Gary Alexander, director of the Department of Human Services, left, listens yesterday to testimony at the global Medicaid waiver hearing before the House Finance Committee. At right is Elena Nicolella, health care financing consultant for DHS; center background is Corinne Calisse Russo, director of the Department of Elderly Affairs.

The Providence Journal / Connie Grosch

PROVIDENCE — When the Carcieri administration announced plans to overhaul Rhode Island’s Medicaid system, Brenda Myette vowed to learn all she could about the proposal.

Myette’s 38-year-old son, Edward, has Down syndrome, making him one of 180,000 Rhode Islanders eligible for the government health services program. He’s lived with Myette and her husband his whole life, but as the Cranston couple settle into their 70s they know the time will come when Edward must live elsewhere, with help from the Medicaid system.

Getting informed about her son’s options is critical, Myette said.

A year later, despite attending every information session offered, Myette still has questions about what the administration’s deal with the federal government –– limiting Medicaid spending to $12 billion over five years in exchange for leeway in how the state offers Medicaid services –– will mean for Edward.

“In order to allay our fears, we asked for concrete plans,” she said. “There were no concrete plans then, and from what [I’ve] heard … solid plans are still lacking.”

Her anxiety was shared by the dozens like her who flooded day two of the House Finance Committee hearing that started Friday and continued into yesterday evening as lawmakers grapple with whether to approve the governor’s first-in-the-nation proposal that he says will save money and give recipients more choices about their care.

Legislators have just three days to reject or amend the plan before a self-imposed deadline. If the General Assembly takes no action by Thursday, the Medicaid agreement stands.

Medicaid has traditionally been a government entitlement program that pays health care bills of the poor, the disabled and the elderly whose incomes are low enough to qualify for coverage. There are no limits on spending or enrollment.

By entering into this agreement, Rhode Island will become the first state to cap spending on the program.

Most who testified during the combined 11-hour hearing applauded the state for trying to stem swelling Medicaid costs that could consume half the state’s budget within two decades.

The trouble, they say, is the lack of specifics in how the change would affect certain services or recipients. Would eligibility for children on the RIte Care insurance program change? Would a senior citizen who leaves a nursing home in favor of home care be allowed to return if necessary? Would disabled adults be assessed by their own income or their parents’?

The unanswered questions outweigh the assurances, they say.

“It’s still too wishy-washy,” said Dawn Wardyga, program director at the Rhode Island Parent Information Network. “There’s not enough information, there’s not enough detail. They have not involved the community from the get-go. If they had, some of the questions we are asking, we might not have had to.”

Department of Human Services officials who negotiated the proposal say the idea behind “the global Medicaid waiver” agreement was to gain flexibility, so that Rhode Island –– not the federal government –– could decide the particulars of how it provides Medicaid services to effectively serve those in need.

“It really is a blueprint for moving forward,” DHS Policy Administrator Ann Martino told the committee yesterday. “I think that’s one of the confusions [when people say] there is no detail. Essentially, what the federal government did is provide us with the authority to do certain things. How we use that authority is part of the implementation process and will be directed in part by the General Assembly and also by input from the community.”

But advocates and parents like Brenda Myette acknowledge that while the waiver does not appear to change benefits or eligibility levels, neither does it identify safeguards to protect services, leaving open the possibility that unexpected changes could be made after the deal becomes law.

“It seems like there’s a large fear of the unknown,” committee member David Caprio, D-Narragansett, observed. Right now, Medicaid recipients and their caregivers are well aware of what services they qualify for and how to get them. The proposed waiver would change all that.

Caprio and other lawmakers appeared sympathetic to the concerns of the citizens who testified, adding questions of their own.

But to reject the governor’s proposal, lawmakers would have to do so this week, a task made more improbable by the fact that they have already booked the projected $67 million in savings by June 30. If they snub the deal, even Finance Committee Chairman Steven M. Costantino acknowledges, they will aggravate an already massive $357-million current-year deficit.

Costantino said the Finance Committee will not make any recommendations until House leaders have a chance to converse with their Senate counterparts. But the Senate Finance Committee does not begin its two-day hearings until this afternoon, leaving the chambers just one day to talk and draft a bill rejecting the plan, were they to choose to do so.

The full House and Senate would then need to pass that bill by Thursday to meet the deadline they imposed last spring.

A more likely scenario suggests that lawmakers will let the Carcieri proposal stand and instead begin drafting what Costantino calls “legislative protections” –– explicit language safeguarding services –– to be added on bit by bit as the administration begins implementing its plan.

Costantino calls that a critical point to remember: the Carcieri team must get legislative approval for each part of the plan it wishes to put in place. That means as DHS officials move from that blueprint stage to crafting details, they must seek legislative approval.

“We need to put a lot of protections in there which we will [create],” Costantino said. “We will guide this waiver as best we can and as close as we can.”

cneedham@projo.com