent retirement of state workers and could be further prolonged if this new process is not effectively implemented and sufficient staff available. '' He said this could put "both consumers and providers at risk.''

And if it is unclear whether they will be paid, he said "providers may be reluctant to admit someone to services.''

He also raised questions about the future "viability'' of many of the state's nursing home if their enrollments are cut, their population's limited to the sickest and frailest, at the same time Carcieri is proposing to cut their reimbursement rates by 5 percent as part of his deficit-closing plan.

'We cannot cripple the nursing home industry as we work to rebalance the current system,'' he warned.