The proposed Global Medicaid Waiver will negatively impact Rhode Islanders who are vulnerable and have little means to supplement their care. If funds are capped over five years as planned, the state will not be able to request more money if costs run over budget, which could leave many without necessary services. While proponents claim the waiver will expand some services, it will ultimately mean those with disabilities or low incomes may have to go without care if costs are not covered. The waiver also fails to address how to transition people from institutions to community-based care as promised, given reductions to transportation services. In general, the plan makes unrealistic assumptions and does not genuinely consider the impact on Rhode Island residents who rely on Medicaid and social services.

1. Op Ed – Providence Journal PostedAug11, 2008
Opinion
Waiver will not help those who are vulnerable
GuestColumn:Mary E. Wambach
Current discussions on the proposed Global Medicaid Waiver have focused on
the specifics of the planned changes, and for the most part, it seems that some
legislators and the public are very concerned about how the “capped” funds
would get Rhode Islanders through a five-year period in which we would not
be able to ask for more Medicaid dollars if we ran out.
Proponents of the waiver have elucidated several items that may be worthy of
our support (expansion of some services, new services for families), but their
spin on the overall impact nullifies the public’s ability to see the reality of the
waiver’s impact: This proposal means that those with little or no means to
supplement services may have to go without them. If they live long enough,
they may survive waiting lists. But we have no plan for that.
The plan is to approve the
plan and then worry after the
fact. Hmmm … isn’t that how we got into this fiscal crisis, by the way?
As a (deaf) person who has worked full time (except when in college) since I
was 17 and who has worked for pay since the age of 8 (babysitting, fruit-
picking, house-painting, lawn mowing), I find it extremely disconcerting that
Medicaid recipients are apparently assumed by the plan’s authors and
proponents to be “others” – not themselves, their families or those close to
them. As an advocate and adult community member for more than 30 years,
and an administrator for more than 25, I wonder if anyone truly believes (as
stated in the plan) that “consumer choice” and “administrative flexibility” will
occur simultaneously. In my experience, these two characteristics tend to be
pretty much mutually exclusive.
More to the point, we are a nation of baby boomers who are aging with
regularity despite the cosmetic, athletic and dietetic services now available.
Those in the two generations before us were guaranteed security and a
passable quality of life through the SSA system, which has been raided by the
federal government for purposes of the Pentagon. I have been waiting for
years to hear about these “borrowed” funds being returned. But instead we are
debating whether to privatize SSA benefits, in the knowledge that the system
cannot continue in its present capacity.
Again – where are the billions of dollars that were taken out? I didn’t give
anyone permission to loan my SSA benefits to another agency or division –

2. did you? Do you have a plan for when your SSA benefits and Medicaid will
not allow you to do more than barely survive?
I mention this because the proposed Global Medicaid Waiver includes the
information that “Medicaid-funded services and supports are being overused.”
This may be true, but I wonder how this is happening and who is responsible.
Rhode Island already has stripped health insurance and daycare from children,
teens and adults with disabilities and parents who are attempting to return to
work or get work-related training. We have ignored the Olmstead Act (after
convening a panel in 2000 that disbanded shortly after), only to pretend that
this proposed waiver will actually address Olmstead issues. In a year when the
R.I. Public Transit Authority tells us it will reduce trips and overall services
due to fuel costs, we’re pretending (through this waiver) that seniors and
others in nursing homes will be transitioned to community-based residences or
back to their homes – apparently the medical services and other supports will
go to the homes, too, seeing as there will be no feasible way for most of these
folks to go anywhere on their limited budgets.
And if we are stupid enough to believe that administrative flexibility and
consumer choice can co-exist, why not draft legislation that regulates or
prohibits aging, disability and injury? In fact, let’s forbid anyone to have more
than a cold or mild allergy in Rhode Island! Let’s let those uppity seniors
figure out on their own how to live on their piddling pensions, SSA benefits
and life insurance that seemed more than adequate back in the day. We’ll
draw pictures so that people with cognitive and developmental disabilities can
begin to understand that certain things are just not available to those with
disabilities, meaning that decent clothing, safe homes and trained staff are just
not in their futures.
The proposed Global Medicaid Waiver is much more than a means to save
dollars and reduce dependence on any system. It is proof that decision-makers
in Rhode Island do not consider themselves to be of the people or for the
people. It’s evidence that those whose goal is to take from the least affluent to
preserve the niceties of the middle and upper classes do not consider
themselves vulnerable to aging, disability, poverty or any of the sudden and
traumatic events that can bring about such characteristics.
Say “No” to the Global Medicaid Waiver. Tell your legislators, the governor,
the Department of Administration and the General Treasurer to do something
innovative and helpful: find a way to make the more affluent pay for what
they use, such as land, construction materials, high-ticket addresses and other
items. Set up public forums so that Rhode Islanders can give our ideas about
how the budget can be balanced and revenue can be increased. Tell them to
stop pretending that aging, disability, poverty, homelessness, addiction, illness
and mental health problems are optional. Let them know that the “free ride” is

3. not being taken so much by those using Medicaid, SSA, Food Stamps or
TANF benefits, but by those whose employment, overtime, vehicles and
meals are guaranteed through the state’s “It’s not what you know but who you
know” club. •
Mary E. Wambach is the executive director of the Corliss Institute, as well as
a trustee of the Rhode Island School for the Deaf, a commissioner of the
Rhode Island Commission for the Deaf/Hard of Hearing and a member of the
State Rehabilitation Council, among other positions.