RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- LONG-TERM CARE, SERVICE AND FINANCE REFORM
H8314 amends Rhode Island’s long-term-care Medicaid statute to further shift the state’s long-term-care system toward home- and community-based services. The bill directs the Executive Office of Health and Human Services to seek any needed federal waivers, state-plan amendments, and rule changes to support a goal of directing at least 50% of Medicaid long-term-care funding for older adults and adults with disabilities to home- and community-based care, while preserving services for people with developmental disabilities. It also requires annual reporting on the split between institutional and community-based spending and on waiting lists for long-term-care services.
The bill expands and reorganizes several Medicaid long-term-care policies, including eligibility criteria, reassessment rules, counseling, conflict-free case management, and payment methodologies. It authorizes consolidation of existing home- and community-based service programs into a single system, allows optional supportive services for people at risk of needing long-term care, and supports payment reforms intended to increase access to homemaker, personal care, adult day, assisted living, and hospice services. It also includes wage-related payment pass-throughs and behavioral health enhancements for direct-care workers, and it specifically increases Medicaid reimbursement for Tier C services in assisted living residences by 13% beginning January 1, 2027.
The bill would amend Chapter 40-8.9 of the General Laws governing Medicaid long-term-care service and finance reform. It would expand the authority and obligations of EOHHS to pursue federal approvals, set eligibility and reassessment rules, consolidate home- and community-based waiver programs, establish conflict-free case management, and adjust reimbursement and payment methodologies for providers and direct-care workers. The bill also affects assisted living reimbursement rates, nursing facilities, hospitals, intermediate-care facilities for persons with intellectual disabilities, home-care agencies, hospice providers, and Medicaid beneficiaries receiving long-term services and supports.
No committee transcripts or recorded votes were provided, so there is no direct evidence of debate or formal support/opposition in the available record. Based on the bill text, the overall policy direction is strongly supportive of expanding community-based care, increasing transparency, and improving provider reimbursement and worker wages. The caption and explanation also indicate a focused, technical Medicaid financing measure aimed at assisted living reimbursement.
The main policy tensions in the bill are between expanding home- and community-based care and preserving the financial viability of institutional services, and between tighter eligibility management and maintaining access for current recipients. The bill authorizes more stringent clinical criteria for institutional care than for community-based services, but also protects certain existing recipients and requires notice and appeals before payment can be denied. Potential points of contention include the cost of wage and rate increases, the consolidation of waiver programs, the shift of funding away from institutions, and the requirement that providers pass through certain reimbursement increases to workers.