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When Rhode Island’s General Assembly passed the state’s 2018 budget, it did something unprecedented. The legislators passed a budget bill that directed Gov. Gina Raimondo to find $25 million in “undistributed savings,” requiring no legislative oversight and depriving the public the opportunity to weigh in on how the savings would be achieved.
In early October, the governor responded, outlining a plan that would draw about 20 percent of those cuts from the state’s Medicaid program. Such a large cut is a burden to Rhode Islanders who rely on Medicaid for their care. Worse, the majority of the Medicaid cuts undermine two of the state’s most important “Reinventing Medicaid” initiatives — “rebalancing long-term care” and “health-care system redesign.”
First, close to $400,000 will be “saved” by stopping a program at the end of November that offers care management services to several thousand Medicaid recipients. The state adopted “community health teams” (CHT) as a model to reduce costs. The teams coordinate with primary care practices to provide services outside of the medical practice offices for high-risk patients to help improve quality of life and decrease unnecessary costs of care. The teams also help patients get to primary care visits, keep up with medications and help address “social determinants of health,” such as housing and nutrition.
One of the CHT programs serving a very vulnerable population has been defunded without opportunity for legislators or community members to weigh in on this decision and review the plans to continue to meet this population’s care coordination needs.
Second, the governor halted the pilot Home Stabilization program, which provides funding for victims of domestic violence, people with behavioral health challenges and others to avoid homelessness. Just launched in January 2017, the program has already helped more than 70 people to remain in their homes by supporting them in renewing leases and understanding their rights and responsibilities as tenants.
Finally, the governor redirected several million dollars in state and federal funds that could have been used to implement proposals in her Healthy Aging in the Community initiative to help seniors and people with disabilities live at home, including increased funding for senior centers.
Instead of putting in place new services to “rebalance long term care”, the governor is now using the funds to pay for the long-overdue pay increases for home care providers, even though this increase was separately funded in the enacted budget. While she has called this an “accounting change,” the reality is that, overall, funds for “long-term care rebalancing” are reduced by several million dollars for 2018.
The Protect Our Healthcare Coalition is a group of 23 leading Rhode Island nonprofits and consumer groups united to protect and promote quality, affordable health care for all. We are disappointed that so much of the “undistributed savings” are squeezed from programs designed to move our Medicaid program forward. We would like to see money restored, and expect that the governor will not make major cuts to the Medicaid program in her 2019 budget.
The truth is that Medicaid matters, and dollars spent today mean a better quality of life and savings tomorrow.
Linda Katz is the chairperson of the Protect our Healthcare Coalition and policy director at Economic Progress Institute. Karen Malcolm is coordinator of the coalition.