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Will Medicaid remain a part of RI EOHHS?

Outgoing Medicaid Director Ben Shaffer was grilled by Senate Commission members, focused on finding legislative solutions to gaps in the continuum of care, caused by low rates, inadequate networks, and alleged poor management of MCOS

Image courtesy of Capitol TV

Outgoing Ri.I Medicaid Director Ben Shaffer testifying at the Nov. 30 hearing before the special legislative commission on the future of R.I. EOHHS

By Richard Asinof
Posted 12/6/21
The latest hearing of the special Senate legislative commission examining the future role of R.I. EOHHS featured attempts by Sen. Josh Miller, the chair of the Commission, to pin down outgoing R.I. Medicaid Director Ben Shaffer on the value of legislative intervention to raise Medicaid rates. Shaffer ducked the questions.
Would a state health finance agency be a better home for Medicaid than within the R.I. EOHHS umbrella? Why wasn’t Director Shaffer perturbed or worried by the fact that the software package being utilized by both Neighborhood Health Plan of RI and UnitedHealth Care, Optum, might be problematic? Should the failure to raise reimbursement rates by Medicaid be seen as a problem that could be solved by legislative intervention? Why has the news media failed to cover machinations around Medicaid, given that it is an insurance company that is responsible for a third of all Rhode Islanders and represents a third of the state’s annual budget? In the future, will the position of Medicaid director come subject of the advice and consent of the R.I. Senate?
The downplaying of the importance of the R.I. General Assembly as having a significant role in solving the low, outdated reimbursement rates set by Medicaid by outgoing R.I. Medicaid Director Ben Shaffer is perhaps symptomatic of the harm that has been done by hiring private contractors to provide “expertise” on health care and social services policy, undercutting the legislative branch of government. To dismiss the efforts of Sen. Miller and Sen. DiPalma is truly a risky business.
During the state’s response to COVID in the initial months of the pandemic in 2020, it appears that a shadow government was created, deploying high-paid consultants from the Boston Consulting Group and McKinsey & Company to supersede the public health authority of the R.I. Department of Health.
As the latest variant of COVID, omicron, appears poised to spread a new wave of infection across the U.S., Rhode Island may need to reassess how it is responding to the increased threats to schoolchildren and the economy.

PART One

PROVIDENCE – State Sen. Joshua Miller had asked the same question in four or five different ways, attempting to pin down departing R.I. Medicaid Director Ben Shaffer on the value of creating legislative solutions to the ever-widening gaps in the continuum of care created by historically low Medicaid reimbursement rates that, in many cases, had not been increased in more than a decade – including rates paid for Early Intervention, for behavioral health care, for dental care, and for residential treatment for teenage girls.

With each new attempt, Shaffer seemed to deflect Miller’s questioning; instead, Shaffer voiced his strong support for keeping the current process in place – in which the agency made its pitch to the Governor on what might be included for spending in next year’s budget, the Governor then proposed a budget, and the R.I. General Assembly then approved the spending, even if the process of implementing any new, improved spending plans to address gaps in the continuum of care took two years.

At one point, when asked by Sen. Miller if there was an “authority gap” in the rate-setting process, Shaffer had glibly replied: “You don’t end up with fee for service rates that have not been updated in 20 years, unless it takes 20 years.” The problem, Shaffer, continued, was “not something created yesterday and is not going to be solved tomorrow,” voicing his unrelenting faith in the slow, deliberate process of governing.

When Miller asked whether any “authority gap” in the Medicaid rate setting process that could be bolstered by legislative action, Shaffer replied: “I am not aware of one. I am not aware of any specific authority that we would need.”

One final attempt by Sen. Miller, sparring with Director Shaffer, occurred at the tail end of the lengthy hearing, more than two hours and 40 minutes long, held on Tuesday afternoon, Nov. 30, on the third floor of the State House.

The setting was the latest meeting of the special legislative commission looking at the future role of the R.I. Executive Office of Health and Human Services.

Indeed, the context under girding the hearing was whether or not R.I. EOHHS should remain as the “single statutory authority for administering Medicaid,” as R.I. EOHHS Secretary Womazetta Jones had argued at the beginning of the lengthy hearing.

“Do you support legislation – like Sen. DiPalma’s on dental [rates], or mine on behavioral health [rates], that says over the next five years, in order to meet the regional median of behavioral health care reimbursements, that you have five years to get the rates up by 23 percent?” Sen. Miller had asked. “Is that kind of legislation important, give that you say your have the authority, or that Medicaid has the authority to move quickly, if they wished, to force an MCO [managed care organization] to increase their rates? Would it be more effective to have this kind of legislation supported and passed?”

Shaffer, it seemed, was unwavering in his efforts to not directly answer Sen. Miller’s questions. “It would be more efficient for the R.I. General Assembly, if the General Assembly so chooses, for whatever reason, for the sake of argument, that everything that EOHHS and Medicaid puts forward in the Governor’s budget goes forward,” Shaffer said.

Still, Sen. Miller persisted. He took one last stab at getting Shaffer to respond to his question. “I think we have statistically, the foundation for this kind of legislation – whether it is the dental legislation that Sen. Di Palma had taken the lead on but we have worked on together, or the behavioral health legislation that I have led on, but he has collaborated on very strongly – is based on data. It didn’t come out of thin air, and the data on why those rate increases make sense is because they are based on a complete continuum of care – results that are longer than a 12-month budget cycle, because they avoid high-intensity care, more expensive care.”

Shaffer, once again, avoided giving a direct answer to Miller’s question. “You will get no argument from me about investing in behavioral health care and primary care, community health workers and doulas, all of the things that keep people out of the hospitals and keep people healthier,” Shaffer replied.

Sen. Miller asked: “Do you think it is probably more successful for a legislator to take that on, if it is based on data, rather than the [Medicaid] department?

Shaffer, unbelievably, replied to Miller by saying: “I truly do not know the answer to that question.” To quote WPRO’s Steve Klamkin, “Really?”

Translated, if the R.I. Medicaid office is removed legislatively from the auspices of the umbrella of R.I. EOHHS, the roots of that decision may no doubt be traced in part to the performance by outgoing R.I. Medicaid Director Ben Shaffer, who admitted that he saw no purpose or advantage in legislative intervention to raise reimbursement rates in order to provide for a continuum of care.

What will happen next? Sen. Louis DiPalma made it perfectly clear, at the end of the hearing, in an impassioned coda, it would be his intention to make sure that the R.I. Medicaid Office is removed from the auspices of R.I. EOHHS by legislative action.

“First, I believe we need a single Medicaid entity. I don’t believe it has to be in R.I. EOHHS, I really don’t,” Sen. DiPalma said. He called the failure of Early Intervention “a failure of the Secretariat.” Sen. DiPalma continued: “We haven’t seen the efficiency or the effectivenss we could expect, want, and desired.” Stay tuned.


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