Proponents of block granting Medicaid have been pointing to Rhode Island’s Section 1115 research and demonstration waiver that includes a global cap on federal spending as evidence of the success of this approach. But as an article that appears in yesterday’s New York Times underscores, this analogy is just another example of the “fact free” policy discussions that pervade our political discourse. There is no hard evidence at all to document claims about how much money the state has saved.
Rhode Island received approval for its proposal in the waning days of the Bush Administration and the spending agreement reached was a cushy deal for the state. Not only did the state get to substitute federal funds for some previously state-only funded programs, the federal spending cap was set at a very high level. Do we really think that current block grant proponents who are in it for budget cutting purposes would similarly increase federal spending under a block grant arrangement? I am a huge fan of Rhode Island (for personal and professional reasons) and mean no disrespect here, but remember the state’s nickname is “Little Rhody”- it is the smallest state in the country. I sincerely doubt that a similar deal would be offered by block grant proponents to all 50 states who want to reduce federal spending sharply.
If Rhode Island is coming up as a model in your state, I urge you to check out this great piece by our colleagues at the Center on Budget and Policy Priorities which lays out these issues in greater detail. I suspect that this is not the last we’ll hear about the Rhode Island waiver.