The Raimondo administration wants to see more efficiency when it comes to spending on Medicaid, the joint state and federal program that provides health insurance to the very poor and people with disabilities. Roughly every dollar spent by the state is matched by the federal government.
During a March 2, 2015, presentation to the Reinventing Medicaid Working Group, the state's secretary for health and human services, Elizabeth Roberts, displayed a slide which said that nearly a third of all state tax dollars goes to Medicaid.
"More than 30 cents of every state tax dollar goes to Medicaid," the slide said. It also contained a pie chart in which Medicaid is shown eating up 31.5 percent of those tax dollars. The slide lists the source as the state budget for the 2013 fiscal year.
But on March 31, 2015, groups that want to create a single-payer health insurance system in the state challenged that statistic and others being used by the Raimondo administration in its push for Medicaid reform.
The Rhode Island chapters of Physicians for a National Health Program and HealthCare Now said the actual percentage isn't 31.5 for fiscal 2013, but closer to 22.
We decided to see who was correct.
Because Roberts specifically mentioned "state tax dollars," for this fact check, we will only look at general revenue funds raised by the state, not federal funds shared with the state or restricted funds.
When we contacted Roberts' office, spokesman Michael Raia said the source of the information was listed incorrectly. The 31.5 percent is based on the current fiscal year of 2015.
According to data from the House Finance committee, this year the state is slated to spend $1.084 billion of its unrestricted money on Medicaid. That's 31.5 percent of the $3.445 billion in general revenue funds. (The state budget enacted that year totaled $8.78 billion, including restricted revenue and federal money for Medicaid and other things.)
That made us curious. What were the numbers in 2013, the year cited incorrectly by Roberts?
The Rhode Island Health Care Association, one of the groups questioning the numbers, referred us to the executive summary of Gov. Lincoln Chafee's budget for the 2015 fiscal year. Page A-5 listed $3.216 billion in general revenue for that year and page 71 of the budget's technical appendix says the Office of Health and Human Services (OHHS) actually received $772 million from the general fund. That would be 24 percent, close to what the critics claimed.
But in the 2013 enacted budget, 20 percent of the state's Medicaid money was spent by other departments, including Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) and the Department of Children, Youth and Families (DCYF). That makes the 24 percent too low.
When all of the state’s spending for Medicaid out of its general revenues is accounted for, the percentage comes out to around 31 percent.
Roberts said more than 30 cents of every state tax dollar goes to Medicaid.
She cited a specific percentage of 31.5 percent and said it came from the 2013 fiscal year. It's actually from the 2015 fiscal year. But the percentage from 2013 is very close to that.
Roberts may have gotten the source year wrong, but it turns out that either year produces the same result. We rate her statement as True.
ReinventingMedicaid.RI.gov, "Working Group Meeting #1," and "Reinventing Medicaid: Sparking the Comeback for a Healthier Rhode Island," both March 2, 2015, both accessed April 3, 2015
ProvidenceJournal.com, "Single-payer advocates in R.I. critical of Medicaid spending cuts," March 31, 2015
RILIN.state.RI.US, "Section VI Special Reports," pages 767-769, "Section II Statewide Overview," page 21, House Finance Committee report on the FY 2015 budget; "Section VI Special Reports," page 703-705, House Finance Committee report on the FY 2013 budget; all accessed April 14, 2015
Interviews and emails, Virginia Burke, president and CEO, Rhode Island Health Care Association, April 3-14, 2015
Budget.RI.gov, "State of Rhode Island and Providence Plantations, Executive Summary, Fiscal Year 2015," "Technical Appendix, Fiscal Year 2015," and "State of Rhode Island and Providence Plantations, Executive Summary, Fiscal Year 2014," undated, accessed April 14, 2015
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