off the charts
POLICY INSIGHT
BEYOND THE NUMBERS

Why Rhode Island Doesn’t Tell Us Anything About a Medicaid Block Grant

My colleague Donna Pavetti has rebutted claims in an op-ed in today’s Wall Street Journal that TANF is a model for converting Medicaid to a block grant.  The op-ed also cited Rhode Island’s experience under a Medicaid waiver as evidence of the benefits of block-granting Medicaid, but these claims, too, are highly misleading:
  • As we’ve written, Rhode Island’s waiver was a sweetheart deal between the outgoing Bush Administration and its former Republican governor that directed extra federal Medicaid funds to the state and greater flexibility over Medicaid rules in exchange for a cap on its Medicaid spending.The cap was set at an inflated level that the state never expected to reach anyway. This influx of extra federal funds — an independent report commissioned by the state pegged this number at $42 million from 2009 to 2011 — is the exact opposite of what would happen under proposals to block-grant Medicaid, where the goal is to reduce federal spending.
  • The Rhode Island waiver did not save the state $100 million, as the Journal suggests.  Rather, the state saved $23 million through policy changes that it could have instituted via a waiver without a funding cap.
  • The op-ed misrepresented the flexibility that Rhode Island received through its waiver.  Some of the steps that Rhode Island has taken to control costs, such as emphasizing home- and community-based services for people needing long-term care and strengthening measures to combat waste, fraud, and abuse, are worth supporting.  But the Journal failed to mention that these flexibilities are available to all states under existing Medicaid rules.