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POLICY INSIGHT
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More Evidence That Rhode Island’s Medicaid Waiver Isn’t a Model for Block Grant

Rhode Island’s Medicaid program has been operating under a federal waiver that proponents of block-granting Medicaid have cited as a model of Medicaid reform.  But as today’s New York Times explains, “An examination of Rhode Island’s experience shows it has not yielded the kinds of savings its supporters claim.”  The Providence Journal has reached a similar conclusion. As we have written, Rhode Island’s “Global Waiver” was a sweetheart deal between the outgoing Bush Administration and Rhode Island’s Republican governor; it tells us nothing about how states would fare under a Medicaid block grant, such as the House-passed proposal by Budget Committee Chairman Paul Ryan.  While federal block grant proposals like Rep. Ryan’s are designed to shrink federal Medicaid funding significantly, the global waiver has done the opposite, enabling Rhode Island to obtain millions of additional federal dollars it wouldn’t otherwise have received. And, as the Times points out, even with the global waiver, total Medicaid spending in Rhode Island has continued to rise. As Steven Costantino, the secretary of Rhode Island’s Executive Office of Health and Human Services, states, “When one does an analysis of this program and you look at what I suspect a block grant would be, many of the tenets just do not match.”