Excerpts from the delegation's letter to Carcieri

According to a note on this letter to Governor Carcieri, from Senators Reed and Whitehouse and Representatives Langevin and Kennedy, it was electronically transmitted today to the governor's office.

As noted in my previous post, the delegation's first such letter on this topic seems to have been sent in August.

We write in regard to the Medicaid Global Waiver.

Despite numerous public briefings held in Rhode Island, a detailed plan and justification are still not public and accessible. Collectively and individually, we have made repeated requests for specific information, but we are still awaiting key details. For example, the State has not provided data on the impact on beneficiaries, nor has it provided projections of state spending, savings, or assumptions and methodologies on which such projections are based. Absent such basic information, it is extremely difficult for us to make an informed and responsible evaluation of the waiver.

From the information we have, one aspect of the waiver seems quite clear. The aggregate cap on spending could leave the State up to $842 million short of its projected obligations over five years. This is because the cap is based on national projections in the President's Budget, and does not factor in Rhode Island's specific circumstances -- including a significant aging population and skyrocketing unemployment. While the President's Budget and the waiver assume an unemployment rate of only 4.9 percent, Rhode Island's unemployment rate is currently 9.3 percent. By the State's own estimates -- which understate the problem by assuming a maximum unemployment rate of 8.0 percent -- 53,433 people will become eligible for Medicaid due to increased unemployment. Because of the cap, the federal share of the costs of enrollees above the cap is at stake.

In these uncertain times, we believe the cap could pose serious risks to the Medicaid program, leading to potentially unprecedented cuts to providers and cost-shifting to the insured as a result. Moreover, unless the state maintains and adheres to an annual target for expenditure consistent with the five-year cap, budgetary pressures and policy decisions could result in accelerated early spending, creating significant shortfalls in the last years of the waiver ....