"Transformative" Medicaid Funding Clears RI House Finance Committee

CPNRI Advocacy Day at the RI STate House 2024 - Photo Courtesy CPNRI

By Gina Macris

The House Finance Committee has recommended Rhode Island fully fund nearly $160 million in Medicaid rate hikes for a broad range of community social and human services – nearly tripling spending proposed by Governor Dan McKee.

The measure, believed to be the largest single-year Medicaid hike in Rhode Island, still needs formal approval by the full House and Senate as part of the next state budget.

But the fact that it cleared the powerful House Finance Committee May 31 signals that General Assembly leadership is prepared to turn aside McKee’s proposal to phase in the rate hikes over three years and slow down the pace of future rate reviews. McKee’s plan was not well received by the Senate Finance Committee in a hearing May 2.

The recommended reimbursement hikes, some totaling more than 50 percent, would apply to privately-run organizations that provide a wide swath of services, from early intervention for babies with disabilities, to treatment for substance use disorder for adults, to supports for the aging. Other services include treatment for autism and behavioral problems, juvenile justice, vocational, and rehabilitation services.

The rate hikes were recommended by the state’s Office of the Health Insurance Commissioner (OHIC), following legislation passed in 2022 that required the office to conduct a review of federal-state Medicaid reimbursement rates every other year.

The goal is to enable service providers in Rhode Island to pay their workers wages competitive to those in neighboring Massachusetts and other New England states.

McKee had put a total of $56 million in federal-state Medicaid funding into his budget proposal. But the House Finance Committee added $103.2 million, for a total of $159.2 million. The committee raised the state’s share from $22.1 million to $62.4 million.

The proposed Medicaid spending could serve as a sign of good faith in talks expected between the state and the Justice Department to resolve alleged civil rights violations of more than 500 children and adolescents, which the federal government said were “warehoused” at the state’s only pediatric psychiatric hospital between 2017 and 2022 for lack of community options.

The state Department of Children, Youth and Families has indicated a willingness to cooperate with the U.S. Attorney’s Office, which announced May 13 the results of a joint two-year investigation with Office of Civil Rights in the U.S. Department of Health and Human Services.

U.S. Attorney Zachary Cunha said the state had violated the Integration Mandate of the federal Americans With Disabilities Act by failing to provide services to children with behavioral health needs in the most integrated setting appropriate.

The House Finance Committee’s move to fully fund the OIHC recommended Medicaid payments won quick praise from a major organization representing service agencies.

The Community Provider Network of Rhode Island, which represents three dozen service providers for people with intellectual and developmental disabilities, said through a spokesperson that the committee’s proposal represents the largest single-year investment in Medicaid services in Rhode Island.

“This investment will have a transformative impact on people with disabilities, seniors, children, families and more,” the spokesman said, in urging the House and Senate to pass the measure as proposed.

Added Grace Duffy, CPNRI Policy Coordinator, “Fully funding rate reform is a significant step in making sure people with disabilities receive the support they need.”

She continued,”This investment is a pledge to build a state where everyone, regardless of ability, has the opportunity to thrive.”

The name of the Department of Children, Youth and Families was misstated in the original version of this article and has been corrected.

RI House Finance: Big Bucks for DD, Human Services

By Gina Macris

Last June, direct care workers serving adults with developmental disabilities in Rhode Island were making an average of about $13.18 an hour.

In July, 2021, their starting pay jumped to about $15.75 an hour. And beginning July 1, they will make about $18 an hour – a $2.25 increase - if the state budget passed by the House Finance Committee last week becomes law.

The latest proposed raise, costing about $35 million in state and federal Medicaid funding, has been driven by the state’s efforts to comply with federal court orders reinforcing a 2014 consent decree that requires a shift to community-based services as mandated by the Americans With Disabilities Act.

A central issue in the court case is an inability to attract enough workers to carry out the reforms. With the blame for the shortage on low wage scales, the state is under court order to raise the direct care rate to $20 by 2024.

In all, the House Finance Committee would allocate $390.3 million from the federal-state Medicaid program to the Division of Developmental Disabilities, about $59.4 million more than in the current budget. The total includes $35 million for the raises, another $10 million to help private service providers move toward community-based services, and roughly $30 million for the operation of a separate state-run group home system.

The privately-run system the state relies on to provide most services for adults with developmental disabilities has been underfunded for a decade, according to the state’s own consultants.

In a bid for new consulting work last fall, Health Management Associates said that in 2011, the General Assembly underfunded the recommendations of its Burns & Associates division by about 18 percent and didn’t catch up until the rate increases of 2021 – a decade later. That’s when direct care wages exceeded $15, a rate Burns & Associates had proposed for 2012.

Tina Spears, executive director of the Community Provider Network of Rhode Island, applauded the House leadership, including Speaker Joseph Shekarchi, Majority Leader Christopher Blazejewski, and House Finance Committee Chairman Marvin Abney for “putting working families first.”

This year’s spending plan also recognizes that the workforce shortage in developmental disabilities extends to all sectors of the human services.

The proposed budget would authorize the health insurance commissioner to oversee an outside review all private human service programs licensed or contracted to state agencies, with the aim of recommending fair market reimbursement rates.

Once the baseline is established, a rate review would occur every two years for privately-run programs used by BHDDH, the Department of Human Services, the Department of Children, Youth and Families, Department of Health, and Medicaid.

The baseline analysis of Medicaid reimbursement rates would enable Rhode Island to become more competitive in attracting caregivers and the periodic rate review would prevent the system from slipping below market rates in the future.

“I’m excited about that. We’re doing something we’ve never done before,” said Sen. Louis DiPalma, D-Middletown, of the proposed changes in the way the state would approachMedicaid reimbursement for private human services.

The comprehensive review and the biennial rate update may seem mundane to many people, but ”it’s a critical thing to vulnerable populations in the state,” DiPalma said.

He and Rep. Julie Casimiro, D-North Kingstown, sponsored companion stand-alone legislation calling for the two-step rate review process.

Spears, the CPNRI director, called the budget an “investment in Rhode Island’s most vulnerable populations.” It sends a “clear message that people of all abilities should be able to access the care they need to live full, inclusive lives in our communities,” she said in a statement.

The House Finance Committee shifted responsibility for the comprehensive rate study from the Executive Office of Human Services to the health insurance commissioner and eliminated a community advisory committee that some critics said might pose a conflict of interest.

The committee also extended the deadline for the initial review for several months, until October, 2023. The extension means that rate changes could not be enacted until mid-2024, instead of next year, as DiPalma and Casimiro had hoped.

In separate legislation, DiPalma and Casimiro had called for a companion baseline study and biennial rate reviews for all Medicaid-funded medical and clinical programs in the state, but these services were not included in the House Finance Committee’s budget. There were substantial one-time reimbursement rate increases for some medical services, like maternity labor and deliver and dental care.,

Other initiatives aimed at strengthening children’s services and mental health come from federal American Rescue Pan Act (ARPA) funding. They include:

• $30 million for community behavioral health clinics

• $12 million for a children’s residential psychiatric treatment center

• $8 million for a short-term stay unit at Butler Hospital, the state’s only private psychiatric hospital for adults

• $7.5 million to shore up pediatric primary care, which lost capacity during the COVID-19 pandemic

• $5.5 million to attract early intervention professionals and reduce waiting lists for therapy among infants and toddlers with developmental disabilities.

Developmental disabilities spending for adults, meanwhile, contains about $10 million in expenses to conform with an in “Action Plan” the state proposed last fall to avoid a hearing over contempt allegations over non-compliance with the consent decree.

Most of that money, $8 million in federal-state Medicaid money, would continue a “transition and transformation fund” to help private agencies and those who direct their own service program change over to individualized, community-based services. Two million of the $8 million would be reserved for the “self-directed” individuals and families.

Another $1 million would fund technology like cell phones and tablets for adults with developmental disabilities to give them access to the same tools that many people take for granted today. And $1 million would provide for state infrastructure to implement and manage compliance with recent consent decree initiatives.

The full House will consider the overall proposed state budget- $13.6 billion - on Thursday.