Rhode Island Sees Long-Term Potential for Expanded Welfare Services Through Health Care Exchange

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By interlinking the new health exchange system with a range of social welfare programs, Rhode Island could emerge as a national trendsetter.  That is what Health and Human Services (HHS) Secretary Steven Costantino, Lt. Gov. Elizabeth Roberts, and Health Benefit Exchange Director Christine Ferguson suggested to reporters during a press conference held a few hours after the U.S. Supreme Court ruled to uphold the federal health care law.

The key quote came from Secretary Costantino who told reporters that once a “unified infrastructure” was in place that offered  “one-stop shopping,” Rhode Island residents could use the system to access not just health care, but a range of social services. Costantino specifically mentioned food stamps and the TANF program, which stands for Temporary Assistance for Needy Families (TANF).

When Costantino was asked if the “unified health information” approach was unique to Rhode Island, he responded by saying that it was, as did Ferguson, the benefit exchange director, and Lt. Gov. Roberts.

“We’re the only ones,” said Ferguson.

“We’re the only ones who have taken this approach of linking these things together,” Roberts added.

In an interview, Jennifer Wood, chief of staff to Lt. Gov. Roberts, acknowledged that state officials may use the health exchange system as a gateway into social welfare programs like food stamps at some point. But she also said this kind of arrangement would only be explored as a long-term option.

The focus between now and when the federal health care law, known formally as the Patient Protection and Affordable Care Act (PPACA), goes into effect in 2014 is on getting the necessary technology up and running, and on facilitating  the new health care services, Wood said.

“From the federal government’s end, it is willing to fund states to establish an interface to the public for the purchase of health insurance, and they [the feds] have said we have to be sure and utilize any technology assets from other states,” she explained. “Rhode Island is part of a New England consortium set up to use the same technology. What you were hearing at the press conference is more of a theme that we don’t want to create three or four computer systems to do the same thing. The entire focus of implementation for the health benefit exchange is on giving the access to the public for health insurance through the new format.”

Once Rhode Island officials move beyond the initial phrase of implementation, it may be possible to incorporate features into the exchange system that are similar to “RI.Gov,” a state web site that allows residents to access multiple services, Wood indicated.

“There is nothing unique about our approach, and frankly those questions [about adding in additional benefits] are questions for 2015, 2016, and 2017,” she said. “We are racing to meet the challenge of having a system that is ready to serve Rhode Island and the public. We do not want to get too far out in terms of taking on additional elements since the focus of implementation is to have a single, non-duplicative enrollment system. We don’t want every state to reinvent the wheel, we want to get the best bang for the public.”

Beginning in October 2013, members of the public will be able to review health care service options available within the exchange system. They can begin making purchases in 2014.

The idea of using health care services as a gateway into expanded eligibility for other government benefit programs backs into a larger national agenda the Obama Administration continues to  advance, Katherine Bradley, a research fellow with the Heritage Foundation, told the Ocean State Current. There are existing loopholes within the food stamp program that enable government officials to increase the eligibility level beyond what was originally intended, she noted.

These loopholes are in operation under what is known as “categorical eligibility” and  LIHEAP (low income heating and energy assistance program), which enable individuals to sign up for food stamps even if their assets and incomes exceed the maximum levels set to qualify for benefits, Bradley explained. By closing the “categorical eligibility” loophole $14 billion would be saved over 10 years, and by closing the LIHEAP loophole $10 billion would be saved over 10 years, Bradley said.

Part of the problem states have is that there are 70 different means tested welfare programs administered through the federal government that have their own distinct eligibility requirements, Bradley observed.

“We at the Heritage Foundation are all for giving the states more flexibility in terms of how they administer these programs; we sympathize with the idea of them wanting to streamline these services,” she said. “However, our first goal is good government. We want to make sure these programs are going to the people they were intended to go to, and we want to be true to the intention of the program.”

Bradley also expressed concern toward the idea of “express lane eligibility,” which has been incorporated into the Children’s Health Insurance Program (CHIP). The idea behind express lane eligibility  is to allow for data to be drawn from a variety of means tested programs and government databases in an effort to speed up eligibility for both Medicaid and CHIP. The express lane eligibility provision included within the 2009 CHIP reauthorization legislation makes it possible “for the first time” for states to “borrow” findings from other government agencies to determine Medicaid or CHIP eligibility, according to a policy brief from Families USA.

Under the PPACA, commonly referred to as ObamaCare, there is a “particular emphasis on simplifying enrollment in Medicaid, CHIP, and premium tax credits, in part, by building on principles of Express Lane Eligibility: minimizing the amount of information a consumer must provide to apply for coverage and maximizing states’ ability to obtain information from existing state and federal databases,” the brief says. “The lessons learned from implementing Express Lane Eligibility for children will also have direct relevance to the enrollment policies that are adopted as part of health reform implementation.”

Although top officials within Gov. Lincoln Chafee’s administration now appear to be backing away from the idea that the exchange system could serve as a gateway from health care to other social services, Mike Stenhouse, CEO for the Rhode Island Center for Freedom and Prosperity is skeptical.

“It is becoming increasingly clear that there may be  a secondary motive behind these state-level exchanges,” Stenhouse said. “This governor’s administration has openly admitted that they have considered how to utilize the so-called health care ‘portal,’ and the enormous amount of personal information they will collect from would-be recipients, as a means to identify and hook more people  onto other government services.”

Stenhouse also suggested that the Rhode Island exchange system could ultimately evolve into a “dependency portal” that is emulated in other states. New regulations issued through President Obama’s Health and Human Services Department that “gut work requirements” point to a larger national agenda, Stenhouse warned.

“It is certainly reasonable to conclude that expanding dependency is a major objective of this government,” he said. “An express lane to dependency flies directly in the face of our deeply held American values of self-reliance. This is not the proper role of  government and all citizens should be alarmed about this dramatic departure from our core principles.”

The RI Center for Freedom & Prosperity is the parent organization of the Ocean State Current.

Wood, the chief of staff to Lt. Gov. Roberts, insists the concept of “one stop shopping” refers just to health care services.

“If you are looking for health care coverage in Rhode Island, you should only have to look in one place,” she said. “Not three or four, that would be ridiculous. The idea is to have less bureaucracy, and we are pretty excited about the new system.”



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