PROVIDENCE — For more than two hours lawmakers yesterday pelted Governor Carcieri’s staff with pointed questions about his cost-cutting plan to reduce Rhode Island’s nursing home population by nearly 700 elderly residents, beginning in July.

And for two hours, top Carcieri officials repeatedly told the House Finance Committee that they would meet the governor’s goal to cut $67 million in Medicaid spending for the elderly and disabled, but that they had yet to draft a specific plan.

“At this point, I’m kind of wondering what we’re doing here today. We’re having a hearing. But from what you’re giving us, we’re kind of flying blind,” said Rep. John Patrick Shanley, D-South Kingstown.

The majority of the committee was equally frustrated by the lack of details provided about Carcieri’s plan to restructure Medicaid spending — a key ingredient in the 2008-09 state budget he proposed two weeks ago that seeks to close a budget deficit of at least $384 million for the fiscal year that begins July 1.

The governor hopes to cut nursing home populations by more than 10 percent next year by encouraging the elderly to stay in their homes and use visiting nurses, adult daycare and other assisted-living programs. Carcieri officials and legislators agreed yesterday that most people would prefer to stay at home.

“Here’s a good policy that you’d probably get a lot of support for that we can’t get one answer on how it’s going to get done,” said House Finance Committee Chairman Steven M. Costantino, adding that the uncertainty is causing fear among the state’s 6,500 nursing home residents. “I have a bunch of letters … from elderly who are in nursing homes who are just fearful because of unknown…Not that the policy is not a good policy. It is unknown.”

Department of Human Services Director Gary Alexander said that elderly residents shouldn’t be afraid because the governor’s plan to reduce nursing home populations would be voluntary.

Rep. Peter L. Lewis, D-Westerly, later responded: “As you said, this is a voluntary program, which, again, is a point of concern …

“So what happens if you don’t have enough volunteers? What happens if your target number, you can’t reach?”

“We believe that that amount of people would [leave],” Alexander said.

“Based on what?” asked Lewis.

“Based on what other states have done …” Alexander responded.

Carcieri said that his proposal to restructure Rhode Island’s system of long-term care, which includes eliminating some expensive residential placements for disabled children and adults, could save taxpayers $34 million next year.

The governor proposed a 2008-09 state budget late last month that contained only a one-page “placeholder” where the lengthy Medicaid plan should have been.

Carcieri’s staff plans to submit legislation detailing the proposals the week of Feb. 25, Adelita Orefice, deputy director of the state Office of Health and Human Services, testified yesterday.

But much of the plan requires the approval of the federal Centers for Medicare and Medicaid Services.

Alexander said that the DHS had been in discussions with CMS, but likely wouldn’t submit a formal request for a waiver until the end of next month.

Timing is an issue, as Carcieri’s budget calls for the new policies to be in place July 1.

The state must hold a series of public hearings before adopting the proposed changes. And the federal Medicaid agency typically has 90 days to issue decisions, although Alexander said he would request an expedited response.

“What I need is a real, real number, and a real, true timeframe,” Costantino said to Alexander. “My gut is telling me that every planet has to be lined up exactly perfect for this to happen July 1. And you know what? Something tells me it’s not going to happen.”

Lawmakers also asked Alexander whether community-based programs were prepared to handle an influx of elderly people beginning in July. The governor’s cost projections assume that 125 people would leave nursing homes and many more would be persuaded not to go in the first place. Altogether, Carcieri’s 2008-09 budget counts on cutting financing for 690 Medicaid-eligible nursing home residents.

Alexander said the community isn’t prepared to handle the influx, but that the state was prepared to invest $7 million in rate increases for assisted-living and adult daycare programs, in addition to developing shared-living arrangements.

Advocates for the elderly who attended yesterday’s hearing generally support the governor’s push to reduce dependence on nursing homes, but decried Carcieri’s immediate plans to make outpatient programs more expensive.

As of today, the state will begin charging higher copays for elderly enrolled in subsidized adult daycare or home-care services — more than 1,200 people who earn less than $20,000 a year. Copays for adult daycare will increase from $9 per day to $11.50; home-care copays rise from $5.50 per hour to $7.50.

The average copay for the low-income elderly will go from $6,000 a year to $8,000, according to an analysis provided by the Senior Agenda Coalition. The state also plans to cut tens of thousands of dollars this year from private organizations that serve the elderly at their homes, such as Meals on Wheels.

Alexander acknowledged it would be a tough road ahead.

“I know it’s difficult, but it can’t be a situation where we’re sort of either adversarial, or trying to pick these things apart,” he told the committee. “At some point, leadership has to be taken and we need to make this change happen, as hard as it may be.”

speoples@projo.com