RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- LONG-TERM CARE, SERVICE AND FINANCE REFORM -- ASSISTED LIVING COMMUNITY MEDICAID, RATES
Summary
H8405 would amend Rhode Island’s Medical Assistance — Long-Term Care Service and Finance Reform law to require the Executive Office of Health and Human Services (EOHHS) to apply an automatic annual cost-of-living adjustment (COLA) to Medicaid reimbursement rates for assisted living services. Starting July 1, 2026, the adjustment would be tied to the percentage increase, if any, in the Consumer Price Index for All Urban Consumers (CPI-U) for the Northeast Region, using the most recently completed calendar year published by the U.S. Bureau of Labor Statistics.
The bill requires the COLA to be applied uniformly across all Medicaid-assisted living rate tiers, including acuity-based or service-level categories. It also states that the adjustment would occur automatically and would not depend on annual appropriation approval, rate rebasing, or discretionary executive action, although the General Assembly could still authorize additional increases or restructure rates in the future. EOHHS would be responsible for adopting any rules, regulations, and Medicaid plan changes needed to implement the law.
Impact
If enacted, the bill would create a statutory mandate for annual inflation-based increases in Medicaid assisted living reimbursement rates, limiting administrative discretion over those rates and reducing the need for yearly legislative or executive action to maintain them. It would affect EOHHS, Medicaid rate-setting for assisted living providers, and the state budget by potentially increasing long-term Medicaid spending whenever the Northeast CPI-U rises. The bill would also require any necessary conformity with federal Medicaid requirements and state plan amendments.
Sentiment
Based on the bill text and the absence of recorded committee testimony or votes, the measure appears to be framed as a straightforward provider-rate stabilization proposal rather than a controversial policy change. Its structure suggests support for predictable funding and inflation protection for assisted living providers serving Medicaid beneficiaries. Because no discussion transcripts or voting history are provided, there is no documented opposition or formal sentiment to assess beyond the bill’s apparent intent.
Contention
The main point of potential contention is fiscal and procedural: the bill removes annual appropriation approval and discretionary rate adjustment from the COLA mechanism, which could be viewed as constraining budget flexibility and committing the state to automatic spending growth. Providers and advocates for long-term care may support the measure as a way to keep pace with inflation and staffing costs, while budget officials or lawmakers concerned about Medicaid expenditures may object to the automatic nature of the increase. Another possible issue is whether the CPI-U Northeast index is the best measure for setting assisted living Medicaid rates and whether federal Medicaid approval would be needed for implementation.
Requires the executive office of health and human services to increase Medicaid payment rates for primary care services furnished by primary care providers to be commensurate with Medicare rates.
Raises the per diem rate by thirteen percent (13%) for Medicaid reimbursement for Tier C services provide by assisted living residence beginning January 1, 2026.
Authorizes an increase in resource eligibility limits for persons with long-term-care needs who reside at home and requires semi-annual reports from Medicaid certified assisted living facilities and adult day service providers to the EOHHS.
Authorizes an increase in resource eligibility limits for persons with long-term-care needs who reside at home and requires semi-annual reports from Medicaid certified assisted living facilities and adult day service providers to the EOHHS.
Increases individual, group, and Medicaid insurance rates of reimbursement for ambulance and wheelchair van services to be equal to reimbursement rates provided by Medicare for the same medical services.
Increases individual, group, and Medicaid insurance rates of reimbursement for ambulance and wheelchair van services to be equal to reimbursement rates provided by Medicare for the same medical services.
Establishes Medicaid fee-for-service reimbursement rates set by the general assembly as the rate floor for Medicaid managed care by home care, home nursing care and hospice providers licensed by the DOH and continue the EEOHH.
Establishes Medicaid fee-for-service reimbursement rates set by the general assembly as the rate floor for Medicaid managed care by home care, home nursing care and hospice providers licensed by the DOH and continue the EEOHH.
Requires the executive office of health and human services to apply to the Centers for Medicare and Medicaid Services for a state plan amendment for reimbursement for health services in a school.