Delivery of Care

What happens to a question deferred?

The newly appointed R.I. Medicaid Director Benjamin Shaffer appears to be adept at deflecting questions and avoiding interviews

Image courtesy of Shaffer's LinkedIn account

Benjamin Shaffer, the newly appointed Director of the Rhode Island Medicaid office.

By Richard Asinof
Posted 4/27/20
The newly appointed director of the R.I. Medicaid office, Benjamin Shaffer, seems adept at dodging questions and skillful at avoiding interviews.
Will the transparency and openness of holding daily news briefings by Gov. Gina Raimondo and her team in the midst of the coronavirus pandemic permeate the other regions of her administration? At a time when behavioral and mental health providers are struggling to cope with the increasing demand for services and low rates of reimbursement, who will hold the actions of the R.I. Medicaid office accountable? Will the R.I. Attorney General Peter Neronha investigate alleged problems with Medicaid rate reimbursements and issues of payments from private contractors?
As mental health and behavioral health providers in Rhode Island seek to retain a skilled work force to deal with the flood of new demands for service as a result of the coronavirus pandemic, sources have told ConvergenceRI that headhunters from other states, including New York, Connecticut and Massachusetts, are attempting to recruit Rhode Island workers, offering them higher rates and better benefits.
In a recent executive order by Gov. Gina Raimondo, it referenced making temporary increases in Medicaid rates to offset lost revenue and increased costs due to COVID-19. Providers want to know: what is the status of those proposed temporary increases? What is the projected time frame for those increases to begin? Will the increases be applied to the rates from the managed care organizations? Will the increases be retroactive to the date of the executive order?

PROVIDENCE – One of the more providential outcomes of the daily news briefings being held by Gov. Gina Raimondo is the manner in which it has achieved a modest leveling of the playing field in terms of access by reporters, some of whom, like myself, in the past, have found ourselves on the outside looking in, frozen out because of the way that news flow had been managed by the Governor’s communications office, in seeking to preserve the cozy relationship preferred by both the Governor’s communications team and the traditional news media honchos.

How much has the landscaped shifted? Alan Rosenberg, executive editor of The Providence Journal, wrote a column published on Saturday, April 25, complaining that some readers had taken offense about his newspaper printing a story about the state’s plans to extend distance learning for the rest of the school year – in advance of the Governor officially making the announcement.

Rosenberg wrote, in response to a reader’s comment, “Gina made it very clear that she is the official news source,” saying: “Well, no, she’s not. In America, we don’t have official news sources that no one dares to contradict. Or to get out ahead of.”

The problem, it seems, is that The Providence Journal no longer functions as an elite “official news source” that no one dares to contradict or to get out ahead of, either. The newspaper’s alleged leadership atop the inverted news pyramid of Rhode Island newsgathering enterprises has faded away amidst corporate buyouts and debt consolidations.

The pandemic as an equalizer
The result of the daily news briefings is that some questions are now getting asked that can not be ignored or ducked or pushed aside. Which is what happened at a news briefing in early April, when a provocative question asked by ConvergenceRI was answered.

The question was: “Would you be willing to make an emergency funding request through Commerce RI to increase the hourly wages of CNA (certified nursing assistant) workers in nursing homes, hospitals, and the home health agencies?”

[Earlier in the news briefing, a similar but less specific question had been posed by Stephen Ahlquist of UpriseRI. Let’s be clear here: none of the traditional news media, who have continued to position themselves as a kind of “father and mother know best” experts in translating the news of the pandemic, have asked questions about CNAs and the problems with their low wages.]

The answer given by Gov. Raimondo was: “So at this time, what we are doing is, I’m in very good contact with hospitals, nursing homes, and the labor unions that represent the CNAs, nurses and social workers.”

She continued: “Soon the federal stimulus money will be made available to hospitals and other health care providers. And then, at that point, I would say that the individual institutions – health care institutions – will have to figure out how to use that additional capital to keep the lights on and keep folks employed and to have the PPE necessary. And I would just encourage each institution to do what they think is in the best interest of their employees and their patients.”

Translated, the Governor said that she was content to let the hospitals and the nursing homes and health care providers divvy up the promised federal stimulus money in whatever way that wanted to do so, an illustration of top-down CEO decision-making deciding what was best.

Fast forward to the news briefing on Friday, April 24, three weeks later, when the Governor announced the creation of a “Congregate Care Workforce Stabilization Fund” for private providers. “For the next month, this fund will provide temporary pay increases to low-wage frontline workers at eligible Medicaid-funded residential facilities. Qualifying employees [earning $20 an hour or less] will be eligible for up to a $200 increase each week from May 4 to June 1,” according to the Governor’s newsletter.

What changed? Good question. And, why did it change?

The value of other voices being heard
In part, it was a realization that congregant living facilities such as nursing homes in Rhode Island – and around the nation – have emerged as one of the key hotspots in the coronavirus pandemic. Deaths of nursing home residents have emerged as one of the leading contributors to the growing death toll here in Rhode Island, which reached a total of 215 as of Saturday, April 25, according to the R.I. Department of Health.

Those most at risk were not just the residents living in such facilities but the staff working there – the majority of whom are low-wage CNAs struggling to survive, often having to work two or three jobs. There continues to be an apparent lack of personal protection equipment available as well as a lack of testing for such workers. They may have been deemed “essential” but protecting them has somehow not yet been made a priority.

It turns out that nursing home industry advocates in Rhode Island had been in constant contact with the Governor’s team for weeks, requesting help, given the difficulty in retaining a low-wage work force under such hazardous conditions. [At the same news briefing on April 24, the Governor also announced that the R.I. National Guard was to be mobilized to provide expert assistance in helping to staff nursing homes.]

Who should get credit for prompting the change in policy by the Raimondo administration? Another good question.

Despite the self-congratulation about their own efforts by many of Rhode Island’s newsgathering enterprises, the disliked fact is that they had consistently ignored the issue of low wages for CNAs and other health care workers on the front lines. It was the persistent questioning, mostly by Steve Ahlquist of UpriseRI, with an assist from ConvergenceRI, which had pinpointed the economic equity issue of low-paid workers in nursing homes and other health facilities.

[Yes, there had been a noisy car caravan protest organized last week by SEIU to support health care workers in nursing homes earning hazardous pay.]

Time to have some uncomfortable conversations about media access
Which brings us to the current difficulty in asking questions and getting answers out of the R.I. Medicaid office.

When Womazetta Jones, the new incoming Secretary of the R.I. Executive Office of Health and Human Services, spoke at a private reception held in her honor on Aug. 22, 2019, at the Rhode Island Foundation, she said: “We have to get comfortable with having uncomfortable conversations [emphasis added] about racial equity.”

As ConvergenceRI reported at the time: “It was the kind of frank declaration rarely made in public in Rhode Island by a high-ranking government official – and even more unlikely ever to be reported on by the local news media.” [See link below to ConvergenceRI story, “It is time to have some uncomfortable conversations.”]

In a one-on-one ConvergenceRI interview a week later, Secretary Jones made her intentions clear. We have to ensure, Jones said, “that we are giving up power. We need the community to know that their voices, those voices, are the ones that need to lead how we do this work, to help us shape this work.” [See link below to ConvergenceRI story, “A change is going to come.”]

In that story, ConvergenceRI commended the straight-ahead approach of Secretary Jones and her candidness in answering questions. That approach, however, does not yet seem to have worked its way down the corporate ladder at R.I. EOHHS, judging from ConvergenceRI’s most recent experience.

Access deferred
On Thursday afternoon, April 23, in the heat of the continuing COVID-19 pandemic, R.I. EOHHS issued a news release announcing that Benjamin Shaffer had been named as the new Medicaid Director for the state of Rhode Island.

The news release contained all the usual effusive praise for Shaffer, a former consultant with the Boston Consulting Group, who had replaced Patrick Tigue, who had departed at the end of January.

Indeed, Shaffer, who had been serving as interim director of the Medicaid office as well as Deputy Secretary, has impeccable credentials as an elite policy wonk, having earned a bachelor’s from Yale University, a master’s in public administration from Harvard University Kennedy School of Government and a master’s in business administration from the University of Pennsylvania’s The Wharton School.

In the news release, Jones praised Shaffer, saying that the during the current public health crisis, the R.I. Medicaid office had submitted more than a dozen federal authority requests documents, containing more than 70 individual waivers. “These steps have been critical to infusing millions of dollars into nursing homes, assisted-living, and group homes that are on the frontlines of the pandemic,” according to Jones in the news release.

Upon receipt of the news release, ConvergenceRI sent off an immediate request, asking for an opportunity to conduct a telephone interview with Shaffer, and if that was not possible, to have him answer a series of questions.

If it was an important enough “priority” to issue a news release announcing the appointment in the midst of a pandemic, it seemed as if it would be important enough for Shaffer to be available to answer questions, ConvergenceRI reasoned.

The questions included:

• Will the Medicaid office be conducting a follow-up study to the problematic Milliman study on Medicaid rates for behavioral health services?

• What is the current backlog in processing Medicaid eligibility requests for long term care services and supports? How many are pending longer than 90 days?

• In terms of dental reimbursements for Medicaid rates, are you planning to recommend an increase?

• Have you seen and reviewed the presentation by CODAC’s Linda Hurley regarding rate reimbursements made to the Senate commission on rate reimbursement? [If not, I would be happy to send you a copy.]

• Given the recent peer recovery program run by RICARES received a $1.5 million grant from SAMHSA, how does peer recovery fit within the RI Medicaid office’s future plans?

• Is there currently an audit underway of Medicaid's private contractors?

• What kinds of rate increases do you believe are required for Rhode Island’s musing homes and skilled nursing facilities?

• What is the status of the implementation of accountable entities in RI for long-term supports and services?

• What are the current capabilities on interoperability for telehealth software being used and reimbursed in RI by Medicaid?

• Will BHLink funding be continued under Medicaid once the current funding stream runs out?

As a “bonus” question, ConvergenceRI asked: “Do you read ConvergenceRI? If not, why not?”

For the record, Shaffer’s appointment had been announced on Thursday afternoon in an email sent at 2:31 p.m. ConvergenceRI’s request for an interview – or a response to 10 questions – was sent to R.I. EOHHS in an email on Thursday afternoon at 5:52 p.m.

The next day, on Friday morning, was the Caseload Estimating Conference, a big deal when it comes to figuring out the state budget, with so many unknowns, given the challenges of living in a time of pandemic and economic disruption.

Not at this time
The request by ConvergenceRI for an opportunity to interview Shaffer or to have the questions answered by Shaffer was declined.

Here is the response from David Levesque, Director of Public Affairs at R.I. EOHHS, in explaining the decision:

“Director Shaffer and his team are engaged in urgent COVID-19-related work,” Levesque wrote. “Sorry, but he will not be able to conduct an interview. Thanks for raising the policy questions, many good questions. I’m sure the Director would like to discuss, but at a later time.”

Levesque continued: “Currently, his focus and the focus of EOHHS is on the day-to-day needs of our residents and our providers during this public health crisis. He and his team also need a firm understanding of COVID-19-related costs and lower utilization of providers before examining other across-the-board rate increases. Director Shaffer discussed much of the existing uncertainty caused by COVID-19 during his caseload testimony today. It’s attached.”

Translated, while the refusal to do an interview or to answer questions was polite and professional, it begs the question: If not now, when?

ConvergenceRI has a policy against re-publishing most news releases and statements as news stories, so as not to serve as a mouthpiece for business or governmental interests.

Further, the answer from Shaffer through Levesque seemed to imply that there may not be a good time for such an interview or to answer questions until the pandemic current subsides, which is likely to be in at least 14 months at the earliest. So much for a culture of transparency, access and accountability existing at R.I. EOHHS. What say you, Secretary Jones?

The reality is that there has been a pending request for an interview, made in person of Secretary Jones in mid-January, and followed up with a written email request, that has yet to receive a response.

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