More on the Medicaid waiver

Word of the Congressional delegation's expression of concern yesterday to Governor Carcieri -- first reported here -- blew up on TV and in today's ProJo.

Meanwhile, gov spokeswoman Amy Kempe got back to me late yesterday. Here's part of what she wrote in response to the delegation's concerns:

The Governor has offered to brief the delegation, here in RI or to fly to DC, on the waiver and has extended the offer for his staff to brief their staff. As for the cap, DHS, CMS and the House Fiscal staff all agree, after extensive and careful analysis of potential future growth, that the State will NOT exceed the cap.

Kempe also sent along a copy of a letter from the governor, dated November 7, responding to an earlier piece of correspondence from Jack Reed. It reads in part:

In proposing the Global Compact Waiver, I am committed to doing no less [than maintaining RI's place as a forward-looking state on health-care]. The critical factor here is what the State stands to gain from taking this risk: the flexibility required to transform Rhode Island Medicaid into a sustainable, cost-effective program capable of adapting to the changing needs of beneficiaries.

I also got some comment on the waiver yesterday from US Representative Patrick Kennedy. Here's what he had to say, in comments relayed by his office via e-mail.

I have been opposed to the waiver from the onset. First and foremost, the waiver offers no protections to ensure that essential benefits are available to those for whom they are medically necessary, instead giving the State unprecedented authority to make changes to services in nursing home care, health insurance for low-income children and parents, and prescription drug coverage for seniors. Further, the aggregate cap on spending could pose serious risks to the Medicaid program, and we’ve yet to see detailed projections on the State’s plan to cover what would appear to be a very large shortfall. These shortfalls could lead to potentially unprecedented cuts to providers and cost-shifting to the insured as a result.

To recap, we have two divergent forecasts on the impact of the waiver. If I were to bet, I'd predict the General Assembly will not hold it up by the deadline tomorrow.