McClatchy: RI’s big Medicaid waiver ‘draws raves, suspicion’May 25th, 2011 at 3:12 pm by Ted Nesi under Nesi's Notes
Last week, The New York Times and the Projo published long examinations of Rhode Island’s hotly debated Medicaid waiver. This week, McClatchy’s Washington bureau (formerly Knight-Ridder’s) weighs in under a Providence dateline.
I don’t see much new in the story, to be honest – it’s another attempt to weigh the claims of waiver lovers like former Carcieri aide Gary Alexander against criticisms from liberal groups like the Center on Budget and Policy Priorities.
If anything, Alexander’s main argument in favor of the waiver – that it saves lots of money – seems like the weakest one its supporters can marshal, since the cap on Medicaid spending was set above forecasts and the state is also getting extra federal funding from it.
A more convincing one might be along the lines of Justice Brandeis’ old “laboratories of democracy” argument. From McClatchy:
Many feared that Rhode Island would use its waiver to impose waiting lists for services, limit benefit packages and tighten eligibility for services. But that hasn’t happened, Costantino said.
Instead, the state used the added flexibility from the waiver to beef up home-care services, overhaul hospital payments, tailor benefit packages to specific populations and inject competition into contracts for program goods and services. It also required most Medicaid enrollees to join managed-care networks.
Critics say Rhode Island could have done most of these things without its unique waiver. It’s a fair criticism, Costantino said.
“I think many of the things we could’ve done without the waiver,” he said. “The more important question is, would we have done it?”
(chart: Center on Budget and Policy Priorities)