What True Flexibility Looks Like
Earlier this month the non-partisan Lewin Group released an analysis of the Rhode Island Medicaid program’s global compact waiver. The waiver, approved by the Bush Administration in January 2009, attempts to reduce expenses by giving the state the flexibility to improve the quality of care. The Rhode Island waiver focuses on promoting home-and-community-based services as a more affordable (and more desirable) alternative to nursing homes, on improving access to primary care through managed care enrollment, and on other similar methods to provide quality care at better cost. And the Lewin report proves that the waiver resulted in numerous successes:
- Shifting nursing home services into the community saved $35.7 million during the three-year study period;
- More accurate rate setting in nursing homes saved an additional $15 million in Fiscal Year 2010 alone;
- Better care management for adults with disabilities and special needs children saved between $4.5 and $11.9 million; and
- Enrollment in managed care significantly increased the access of adults with disabilities to physician services.
Lewin’s final conclusion:
The GW [Global Waiver] initiatives and budget actions taken by Rhode Island had a positive impact on controlling Medicaid expenditures. The actions taken to re-balance the LTC system appear to have generated significant savings according to our estimates. The mandatory enrollment of disabled members in care management program reduced expenditures for this population while at the same time generally resulting in improved access to physician services. Continuing the GW initiatives already undertaken by the state and implementing the additional initiatives included in the GW will result in significant savings for the Rhode Island Medicaid program in future years.
All this progress comes despite the Obama Administration’s efforts, not because of them. Pages 14-15 of the Lewin report note that maintenance of effort mandates imposed in Obamacare and the “stimulus” prevented Rhode Island from imposing modest premiums on some beneficiaries, even though the approved waiver was supposed to give the state that flexibility.
And therein lies the problem. While flexibility would allow innovative solutions like Rhode Island’s to take fruit, Washington is imposing new requirements on states instead. At a time when states face budget deficits totaling a collective $175 billion, Obamacare is imposing new unfunded mandates of at least $118 billion.
In many states, Medicaid is a fundamentally broken – and fiscally unsustainable – program. Unfortunately, Obamacare not only did not fix Medicaid’s woes, it is actively impeding states’ ability to fix their own programs using new and innovative solutions. It’s one more reason why Obamacare is the furthest thing from “reform.”