By Jeffrey A. Marshall, CELA*
Governor Elect Tom Corbett has announced that he will nominate Gary Alexander to become the new head of Pennsylvania’s Department of Public Welfare.
Mr. Alexander is a lawyer. He received his bachelor’s degree in political science from Northeastern University and his J.D. from Suffolk University School of Law. He and his wife of 14 years have two children.The approval of his nomination by the Pennsylvania Senate appears highly likely.
Mr. Alexander previously headed the Rhode Island Office of Health and Human Services where he oversaw that State’s innovative and controversial Global Medicaid Waiver Program. Under that Waiver, approved by the federal Bush Administration, Rhode Island agreed to a cap on federal funds in return for unparalleled flexibility in designing its Medicaid program and spending those funds.
The Global Waiver allows the state to limit federal Medicaid entitlements in favor of state determined priorities. The premise was that an unfettered Rhode Island could cut costs by pursing strategies such as reducing institutionalization through expanding home and community based care.
Readers who would like more information about Rhode Island’s Medicaid Waiver can find it at the following links:
A recent column by Mr. Alexander: Medicaid Waivers and the Rhode Island Model
An overview from Stateline.org: Rhode Island’s Medicaid Gamble
A December 10, 2010 article by Randal Edgar and Katherine Gregg in the Providence Journal's Rhode Island News states:
The final story has yet to be written on the Global Medicaid Waiver that [Rhode Island Governor] Carcieri won from the Bush administration, in its final days. . . .
As for the waiver itself, Carcieri acknowledges it has not yet produced the $60 million in annual savings he anticipated from the state’s newly won freedom to use its Medicaid dollars to pay for less-expensive alternatives to nursing homes. An interim report indicates the number of nursing home patients has indeed dropped 12 percent since Jan. 1, 2009, but the state’s $308-million nursing home bill rose 6.9 percent. The cost of providing home care and other “community-based services” went up 45 percent during the same span.
Carcieri says “these things take time.” Had it not been for the new opportunities provided by the waiver, nursing home costs “would have tripled,” said his spokeswoman, Amy Kempe.
So, it is probably accurate to say that the jury is still out on the Rhode Island Global Waiver. The program has yet to produce the kinds of savings initially predicted by its proponents. But, in fairness, its results have undoubtedly been impacted by the recent Great Recession. The past two years were not a good test period.
At this point, we can only speculate on the Corbett/Alexander plans for Pennsylvania’s Medicaid program. Much has changed in the few years since Rhode Island received federal approval of its Global Waiver. The Obama administration may be less receptive to this kind of proposal than was President Bush. And the new Health Care Reform law is now set to provide health insurance coverage to many otherwise uninsured through an expansion of Medicaid.
I do expect that, in an era where the political password is “austerity,” Mr. Alexander will be tasked with reducing the escalation in the state’s share of Medicaid costs without jeopardizing the health of the program’s vulnerable beneficiaries – our children, the disabled, and seniors.
This won’t be easy. Medicaid is big business in Pennsylvania. Any new initiatives will face a gauntlet of interested stakeholders including health insurers, nursing homes, hospitals, health professionals, unions, and other interest groups, all of whom have a strong voice in Harrisburg. And the public believes in Medicaid. 80% of the public thinks that it is the government’s responsibility to help pay for health and long term care services for people with disabilities and chronic health conditions who cannot afford to pay for it themselves, according to The Kaiser Family Foundation , National Survey of the Public's Views About Medicaid (June 2005).
I join with other Pennsylvania Elder Law Attorneys in welcoming Mr. Alexander to Pennsylvania and wishing him well as he embarks upon his difficult new position. We will be anxious to meet him and learn of his plans for the future of Pennsylvania’s Medicaid safety net.
*Jeffrey A. Marshall is Certified as an Elder Law Attorney by the National Elder Law Foundation, under authorization of the Pennsylvania Supreme Court.