New efforts on Smith Hill to increase Medicaid reimbursement rates

Published in RINewsToday on April 18, 2022

On March 8th, a press conference on Smith Hill put the legislative spotlight on introduced rate setting legislation intended to fix Rhode Island’s long-time problem of paying insufficient reimbursement rates to human-service agencies delivering social, human and clinical services to Medicaid recipients. 

Over 80 human service providers, clients, and aging advocates, came to support Sen. Louis DiPalma and Rep. Julie Casimiro’s two pieces of legislation to fix a broken Medicaid payment reimbursement system. These bills would provide for periodic rate review/setting processes to ensure accurate and adequate reimbursement of social, human and clinical services.

“Senate President Dominick J. Ruggerio came, giving his blessings, too. “It is critical that we undertake a review of reimbursement rates so that we have a thorough understanding of the data and we can make informed decisions,” said the top Senate lawmaker. “These bills will help bridge the gap and bring reimbursement rates where they need to be,” he said.

The Reimbursement Fix…

DiPalma and Casimiro’s bills do not specify dollar amounts for adequate hourly wages but would hammer out the “periodic rate review and setting process.”

The first bill (2022-S 2311 / 2022-H 7180) establishes a process which would require the Executive Office of Health and Human Services (EOHHS), assisted by a 24 member advisory committee, to provide review and recommendations for rate setting and ongoing review of social service programs licensed by state departments, agencies and Medicaid. 

The second one (2022-S 2200 / 2022-H 7489) establishes a process which would require Executive Office of Health and Human Services (EOHHS), assisted by a 24 member advisory committee, to provide review and recommendations for rate setting and ongoing review of medical and clinical service programs licensed by state departments, agencies and Medicaid.

At press time, legislation has been referred to the Senate and House Finance committees for review. 

“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,” claims DiPalma, (D-District 12, Middletown, Little Compton, Newport and Tiverton), a long-time advocate at the Rhode Island General Assembly for human services providers and disabled Rhode Islanders.  

DiPalma says a comprehensive rather than a piece meal approach is now needed to address this reimbursement issue. Stressing that the two bills would fix the continuing reimbursement issue. “For our providers, the people they serve, and the future of our state, it is imperative we act now,” he warns. 

Rhode Island’s healthcare system is suffering a crisis of care that’s only worsened due to the pandemic, charges Casimiro (D-Dist. 31, North Kingston and Exeter), noting that the state’s human health agencies are understaffed and under-supported and it is hurting the state’s most vulnerable residents.  

“Our reimbursement rates have remained too-low and unchanged for many years and the residents of our state cannot access the crucial services they need if there is no one there to provide the care,” said Casimiro, urging Rhode Island lawmakers to stop the exodus of human services workers for their jobs.  Proper oversight of the rate setting process and appropriate reimbursement rate increases will ensure a high-level of care provided, sorely needed now, she says.    

Providers call for ratcheting up RI’s Medicaid payment rates

Long-time aging advocate and former Representative, Maureen Maigret, translated the rate payment issue into a “dollar and cents” example. Maigret, a policy consultant who previously chaired the Long-Term Care Coordinating Council’s Aging in Community Subcommittee, noted that the Bureau of Labor Statistics show in 2020 in Rhode Island the average wage for a home health aide was less than $15 per hour and nursing assistants slightly $16. “These low wages do not come close to meeting one’s basic needs, forcing workers to work more than one job or, as more are doing, just abandoning this type of work altogether for better pay, she added, stressing that this was before these workers faced 7% inflation and gas prices reaching over $5 per gallon,” she said.

“High workforce turnover rates are especially troubling for patients receiving homecare, who value building a long-term relationship with someone coming into their home frequently, says Bernie Beaudreau, Executive Director, the Senior Agenda Coalition of Rhode Island, “Seniors cannot age with independence and dignity if homecare workers are not treated with respect in wages and working condition,” he says.

This legislation is a step in the right direction and provides the state an opportunity to move toward the realignment of reimbursement rates that accurately reflect the actual cost of the delivery of behavioral health treatment and services,” says Susan Storti, President and CEO of The Substance Use and Mental Health Leadership Council of Rhode Island.

“These bills ask our state a clear, direct question: do we, or do we not, support inclusive lives in our communities? We must reply with an equally clear answer: ‘Yes, we do’ and pass S-2311 and H-7180, says Tina Spears, Executive Director, Community Provider Network of Rhode Island, noting that for CPNRI and its members it is all about inclusion of children and adults with disabilities and behavioral health conditions in our society. 

Time to pay providers adequately  

With all 38 Senators co-sponsoring both his Senate bills, DiPalma is pleased with the positive reception his legislation has received in the upper chamber. “We cannot delay any longer. The time to act is now,” he says, stressing that it’s important for lawmakers to get these bills over the “goal-line. “There are hundreds of thousands of Rhode Islanders counting on us to get this done,” he adds.

DiPalma says that a Senate hearing is being planned  to consider S 2311 and S 2200 on Thursday, April 28 at the Rise of the Senate in the Senate Lounge. All are encouraged to attend the hearing and voice their support. 

Fifth Time a Charm for Direct Care Worker Raises?

Published in Woonsocket Call on November 6, 2016

When the Rhode Island General Assembly wraps up its session many times the stars are not in political alignment for passage of a particular legislative proposal or budget amendment, even if many lawmakers considered these to be worthy of passage. Sen. Louis P. DiPalma understands this very well.

During the past four legislative sessions he has unsuccessfully pushed to increase pay for direct care workers serving persons with intellectual and developmental disabilities by boosting the state’s budget funding for these workers.
DiPalma, a Middletown resident who as a senator has represented Little Compton, Middletown and Tiverton for over 8 years, has come back for a fifth time, hopefully the last, to see his efforts succeed in providing a living wage to these providers, enhancing the quality of life of their lives.

A Call for a ’15 in 5’ Pay Increase

At a news conference held on Friday, Oct. 28, at Warwick-based West Bay Residential Services, DiPalma along with fellow Senators, announced their support for his proposal: ’15 in 5’ pay increase for workers serving persons with intellectual and developmental disabilities. The Democratic senator envisions annual, incremental increases in compensation to reach $15 an hour in five years, and tying the pay rate to inflation thereafter.

A 2015 survey by the Community Provider Network of Rhode Island paints a picture of Rhode Island’s direct care workers. The majority of these individuals are women of households. Many receive state assistance from programs geared towards low-income workers, such as SNAP benefits, WIC, heating assistance, day care assistance, and housing aid. More than 40 percent of the workers hold more than one job to financially survive.

At the 53-minute press conference, DiPalma urged Rhode Island Governor Gina Raimondo to include his funding proposal in her 2017 budget submission. He also plans to submit legislation in the 2017 session to address the compensation system for these direct care workers, providing annual increases so that the pay rate of direct care workers reaches $15 in five years, and tying future wage increases beyond five years to inflation.

“The minimum wage has increased by 30 percent since 2012, but the rate paid to these essential direct care providers has remained stagnant,” charged DiPalma, at the press event. “The pay is now barely more than minimum wage, which is having a detrimental effect on staff retention, training costs, and, as a result, quality of care [for persons with intellectual and developmental disabilities],” he says.

DiPalma noted that the need for this pay increase is obvious. “The facts and data show that our direct care workers love their jobs and want to stay in the field. They genuinely care about the population they serve. Yet, 62 percent of respondents to a recent survey indicated that low salary was a factor that may make them leave their jobs. We need to act to address this urgent situation,” he said.

According to DiPalma, the average annual staff turnover rate in the private provider network is approximately 33 percent. “This is three times as high as the approximately 11 percent staff turnover rate for comparable positions with the state-run providers through the Rhode Island Community Living and Supports (RICLAS) at the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, according to providers and RICLAS,” he says.

The average private-sector direct care worker makes $10.82 per hour, or about $22,500 a year, says DiPalma, noting that entry level provider positions at state RICLAS pay $17.15 per hour. When considering longevity, the average wage for all RICLAS direct care workers is approximately $42,278. RICLAS workers also receive state employee benefits.

Jumping on the Band Wagon

Two days before DiPalma’s press conference, Secretary of Health and Human Services Elizabeth Roberts penned her endorsement of his wage increase proposal. In her Oct. 26 correspondence, she strongly endorsed his efforts to implement multiyear wage increases to Rhode Island’s direct service providers. “These workers are critically important to realizing the goals set forth in our clients’ person-centered plans,” she adds, noting that these workers provide services necessary for ensuring that persons with disabilities are integrated in Rhode Island communities.

At the press conference, S came to give DiPalma his blessings. “Increasing wages to private direct care workers addresses an important part of the wage inequity problem, and helps improve outcomes for the individuals they serve. At the same time, we need to continue to review the methodology for compensating all those direct care workers who serve our children, homebound elderly, and individuals with disabilities through other types of provider agencies,” says Da Ponte.

Like other speakers at the press conference, Donna Martin, executive director of Community Provider Network of Rhode Island, called initial salaries for direct service workers “woefully inadequate” for the work they perform. “They are working nights and holidays leaving their families behind to support individuals under their care.,” says Martin. “These individuals serve as mentor, friend, confident and even some serve in the role of family to their clients,” she adds.

Adds speaker Anthony Antosh, Director of the Paul V. Sherlock Center on Disabilities: “The field of developmental disabilities has dramatically changed in the past two decades as have the responsibilities and expectations for direct support staff. The outcomes achieved by adults who have a developmental disability are directly connected to the quality and stability of direct support staff. Developing a career ladder built on quality training and fair wages will go a long way towards stabilizing the direct support workforce and improving quality of services.”

Marie Carroll, a direct service provider employed by ARC of Blackstone valley, a
Pawtucket-based agency employing over 200 employees, sat in the audience to support DiPalma in his efforts to increase funding for direct care workers. She sees Rhode Island’s lower wages pulling her colleagues into Massachusetts for higher incomes.
Carroll hopes to see the Rhode Island General Assembly in the upcoming session value the work she and 3,500 direct care workers provide. “People who care for the state’s disabled should not be paid poverty wages. You can’t expect people to work in an emotional and sometimes physically demanding job for $11 per hour,” she said, stressing that low wages keep these workers from taking adequate care of their own families.

Boosting Wage Payments in Next Year’s Budget

At press time, DiPalma’s wage increase proposal has received a seal of approval from President of the Senate M. Teresa Paiva Weed and Senate Finance Committee Chairman Da Ponte. Roberts, as Secretary of Health & Human Services, who oversees the state’s disability programs and services, gives her enthusiastic support for boosting funding of direct services workers in the upcoming 2018 budget. But, press secretary Larry Berman says that House Speaker Nicholas A. Mattiello is studying DiPalma’s proposal and has not yet taken a position on this issue.

Even with early political support of DiPalma’s ’15 in 5’ Pay Increase proposal, its ultimate passage lies with either Governor Raimondo boosting direct car worker wages in her FY 2018 budget proposal or in the state’s final budget crafted by the House with the sign off of the Senate. For DiPalma and those working with persons with intellectual and developmental disabilities, the Governor, House Speaker and President of the Senate must be on the same page to move DiPalma’s proposal forward. Hopefully, the “fifth time is the charm.”