Rep. Joseph Almeida, D-Providence, right, talks with Council 94’s James Cenerini in the House chamber.

The Providence Journal / Connie Grosch

PROVIDENCE –– The state House of Representatives last night moved to protect the Ocean State’s most vulnerable residents, overwhelmingly approving legislation requiring strict General Assembly oversight as Governor Carcieri begins to overhaul Medicaid programs that touch one in seven Rhode Islanders.

But even with the oversight, supporters acknowledged that major questions remain unanswered.

It’s unclear whether Carcieri’s unprecedented plan –– dubbed the “global Medicaid waiver”–– interferes with a federal stimulus package that may funnel hundreds of millions of dollars to Rhode Island in the coming months. It’s unclear how the part-time Assembly will fulfill its oversight role during the six months lawmakers aren’t in session each year.

And it’s unclear when the governor will hire dozens of employees needed to implement the first stages of the massive overhaul, which are supposed to be in place as early as April 1.

“There are an awful lot of people outside this room who don’t believe for a minute we’re capable of handling this level of responsibility. I personally think we are,” said House Minority Leader Robert A. Watson. “We will be judged and we will be blamed if this doesn’t realize the type of benefits that we contemplate.”

Rhode Island last month entered a contract with the federal government giving the Carcieri administration unique power to reshape health-care programs that currently serve 180,000 elderly, poor and disabled residents. In exchange, the state must limit Medicaid spending –– usually shared between the state and federal government — every year for the next five years.

Rhode Island is the first state in the nation to secure such a deal.

The legislation adopted last night –– which requires Senate passage to become law –– requires the governor to obtain Assembly approval for virtually every change to Medicaid programs through 2013. It also establishes a task force to oversee the implementation.

One of just two lawmakers to vote against the bill, Rep. Brian C. Newberry, R-North Smithfield, warned that the strict oversight is a “recipe for paralysis,” simply swapping federal bureaucracy for state bureaucracy.

But Department of Human Services Director Gary Alexander, a member of Carcieri’s Cabinet, earlier in the day reiterated support for the legislation. He also promised to delay major changes until the oversight bill becomes law, even though the agreement took effect Jan. 16.

“We’re waiting for the House and Senate to finalize the legislation,” he said, suggesting that the bulk of the overhaul won’t take effect until July, the beginning of the new fiscal year.

Generally, that’s also when part-time lawmakers leave Smith Hill for the year.

During a brief House debate before last night’s vote, Rep. Lisa Baldelli-Hunt, D-Woonsocket, asked how the governor’s office would obtain Assembly approval for Medicaid changes during the six-month recess.

It would require careful planning, responded oversight bill sponsor, House Finance Committee Chairman Steven M. Costantino.

“We hope by the end of the session we would know what they’re going to do for the next six months, and they would know what they’re going to do for the next six months,” he said.

Rep. Alfred A. Gemma then asked whether the agreement complicates Rhode Island’s access to the $819-billion stimulus package being debated in Congress.

Costantino acknowledged that those questions are largely unanswered.

“If we get hurt by the stimulus package, Rhode Island can go back and say [to the federal government], ‘Listen, that cap you gave us, we’re getting hurt by it, we want it higher. If you don’t agree, we want out.’ ”

And staffing continues to be a key concern.

It was Costantino who pointedly asked DHS director Alexander earlier in the day whether he would fill 47 vacancies by March 1, as outlined in a management plan presented to lawmakers just two weeks ago. An exodus of retirements last fall left Medicaid-related agencies with hundreds of openings.

Alexander said that just between 25 and 30 jobs would be filled. He later said that the governor has yet to sign off on the staffing increases.

“The biggest issue with the global Medicaid waiver, I would suggest, is the question of the capacity of the department to implement,” Costantino said. “And now we hear that you are amending your management plan, which causes me great concern.”

The Senate expects to debate its own version of the oversight legislation in the coming days.

speoples@projo.com