August 26, 2011
Hikes in RIte Care, RIte Share Premiums Criticized
The Providence Journal
Link to article
PROVIDENCE — Advocates for the poor and low-income families on Thursday said that a planned increase in the amount some families pay each month to participate in RIte Care and RIte Share, the state’s subsidized health-insurance programs, violates federal law.
They are requesting that the federal Centers for Medicare and Medicaid Services halt the change, which takes effect Oct. 1.
At a public hearing at the DaVinci Center, Linda Katz, policy director at the Poverty Institute, argued that state lawmakers violated the federal Patient Protection and Affordable Care Act — President Obama’s controversial national health-care reform legislation — when they included an increase in the monthly premiums for certain RIte Care and RIte Share families as part of the state budget.
Specifically, Katz says, the change violates the federal law’s “maintenance of effort” (MOE) provisions, which generally prevent states from imposing new premiums or increasing existing ones.
“To allow Rhode Island to implement dramatic increases in premiums would fly in the face of the purpose of the MOE provisions — to ensure that states continue to provide access to health coverage for low- and modest-income children and adults, pending full implementation of the [Affordable Care Act’s] coverage provisions,” Katz said.
Other local advocacy groups, including Rhode Island Kids Count, the Rhode Island Council of Community Mental Health Organizations and the Rhode Island Council of Churches, will join the Poverty Institute in calling for a stop to the premium hike, according to Katz.
State officials hosting the hearing said, through a spokesman, that the state has authority under Rhode Island’s so-called “global Medicaid waiver” agreement to enact the changes without federal approval.
That agreement, formally known as the “Global Consumer Choice Compact Waiver,” was negotiated in 2009 by then-Gov. Donald L. Carcieri and generally grants Rhode Island greater flexibility in designing its Medicaid program, in exchange for living under a $12-billion spending cap between 2009 and 2013.
Advocates at Thursday’s hearing, however, disagreed with officials. Katz said that while some exemptions exist to circumvent the federal law, none apply in this case.
Jill K. Beckwith, a policy analyst at RI Kids Count, argued that the state’s health-care premiums are already among the highest in the country. She said increasing them further would only put more families at risk of losing health-care coverage.
Beckwith said that under the current premium levels, about 200 children and 60 parents lose RIte Care or RIte Share coverage each month for failure to pay their premium.
“We urge the department to confirm with CMS whether these increases would be an MOE violation […] in order to avoid investing scarce resources in implementing a change that might not be allowable and which could cause coverage disruption for Rhode Islanders,” she said in a written statement.
The premium increase calls for families with an income between 150 percent and 185 percent of the poverty level to go from paying $61 a month to $91 a month. Families with incomes between 185 percent and 200 percent of the poverty level will see their premiums increase from $77 to $113. And families between 200 percent and 250 percent will see theirs increase from $92 to $122.
The changes would result in $670,000 in general revenue savings, but affect about 13,000 people on RIte Care or RIte Share, state officials have said. Families with an income less than 150 percent of the poverty level do not pay a monthly premium under either program.