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Delivery of Care

Where’s the fire? In your eyes

When things fall apart, the need for urgency becomes a political football

Photo by Richard Asinof

Camilla Pelliccia at the tent city in front of the State House on Thursday afternoon, Dec. 2, in support of the action being led by state Sen. Cynthia Mendes.

By Richard Asinof
Posted 12/6/21
The political theater of setting up a tent city on the steps of the State House to try to force the state to take action to protect those lacking shelter accentuates the difficulties inherent in government trying to respond to emergency situations with processes stuck on preserving the status quo.
Why did WPRI fail to ask former CVS CEO and gubernatorial candidate Helena Foulkes about the fact that pharmacy costs for prescription drugs are the major driver of higher health costs in Rhode Island? Why did the Rhode Island Foundation, in its analysis of the proposed merge between Care New England, Lifespan, and Brown, fail to discuss the role that Medicaid plays within the health care delivery system? Why is there so little accountability for the alleged inaccuracies in data prepared by managed care organizations?
Beyond the ongoing scandals related to Eleanor Slater Hospital and the questions regarding the delivery of care to vulnerable patients and apparent mismanagement of Medicaid funding, there is a new twist: In 2019, Rhode Island was approved for a substance use disorder IMD waiver, which allowed SUD IMD facilites to bill fee-for-service Medicaid, according to a document capturing the state’s intentions around how to pay for future residential treatment.
Apparently, the state has never transitioned the IMD providers to fee-for-service billing, instead covering them under the BHDDH’s Substance Abuse [and Mental Health Services Administration] block grant.
Using the block grant funds in such an alleged way, according to members of the recovery community, may have been illegal. When asked to confirm the details, R.I. EOHHS has refused to respond.
There is apparently a proposed budget amendment being developed by RI EOHHS to fix this problem, raising rates in FY 2023 to match the more appropriate levels, which is roughly $180 to $250 per day, compared to the current rate of $94.80 per day. What is missing from the conversation is transparency and direct involvement by the recovery community, which has been kept in the dark by the McKee administration.

PART Two

PROVIDENCE – Ironically, the question-and-answer exchange between Sen. Josh Miller and departing Medicaid Director Ben Shaffer occurred on the very same afternoon that housing advocates and political activists were preparing to launch a tent city on the brick-and marble plaza at the entrance to the State House, led by state Sen. Cynthia Mendes, a declared candidate for Lt. Governor in 2022 under the R.I. Political Coop flag, demanding that the state’s leaders take immediate emergency action to keep the homeless from freezing on the streets.

The action by Mendes and her supporters crystallized the conflict between taking action in an emergency situation and staying the course on preserving the status quo, much like the same conflict being played out on the third floor of the State House during the commission hearing.

The announcement on Dec. 1 by Gov. Dan McKee of his support for nearly $31 million in awards for 23 affordable housing projects that will create or preserve more than 600 units of affordable housing, using bond money that was approved by voters in March, nine months ago, seemed timed to counteract the messaging of the demonstrators.

The problem with conflating the two – the protests at the State House and the new grants to spur affordable housing – is that the new affordable housing development will take years to bring to fruition, while the emergency money being sought by Sen. Mendes and her supporters seeks to address the immediate, urgent situation: to keep folks without shelter from freezing in the cold.

That contrast was made even more visible when Mendes and her supporters disrupted the Christmas tree lighting ceremony at the State House presided over by Gov. Dan McKee last week.

Not surprisingly, the efforts by Sen. Miller and commission members to pin down R.I. Medicaid Director Shaffer on whether legislative interventions were needed to address the disruptions in the force around the delivery of Mediciad services caused by low reimbursement rates remained in the shadows, without coverage by the news media, save for ConvergenceRI. Why is that?

The need for speed
The failure to date by Rhode Island state government to invest more than $1.1 billion in American Rescue Plan Act funds – and the subsequent efforts by many players to frame the discussion about how that money should be spent, from the Rhode Island Foundation to Gov. Dan McKee, from the Childhood Lead Action Project to HousingWorks RI, is an accurate reflection of the difficulty state government has had in responding to what R.I. Medicaid Director Ben Shaffer termed “the public health emergency” in describing how the cornornavirus has disrupted seemingly every aspect of life in Rhode Island.

The status quo doesn’t work, the current business models for health care delivery are unsustainable, but there is an unwillingness to abandon the concept of scarcity – that there is never enough money to go around to invest in poorer Rhode Islanders, even when there is a huge budget surplus of state and federal funds.

Here is PART Two of an in-depth story detailing how government works in Rhode Island – or more aptly, how it does not work, as captured by the most-recent Senate commission hearing, whose members met on Tuesday afternoon, Nov. 30, to discuss the future of the R.I. Executive Office of Health and Human Services, at the State House.

The first meeting of the Commission had been reported on by ConvergenceRI, which, after 15 years, was putting R.I. Exeuctive Office of Health and Human Services under a stress test, to ask and answer: how has agency consolidation worked? [See link below to ConvergenceRI story, “To have and have not.”]

Unfortunately, similar to what happened at the first meeting of the Commimsion, there was no media coverage of Nov. 30 meeting, other than ConvergenceRI.

What took place was, essentially, a long exit interview conducted by the Commission members, led by state Sen. Josh Miller, grilling outgoing R.I. Medicaid Office Director Ben Shaffer. [See link below to Capital TV video of the session.]

The more than two-hour session was framed by introductory comments made by R.I. EOHHS Secretary Womazetta Jones, followed by a response from Sen. Miller, which characterized the conflict about the need for speed in the government’s responses to the ongoing crises as the safety net for the most vulnerable Rhode Islanders has unraveled.

“EOHHS has three guiding principles on how we approach our work,” Jones began. “They are choice, racial equity, and community engagement. We should never waver from these fundamental guiding principles.”

The Mediciad program, Jones continued, “is the common denominator of all of the agencies under the Secretariat’s umbrella – including the Department of Human Services, the Office of Healthy Aging, the Office of Veteran Affairs, the Department of Children, Youth and Families, the Department of Health, and the Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals.”

“We are that umbrella agency,” Jones repeated. “Medicaid is the common denominator. I want to state very clearly, as we start, my belief, which is also the view of the administration, that we should maintain EOHHS as the single state agency for administering Medicaid.”

Jones continued: “Sen. Miller closed our last hearing, and I am going to paraphrase [what he said]. It is in the interest of EOHHS, and in the context of coming out of COVID, that we should take advantage of the federal, state and local government’s ability to come together and act very quickly.”

Jones said she couldn’t agree more with that paraphrasing of Miller’s statement. “COVID has exposed many of the systemic issues… Together, we have an opportunity to address them, to ensure access to high-quality and cost-effective services. I want to express my gratitude to each of you, so we can work together and maximize the true potential of the Secretariat model, recognizing the changes in our state’s population since the statute was enacted [in 2006].”

Sen. Miller responded by asking to make one quick adjustment to Jones’ paraphrasing of his quote. “It is not that I think government should move quickly except when there is an emergency.”

Sometimes fortunately, and sometimes unfortunately, Miller continued, government has been designed to move slowly. “We have shown that it can do both, to move very quickly and respond very quickly [rather than just by design of slowly].”

Jones responded: “ I agree wholeheartedly. Every single agency within the umbrella of EOHHS truly has an impactful role in the lives of human beings, and some of these human beings are individuals whom society has chosen to think of as invisible.”

There are days, Jones continued, “when it is [a matter of] life and death, not even days, but hours within my day, when I can see the difference in whether someone survives, or they do not, whether it is access to the various services they may need, to get into a program, to [finding out] where is the Narcan.”

We work in an area, Jones stressed, “where slowness could truly mean the difference of life and death. Everyone deserves to have a life that is built on quality.”

Addressing Sen. Miller directly, Jones said: “You are right; we cannot continue to move slowly, at least not in my world.”

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