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What wouldn’t fit in the feature

September 23, 2011

If you haven’t yet, check out my feature that aired today. It’s a story of state bureaucracy making the lives of parents even harder. There’s even a happy ending- after more than a decade of talking about changing the policy, RI finally did!

This story is hard to fully explain on the radio because it involves some technical aspects of how state government funds its services.  I left out those details in the sound piece, but I can talk about them here.

So first, Medicaid.  Rhode Island and the federal government split the bill on offering health insurance to low income, elderly, and disabled residents. Currently, the Feds give us about 53 cents for every dollar we spend.  But Medicaid doesn’t cover everyone who’s low income. These are the people that qualify for the federal Medicaid program

  • Pregnant Women
  • Children and Teenagers
  • Person who is Aged, Blind, and/or Disabled

Rhode Island’s RIte Care health insurance program expands eligibility for Medicaid a little bit. These are the people that qualify

  • Pregnant women (family’s income less than 250 percent of the Federal Poverty Level- FPL)
  • Children up to age 19 (family’s income less than 250 percent of the FPL)
  • Parents with children under age 18  (family’s income less than 175 percent of the FPL)

Notice that healthy, low income residents aren’t on any of these lists. Currently, you have to have kids if you want to get health insurance from the government. Thus the problem when low income parents lose custody of their children-they’re no longer technically part of a family, so they don’t qualify for health insurance.

This becomes a problem when a mom or dad loses custody because of an addiction or mental health problem. How are parents supposed to get better when they only qualify for very scarce “public beds” in treatment facilities?

But the RI Department of Human Services says this policy wasn’t just a problem for parents with addictions.  If a child left home for any reason, the adults no longer had health insurance.  That includes juveniles who go to prison, or have such severe mental or emotional issues they have to be institutionalized.

DHS says sometimes parents with really troubled children would wait too long to put their kid in an institution because it meant giving up health care for themselves. The policy change profiled in my feature allows them to avoid that worry.

As for how this change happened-Rhode Island knew it was a dumb idea to kick parents off Rite Care just when they needed it the most, but keeping them on the program was too expensive. That’s because the feds stopped splitting the bill once moms and dads lost their kids.

When Rhode Island received the controversial Global Medicaid Waiver from the federal government, the agreement allowed for more flexibility on how Rhode Island could use federal matching funds. The so called Costs Not Otherwise Matchable (CNOMs) meant RI could experiment with new ways to split the bill with the federal government, including buying health care for parents who don’t live with their kids.

The Global Medicaid Waiver expires on December 31, 2013, but DHS is pretty confident the federal government will still chip in to pay for parents’ health insurance. I asked RI Medicaid director Elena Nicolella what the state will do if that doesn’t happen.

I don’t know. I guess we’re just assuming we’re gonna continue to get the federal funding because it’s just that good!

Nicolella said this with a laugh, and then clarified-

We will devise a way to continue to do this, because no one will argue that it’s not good policy. We just have to fund it.

At first I thought this program would only matter for the next 2 1/2 years.  That’s because in 2014, under the health care overhaul, low income individuals will qualify for Medicaid on their own. But Nicolella says the policy change will continue even then to make sure there’s no interruption in services.

What we’re putting in place today, we are fully expecting would remain because it would facilitate the continuity of services. So even if the people were able to maintain insurance after the Medicaid expansion, there’s still that possibility that there would be a disruption in services because they’d be moving from one category of eligibility to another.

A few other details on the program- it will cost RI $345 dollars a month per person. That’s the same price it pays when parents are on RIte Care. The coverage is limited to three months, with room for 30 day extensions if parents are close to reunifying with their families.  Did I leave anything out?

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