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Tuesday, December 6, 2016

The future of state Medicaid is in doubt

By Steve Ahlquist in Rhode Island’s Future

Image result for will medicaid survive TrumpGovernor Gina Raimondo‘s “Reinventing Medicaid” paid off with the announcement of nearly $130 million in federal funds that will help facilitate health care professional training and alternative payment models. But questions remain: Are we training students for good paying jobs or poverty? 

Will Medicaid survive Trump?

Governor Gina Raimondo and Health and Human Services Secretary Elizabeth Roberts announced that Rhode Island has received $129.7 million in federal funds that will be used to “implement new Medicaid payment models that result in better health outcomes and better-quality care, and to strengthen the state’s healthcare workforce pipeline.”


“These federal funds will help us continue to shift our publicly financed healthcare system towards alternative payment models that ensure we’re paying for value, rather than volume of services. They will also help us invest in the healthcare workforce required to realize our shared vision of better care, healthier people, and smarter spending,” said Roberts during the State House announcement of the funds.

Senator Sheldon Whitehouse and Representatives James Langevin and David Cicilline were on hand to be lauded for their efforts in securing the federal funds.

Cicilline struck a cautious note about the funds and about Medicaid in general, saying, “I think we are in for some challenging times for the next couple of years, depending on the new administration’s view on Medicare and Medicaid, certainly our current Speaker [Paul Ryan] has articulated a different vision of ending the guarantee of Medicare and turning it into a voucher requiring older Americans to go out and buy insurance which would be catastrophic, so, hopefully the example of Rhode Island will be evidence, ammunition, frankly,  for us to make the case that this current system when administered properly can produce results in a cost effective way and help us continue to Medicaid and Medicare and other essential programs.”

CCRI (Community College of Rhode Island) President Meghan Hughes said that “training and educating Rhode Island’s health care professionals is one of the things CCRI does best… This partnership, and the financial investments being made in education will help our students advance.” Hughes said that 90 percent of health industry students who attend CCRI stay in Rhode Island, raising families, purchasing homes and paying taxes. Investing in CCRI is an investment in the state’s economy.

But what are we paying these students once they graduate? Patrick Quinn, executive vice-president of SEIU 1199NE, representing 29,000 workers in RI, MA and CT, wrote that while news of the federal investment of $130 million is welcome, “…far too often both locally and nationally we see redundant administrative costs and outrageous executive compensation packages while front line caregivers struggle to get by and provide for their families. A handful of people have become “Medicaid Millionaires,” while the rest of us – consumers, patients, residents, and direct care staff – have been left behind.”

Medicaid was developed to help combat poverty, Quinn reminds us. “Low wages plague long-term care jobs, causing high turnover among our workforce and harming our efforts to enhance the quality of care.

“That’s why workers in nursing homes, community programs for individuals with developmental disabilities, and home care across the country and in Rhode Island have joined in the Fight for $15 and a Union.”

However, looking at the state’s priorities for the money, “stabilizing the workforce with living wages, good benefits, and a union” (Quinn’s words) is not a priority.

Instead, what Raimondo and Roberts are calling “Reinventing Medicaid 2.0 – Health System Transformation, Rhode Island” will spend its money to improve health outcomes for the one in four Rhode Islanders enrolled in Medicaid. 
  • For example, over the long term the funds will help transform Rhode Island’s healthcare system so that:
  1. -More Rhode Islanders get well-coordinated care that better addresses all of their needs – mental, physical, and social – so they can stay healthy and avoid more expensive hospital visits and procedures.
  2. -More elderly Rhode Islanders get the long-term support they need to age with independence in their homes and communities, whenever possible.
  3. -Rhode Islanders who require a more intensive level of care and support receive high-quality, better-coordinated care that improves outcomes at hospitals and nursing homes.
  • Leverage millions of dollars of additional federal funds to continue transforming Rhode Island’s healthcare system.
  • Focus on better coordination of care through our managed care organizations and new provider partnerships.
  • Ensure Rhode Island has the healthcare workforce it needs by investing in strategic partnerships between Rhode Island’s public higher education institutions and healthcare providers to train students with the skills they need for 21st century healthcare jobs.
  • Support better care, healthier people, and smarter spending.
Raimondo was introduced by John Oleksa, a Medicaid recipient, “whose life was changed by more intensive, better coordinated care to help him gain back his mobility and get a personal care attendant who can help him stay in his home and live independently.” Oleksa said that the care he received helped him, “get his life back.”

Steve Ahlquist is an award-winning journalist, writer, artist and founding member of the Humanists of Rhode Island, a non-profit group dedicated to reason, compassion, optimism, courage and action. The views expressed are his own and not necessarily those of any organization of which he is a member. atomicsteve@gmail.com and Twitter: @SteveAhlquist

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