"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.

ACLU and DRRI Urge RI TO Shift Funding For Children's Mental Health

By Gina Macris

Disability Rights Rhode Island (DRRI) and the American Civil Liberties Union of Rhode Island (ACLU) made an urgent plea May 24 to the House leadership to shift its focus on residential treatment for acute children’s behavioral health issues to “robust funding” for comprehensive community-based services accessible at home and at school.

The letter to Joseph Sheckarchi, Speaker of the House; Majority Leader Christopher Blazejewski, and Finance Committee Chairman Marvin Abney, comes on the heels of federal findings that the state harms children in prolonged institutional care, - and in the midst of the General Assembly’s final negotiations on the upcoming state budget.

The timing gives the General Assembly an opportunity for “righting the current course and establishing a long-term solution for children rather than continuing on its apparent present course of spending tens of millions of dollars on residential treatment facilities,” wrote Morna Murray, executive director of DDRI; and Steve Brown, executive director of the ACLU.

They said the cost of residential settings is “astronomical” compared to the costs of serving children in the community.

According to the federal findings released last week, the state spent more than $13.6 million in Medicaid dollars on psychiatric hospitalization of children in state care between July 1, 2020 and June 30, 2021 and nearly $27 million for children’s residential treatment during the same period – some of it out of state.

In-state residential treatment can cost as much as $990 a day, while therapeutic foster care may cost $48 to $125 a day, U.S. Attorney Zachary Cunha said in a complaint alleging the state for years has violated the civil rights of children with behavioral health issues.

Meanwhile, the state budget proposal that would take effect in about five weeks – on July 1 - contains $11 million to expand the troubled St. Mary’s Home in North Providence, even though the state’s child welfare agency is pulling children out of that facility.

In addition, the state is planning to spend $45 million over the next three years to build an intensive residential treatment facility for girls in Exeter, on the site of the former Ladd School, which once housed people with intellectual and developmental disabilities.

Last week’s DOJ findings warned about the harmful effects of long-term hospitalization and institutional care on children. It serves as a “wake-up call” that the state “cannot build its way out of its obligations to care for vulnerable youth in the state,” said Brown in a statement.

“This long-standing issue harms the most vulnerable children and represents a violation of their legal rights,” said Murray in the same statement. “The time has come for the state to comprehensively correct this injustice,” she said.

Quoting the U.S. Attorney, Murray and Brown said in the letter that “it’s not an issue of not enough beds.”

Study after study has shown that children treated during long stays in hospitals and psychiatric residential facilities, like St. Mary’s Home for Children, experience physical and emotional abuse, over-medication, trauma and rehospitalization at higher rates, with their long-term success in life diminished, the letter said.

Brown and Murray asked the House leadership to take the DOJ findings to heart and to re-direct into the community the funding which put more children in residential treatment facilities “that cannot solve the problem.”

Companion bills sponsored by Sen. Louis DiPalma, chairman of the Senate Finance Committee, and Rep. Tina Spears, D-Charlestown, Westerly, South Kingstown and New Shoreham, would require the General Assembly to fully fund rate increases for a broad array of home and community services as recommended by the Office of the Health Commissioner (OHIC) every two years.

The governor’s budget would spread out existing OHIC recommendations over the next three years, with $22.1 million proposed for the next fiscal year.

Future rate reviews would be conducted once every four years for each of four categories for community services, according to a budget amendment the governor submitted to the General Assembly in April.

Developmental Disability News asked spokespersons for both the governor and the House leadership on May 23 – a day before the DRRI and ACLU letter - whether the DOJ complaint will affect budget talks about the OHIC-recommended increases for the next fiscal year, but there has been no immediate response from either.

May 23 was the deadline for the state to respond to the DOJ complaint, which alleged that the state violated the Integration Mandate of the Americans With Disabilities Act (ADA) by “warehousing” children with behavioral problems at Bradley Hospital, the state’s only children’s psychiatric hospital.

DCYF director Ashley Deckert wrote to Assistant U.S, Attorney Amy Romero May 22, saying “we look forward to working cooperatively with the U.S. Attorney’s Office and HHS (the Department of Health and Human Services) to address the findings.”

Deckert said she will call Romero “shortly to establish a framework for our collaboration going forward” to find a “mutually agreeable strategy to address what we believe are nationwide mental health staffing challenges.”

Bill Promoting Olmstead Plan Passes RI Senate

By Gina Macris

The Rhode Island Senate on May 21 passed a bill that would lead to an Olmstead plan for funding an array of community-based health and human services to prevent the unnecessary segregation of children and adults with disabilities.

The bill is moving through the General Assembly at a critical time, just a week after U.S. Attorney Zachary A. Cunha alleged the state has failed “miserably and repeatedly” to meet its legal obligations to provide appropriate services to children with mental health and developmental disabilities in their communities.

Instead, children and adolescents have been “warehoused” at the state’s only children’s psychiatric hospital, Bradley Hospital in East Providence, Cunha said, calling the state’s reliance on a single option an “appalling failure.”

The state must respond by tomorrow, May 23, to alleged violations of the Integration Mandate of the Americans with Disabilities Act (ADA), according to a spokesman for Cunha.

The Senate’s proposed Olmstead plan takes its name from a 1999 U.S. Supreme Court decision which reinforced the Integration Mandate of the ADA. The decision said the ADA requires public services for people with disabilities to be offered in the least restrictive environment that is therapeutically appropriate, and that environment is presumed to be the community.

Rhode Island is the only state in New England and one of seven in the nation that does not have an Olmstead plan, said Sen. Louis DiPalma, D-Middletown, in describing the bill on the floor of the Senate.

Last week’s allegations of civil rights violations serve as a prime example of the reason the state needs such a plan, said DiPalma, the chief sponsor of the legislation.

The bill, which has been sent to the House, would establish a 25-member commission to make annual recommendations for “integration for all” to the governor and the General Assembly, beginning on Jan. 15, 2025. The bill also requires the commission to do a comprehensive assessment of needs and accomplishments every five years.

More immediately, a spokeswoman for Governor Dan McKee has said the state will cooperate with the DOJ to resolve the brand new Olmstead civil rights allegations.

The findings, the result of a joint investigation of the U.S. Attorney’s Office and the Department of Health and Human Services, make two broad recommendations:

· The state must ensure that existing community-based services are available in sufficient quantity to prevent long and repeated hospitalizations at Bradley. These services include intensive in-home and community services, crisis services, and therapeutic foster care.

· The state Department of Children, Youth, and Families must make improvements in discharge planning to smooth the way for a prompt transition to the most integrated setting that is appropriate.

Rhode Island has a new law that could go a long way toward adequately funding community-based children’s services and satisfying the demands of the Olmstead complaint.

In 2022, the General Assembly enacted a requirement that all federal-state Medicaid reimbursement rates for struggling community-based social and human services undergo a review every two years by the Office of the Health Insurance Commissioner (OHIC).

The first OHIC rate review recommended hefty hikes which would have cost an estimated $90 million in state revenue in a single year, according to a spokeswoman for Governor McKee.

That does not include more than $50 million for health care providers outside the OHIC review and $29.1 million for Certified Community Behavioral Health Clinics, she said.

The governor has recommended implementing the recommended OHIC rates over three years, including $22.1 million that would represent the state’s share of the federal-state Medicaid match in the next fiscal year. He would also slow the pace of future rate reviews in each of four categories of services to once every four years.

But companion bills sponsored by DiPalma and Rep. Tina Spears, (D-Charlestown, South Kingstown, New Shoreham, and Westerly,) in the House would require the governor to use figures from OHIC rate recommendations in his budget. It would also require the twice-yearly caseload estimating conference to adopt the latest OHIC rate recommendations in advising the governor and the General Assembly on Medicaid costs for the next budget year.

In an email to supporters, Spears says those two bills “gained traction” after 100 advocates went to the State House May 14.

Grass roots advocacy for those relying on a broad array of community-based health and human services has been a hard slog for nearly 15 years.

In 2014, the state entered into an Olmstead consent decree with the DOJ to end the segregation of adults with developmental disabilities. It was not until 2021, when it faced the threat of heavy fines for alleged non-compliance, that the state began overhauling Medicaid rates to community service providers and changing its approach to services for adults with developmental disabilities.

Those changes are still underway, and federal oversight continues in the developmental disabilities case.