CMS OKs Rhode Island's medicaid global waiver.

Rhode Island's Aug. 8, 2008, application for the Medicaid waiver proposal has been approved by the Centers for Medicare and Medicaid Services for a period of five years beginning Jan. 16, 2009, or with the enrollment of the first demonstration participant through Dec. 31, 2013.

In Rhode Island, there is a strong consensus that the Medicaid program as it is configured can no longer be sustained in the current fiscal environment, given the nature of the demand for health care services. It is this consensus that provided the impetus for enacting the Rhode Island Medicaid Reform Act of 2008.

The Medicaid Reform Act directed the state to apply for a global demonstration under the authority of the Social Security Act to restructure the state's program to establish a "sustainable cost-effective, person-centered and opportunity-driven program utilizing competitive and value-based purchasing to maximize available service options and a results-oriented system of coordinated care."

Rhode Island will operate its entire Medicaid program under a single Section 1115 demonstration. All Medicaid-funded services on the continuum of care, including preventative care in the home and community, care in high-intensity hospital settings, long-term, and end-of-life care--will be organized, financed and delivered through the demonstration. The state's current operating waivers and demonstrations will be terminated and the services will instead be furnished through the Global Consumer Choice Section 1115 demonstration.

The Global Consumer Choice Demonstration provides for administrative flexibility combined with a potential to rebalance the long-term care system, which will allow individuals to remain in the community to receive their care, according to Gary Alexander, secretary of the state's Department of Human Services.