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R.I. lawmakers aim to end ‘years of stagnation’ in human service reimbursements

Senator DiPalma and Representative Casimiro introduce bills to create process for reviewing and setting Medicaid rates in Rhode Island

Senator Louis P. DiPalma, a Middletown Democrat, speaks during a State House news conference about legislation to create a process for reviewing human service reimbursement rates.Edward Fitzpatrick

PROVIDENCE — After having a stroke five years ago, Patricia Silvia spent three months in a nursing home. But then she managed to live at her home in Newport with the help of a certified nursing assistant.

“My CNA helped me to shower safely, prepare my meals, and clean my house,” Silvia said. “She was also a really good friend that I highly valued. I had a good life.”

But in August, her CNA died. And with many Rhode Island nonprofits facing staffing shortages and inadequate Medicaid reimbursement rates, no one was available to take that CNA’s place, she said.

“So now I am doing everything for myself,” Silvia said. “And I am scared that I may fall and nobody is going to be there to help.”


Patricia Silvia, of Newport, speaks in favor of legislation to create a process for reviewing and setting reimbursement rates for human services in Rhode Island.Edward Fitzpatrick

With use of just one hand, she has difficulty cutting meat, preparing food, and scrubbing pots and pans. She said she relies on frozen meals and has lost 15 pounds since August. “This is putting my health and independence in jeopardy,” she said.

On Tuesday, Silvia took part in a State House news conference, calling for the General Assembly to pass legislation to create a periodic rate review processes to ensure adequate government reimbursement for social, human, and clinical services in Rhode Island.

“Years of stagnation in our state’s Medicaid reimbursement rates have negatively affected hundreds of thousands of Rhode Islanders who rely on a wide range of services,” said Senator Louis P. DiPalma, a Middletown Democrat who introduced the legislation in the Senate. “For our providers, the people they serve, and the future of our state, it is imperative we act now.”

“We are here today because our healthcare system is suffering a crisis of care that’s only been worsened due to the pandemic,” said Representative Julie A. Casimiro, a North Kingstown Democrat who introduced the legislation in the House. “Our system is understaffed and under-supported, and it is hurting our most vulnerable residents.”


Casimiro said human service employees in Rhode Island are being “severely underpaid” at a time when they can go across the border to states like Massachusetts to find better paying jobs. And DiPalma said Massachusetts and Colorado have adopted similar rate review processes.

So DiPalma and Casimiro are sponsoring two bills that would create a process for the Executive Office of Health and Human Services to provide rate setting and review of social service, medical, and clinical service programs licensed by state departments, agencies and Medicaid. A 24-member advisory committee would assist in that process.

DiPalma said that in his 14 years as a state legislator, this is the first time he has had all 38 senators co-sponsor a bill.

Senate President Dominick J. Ruggerio, a North Providence Democrat, spoke during the news conference in the State Library, saying, “Obviously, it’s critical that we undertake a review of the reimbursement rates.”

Low reimbursement rates place a strain on the state’s medical, clinical, social, and human service providers, Ruggerio said. “It makes attracting and retaining workers very difficult,” he said. “I’m proud to support these bills.”

Tanja Kubas-Meyer, executive director of the Rhode Island Coalition for Children and Families, said, “Our social service agencies are in a workforce crisis now and rate setting is critical to addressing the long-term structural issues for our member community-based organizations.”

Tina Spears, executive director of the Community Provider Network of Rhode Island, said the low reimbursement rates have a negative impact on about 100 organizations, mostly nonprofits, that provide services to thousands of Rhode Islanders ranging from the very young to the very old, people with developmental disabilities and people with behavioral health conditions.


She noted that last year infants and toddlers with developmental disabilities had to wait for early intervention services because of a severe shortage of therapists and clinicians.

Christina Battista, of Johnston, also spoke during Tuesday’s news conference, saying she and other Rhode Islanders rely on personal care assistants.

“This means for me personally, someone is literally my hands,” she said, explaining that a personal care assistant helps her shower, cook meals, wash and fold laundry, and go shopping.

“Without them, I don’t know what I would do,” Battista said. “Being able to live rather than just exist means more than I can ever express in words.”

With their help, she has been able to earn a master’s degree and work full-time at Skills for Rhode Island’s Future, helping others with disabilities reach their employment goals. But despite filling such crucial jobs, personal care assistants are underpaid with low hourly rates, she said.

So, Battista said, “Both in my personal and professional roles, I say the importance and the need to pay support staff is essential.”

Edward Fitzpatrick can be reached at edward.fitzpatrick@globe.com. Follow him on Twitter @FitzProv.