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If you're strapped for cash, as Rhode Island certainly is, you're always looking for a way to cut expenses.
One area often targeted by pundits, because it makes up such a large share of the state budget, is spending on human services such as Medicaid, which provides health care to low-income people.
In April, we looked at one aspect of that portion of the budget, giving a Half True to a statement by Rhode Island Tea Party founder Colleen Conley that Rhode Island has the most generous welfare benefits in New England. (We found that every New England state, except Maine, pays more to its welfare recipients.)
During the June 26 broadcast of 10 News Conference, Gary Sasse, former director of the Rhode Island Department of Administration and the business-backed Rhode Island Public Expenditure Council, made a related comparison, saying that the state gives out far more benefits than the national average.
Speaking of what is now the 2012 state budget, Sasse said that "of the $200-million increase [in overall spending], 90 percent is to support human service programs. We spend 52 percent more per capita on human service programs than the national average."
When reporter Bill Rappleye asked for specific numbers, Sasse said, "Well, we spend about $9,300 per capita on Medicaid programs, and that's soup to nuts, that's everything from RIte Care to nursing homes. The average for the country is about $6,100. There's a $3,000 difference.
"So the question on human services is not necessarily cutting back on eligibility, but looking at what optional services we provide. We provide about $60 [million] -- probably more than that, probably about $70 million -- in optional Medicaid services that many other states don't provide."
We asked Sasse for the source of his assertion that Rhode Island spends $1.52 for every $1 spent nationally.
He gave us two.
The first is a Feb. 10 presentation developed by the House Finance Committee, which reported that in 2008, a total of $294 billion was spent nationally on Medicaid recipients. That averages out to $6,120 per recipient (19.4 percent of the money went to children, 13.5 percent went to adults, 43 percent was for the disabled and 24.1 percent was spent on the aged).
In Rhode Island that year, the state spent $1.7 billion (about 52 percent of it federal funds) or $9,341 per recipient, with children and adults getting less (13.5 percent and 10.1 percent respectively) and the disabled getting a lot more (51.4 percent). House spokesman Larry Berman said the source of those numbers was the Henry J. Kaiser Family Foundation, which collects state and federal spending data.
The per-enrollee spending is 52.6 percent higher in Rhode Island than the United States. Sasse said that's where his 52 percent statement came from.
But what about the "per capita" spending?
Sasse said in an interview that when he said "per capita," the population he was referring to was enrollees. However, we believe most people who hear the term will think it's based on the population in Rhode Island.
Would the number be different if calculated using the general population?
As a second source, he referred us to RIPEC's 2010 "How Rhode Island Compares" report. It's based on U.S. Census data from 2008 and looks at the cost of public welfare -- Medicaid and cash payments to the poor -- on the basis of state population. That report says public welfare costs were $2,036 per Rhode Island resident, which is 51.8 percent more than the $1,341 spent per capita nationally.
If you just look at RIPEC's Medicaid numbers, as the House Finance Committee staff report did, per capita spending in Rhode Island is actually 55.8 percent more than the national average, a bit higher than Sasse said.
Why does Rhode Island spend so much more?
"We have very high residential care costs," said Sasse, a factor others have noted.
In addition, Rhode Island covers some services regarded as "optional" by the federal government, such as adult daycare, assisted living for the elderly and hospice care for the dying.
Sasse offered no specific suggestions about what to cut. He said that's for the politicians to decide; he's just looking at the basic numbers.
Fred Sneesby, spokesman for the state Department of Human Services, said in April after we published our earlier item that it's important to consider "other fiscally meaningful differences among states; for example, the percentage of disabled and elderly in Rhode Island is significantly higher than in neighboring states as well as the national average."
He pointed us to section of the Kaiser website, StateHealthFacts.org, showing that since the 2004 fiscal year, the state's growth in Medicaid spending has been significantly less than the U.S. average. He also said that eligibility for Rhode Island programs is as strict -- if not stricter -- than Massachusetts and Connecticut.
To sum up, Sasse said Rhode Island’s per capita human services spending -- by his definition, Medicaid spending per enrollee -- is 52 percent higher than the national average. By that definition, he’s correct.
He’s also correct in the more common use of "per capita" -- spending by population.
So we rate his claim True.
As often happens, our research on this item raised questions that go beyond the statement we evaluated. Chief among them: How concerned should we be that Rhode Island spends more than the national average?
Advocacy groups rarely address the question directly when they offer their reports and statistics.
The 52-percent figure could mean that the state is being overly generous with its benefits.
Or it could mean that the characteristics of Rhode Island's population require us to spend more to give the same level of service that other states provide.
Or it could mean that the national average is depressed by states that are declining to provide some of the "optional" services, such as hospice care for the poor, that some Rhode Islanders might regard as anything but optional.
Such context would help voters and their leaders make intelligent decisions about where to attack the problem. It would also help them ensure that our money is being spent wisely on the services we want to offer.
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TurnTo10.com, "10 News Conference: June 26, 2011," accessed June 27, 2011
PolitiFact.com, "R.I. Tea Party founder says Rhode Island is the most generous state in New England when it comes to welfare," April 24, 2011
Interview and emails: Gary Sasse, June 27, June 28 and July 6, 2011
RILIN.state.ri.us, "Human Services & Medicaid Issues," Feb. 10, 2011, accessed June 28, 2011
Emails, Larry Berman, spokesman, Rhode Island House, July 1 and 6, 2011
StateHealthFacts.org, "Medicaid & CHIP," The Henry J. Kaiser Family Foundation, accessed July 1, 2011
RIPEC.org, "How Rhode Island Compares, 2010 edition," accessed June 28, 2011
Census.gov, "2008 State & Local Government," State & Local Government Finance section, accessed June 30, 2011
Census.gov, "Annual Population Estimates 2000 to 2007," National and State Population Estimates section, accessed June 30, 2011
Email, Ashley Denault, director of research, Rhode Island Public Expenditure Council, June 30, 2011
Email, Fred Sneesby, spokesman, Department of Human Services, April 22, 2011
StateHealthFacts.org, "Rhode Island: Average Annual Growth in Medicaid Spending, FY1990-FY2009," The Henry J. Kaiser Family Foundation, accessed July 1, 2011
Scribd.com, "Health and Human Services Eligibility and Service Fact Book," accessed July 1, 2011
Interview, Kate Brewster, executive director, The Poverty Institute, June 30, 2011
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