Block and Foulkes address Aging, Disability, Behavioral Health at Gubernatorial Forumof Healthy

Published in RINewsToday on October 5, 2026

By Herb Weiss, contributing writer

Democratic gubernatorial candidate Helena Foulkes and independent candidate Ken Block squared off Friday, Oct. 2, at a gubernatorial candidate forum focused on issues affecting older Rhode Islanders, people with disabilities, family caregivers, and those receiving behavioral health services.

The forum, held at Rhodes on the Pawtuxet in Cranston, was sponsored by the Senior Agenda Coalition of Rhode Island, AccessPoint Rhode Island (SACRI), and the Mental Health Association of Rhode Island.

“It was an honor and a pleasure to partner with AccessPoint RI and MHARI to present this forum,” said Carol Costa, Executive Director of SACRI, emphasizing their continued dedication to the intersection of Behavioral Health, Developmental Disabilities, and Aging.

“It was a distinct honor to welcome gubernatorial candidates Helena Foulkes and Ken Block to a forum focused on issues that directly affect older adults, people living with mental health challenges, and communities across Rhode Island,” said Costa.

“We appreciate the candidates’ time and their willingness to engage thoughtfully on these interconnected priorities,” she noted. “At a moment when democracy and civic discourse matter more than ever, their participation demonstrated a meaningful commitment to respectful dialogue, public service, and the people of Rhode Island.”

Unlike many gubernatorial forums that focus heavily on taxes, housing, education, and the economy, this forum allowed the candidates to address issues that often receive less attention during political campaigns: aging in the community, long-term services and supports, nursing home care, Medicaid, family caregiving, behavioral health, and services for persons with disabilities.

Here is a video of the forum, courtesy of Pat Ford, The Coalition Radio Network. Following the video is a “transcript” of the questions and responses.

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We edited the questions and candidates’ responses for length, grammar, and clarity. We did not change the meaning of the questions or the candidates’ responses. Refer to the video here for more information.

Carol Costa announced the following at the beginning of the forum:

“Before we begin, you’re all entitled to know that Aaron Gukian committed to taking part in this forum. He accepted my invitation and we planned this program around his participation. He is not here today. I received a phone call at 3:00 PM that he would not be here. I’m not going to let that take time away from this value forum. We’ve adjusted the program, and we will move forward in a focused and streamlined way so that these candidates who have taken the time to be with this audience get the forum they deserve. But you should know he did make a commitment to this community and he did not keep it.”

Here is what Foulkes and Block told more than 80 attendees at the forum.

Opening Remarks

  • Helena Foulkes (Democrat):

I really wanted to thank the SACRI for pulling this together, the Mental Health Association of Rhode Island, and AccessPoint Rhode Island for all you do.

I want to say that I feel very strongly that the senior population in our state is an incredibly untapped resource.

The wisdom, the expertise—and we’re going to talk a lot tonight, I’m sure, about caring for many of the elder folks and others in our state who need our support. But I think we often forget how much wisdom exists and how much more we could benefit as a state by tapping into all of your expertise.

I am very excited to be looking to the senior community to help me think about things like a Senior Corps-style effort. How do we take, as I said, the wisdom and expertise and tap into your sense of volunteerism?

I’ve been crisscrossing this state for the last few years, mostly in people’s kitchens and living rooms, listening, showing up, and asking people, “What’s one thing you’d love the next governor to do for you?”

  • Ken Block (Independent):

I’m very happy to be here tonight. Helena and I have been in front of many forums this year, hosted by advocacy groups for different purposes, all providing services or looking out for the interests of different groups of people.

This group has been remarkably effective at educating me about their issues and talking with me about the challenges different groups experience as they age.

I have been on this journey with my parents as they’ve aged and passed away. My wife’s parents are now in their 80s and are experiencing a very different journey than my parents did. They’re aging in place, let’s say, challengingly.

Dealing with that remotely has been a challenge for both my wife and me. It makes me realize that while my parents and Jen’s parents have been really supported, others on the journey don’t have the level of support and family involvement we had.

That’s where groups like this, or advocacy organizations like the ones we have here representing different services that can provide the help people need, are so vitally important.

  1. As governor, what would you do to strengthen the Office of Healthy Aging (OHA) and better support healthy aging and aging in the community?
  • Helena Foulkes (Democrat):

On this topic, I absolutely am open to the idea of a cabinet-level position. I need to understand it more closely, but I would say Maryland is a place where this does exist.

I’m good friends with Wes Moore. So this is an example where, using some of my relationships and even many other governors, I’d love to understand what does great look like as we think about serving the senior population.

I also want to speak to the fact that I think we need a whole-of-government approach. Tonight, it’s really hard to give you a hard commitment on dollars given that I don’t know what the state of the budget will be.

You look at education, the Department of Labor and Training, and the Rhode Island Public Transit Authority—lots of places where seniors need access to support. And we’ve got to have, under my leadership, a government that is really focused on how we serve seniors in the state because, to Maureen’s point, it’s a huge portion of our population, higher than most other states.

I would also like to have a master plan on aging. I’m sure many of you have parts of that. I want to pull it together.

So that’s where we need a governor who will set the expectation that I want to see – a plan. I’ll have deadlines because I want to benefit from the expertise, as I mentioned, involving you. Still, I also want to make sure we have a plan where we can hold ourselves accountable to making seniors’ lives better.

  • Ken Block (Independent):

Yes. I believe OHA should be a cabinet-level position for a simple reason: a substantial portion of our population has interests that line up directly under OHA.

And as governor, I want to make sure every large group of people who live here has a voice I can hear. Having OHA as a cabinet-level position gives me the ear I need to hear their needs.

I don’t disagree with anything Helena just said, but I would like to tackle the issue a little bit differently because I don’t think the state is being responsive enough.

I hear a lot of dismay and unhappiness with how responsive the state is to the needs of advocacy groups and the nonprofits that work with it. Several areas of dysfunction seem to be particular sticking points, especially OHHS.

So I describe myself as an operational manager. I’m a specialist in understanding where an organization doesn’t work well, where the friction points are, and what changes we need to make to improve it.

And I look at Rhode Island as a—right now, Rhode Island government’s kind of a target-rich environment.

  1. What steps would you take to reduce the number of lower-acuity residents living in nursing homes?
  • Helena Foulkes (Democrat):

I want to start on a human level around this question because I think the idea that more of our senior citizens should be able to live at home and have caregiving at home is a really great aspiration.

I think one barrier is not having the home healthcare workers we need to support folks in the state.

I speak to a lot of caregivers who don’t even talk about the dignity of their own work, how challenging it is, how low-paid it is. Most of the people I speak to don’t even have healthcare insurance themselves.

So I think we need to start by understanding what the gap is to get to this target, what the gap is in terms of the number of community healthcare workers who can do these jobs, and how do we make sure more of them get trained up, paid appropriately so that we can really be providing service.

You have Donald Trump, who is now essentially targeting many of these home-care providers and healthcare workers by threatening to send immigrants out of this country.

And I’ll use the Haitian community as one example of that. An incredible community of hardworking, loving, dedicated healthcare workers who are now unsure whether they’ll be able to stay here.

  • Ken Block (Independent):

Research shows that care for nursing home residents who need lower levels of care can be provided more cost-effectively outside nursing homes.

So from the governor’s office perspective, my job would be to make sure that we can pave the way for these alternative treatment and housing solutions, that they’re available, and that we can help families who might be taking on some of the burden of caregiving by providing resources to them to make the job easier.

As you all know, the state budget is under tremendous pressure, both from within and without. Washington, D.C., is threatening us. We have a structural deficit coming into this budget year, and Helena and I have both heard requests for what I estimate to be billions of dollars in additional funding this year from the different groups we’ve spoken to.

I have no idea how we prioritize all the different needs or how we can pay for them. It’s going to be very difficult.

But what you have done here, and what other groups have done, has demonstrated beyond a doubt that your requests are worthy.

  1. What would you do to expand home – and community-based care for persons with disabilities and behavioral health conditions?
  • Helena Foulkes (Democrat):

What I’ll add to my last answer is the idea of helping families navigate the complexity of this and thinking about this concept of “no wrong door.”

The idea is that I could go to a state website and get help figuring out how my loved one gets the best level of care in the state.

It’s really hard right now.

And what I’ve always said in my career is I don’t need to be the smartest person in the room. You all know much more about this than I do.

But what I want to do is ask all of you, as it relates to something like this, what are all the stupid things we do? What barriers do we put in your way, and how can we make it much easier for families navigating the complexities of this issue?

  • Ken Block (Independent):

With developmental disabilities, you have a challenge at some point where the severity of it is such that a home-based solution can be not only very difficult, but at times could also be maybe somewhat dangerous.

So I believe that the state government, the governor’s office, our job would be to make sure that people understand whatever services are available, whatever programs of support are available.

It’s a good idea when it works and as long as we can do it safely. That would be my biggest concern: making sure everybody can be safe.

We know that moving eligible individuals out of group homes or institutional settings and into the home environment can often lead to better results.

  1. What would you do to ensure implementation of the nursing home behavioral health per diem and protect the principles of Olmsted regardless of federal challenges?
  • Helena Foulkes (Democrat):

The last couple of years, the drumbeat around healthcare has gotten really loud. People are really worried that their primary care doc is going to retire and they won’t be able to find anyone.

We have two hospitals in our state that are on life support, I would say: Roger Williams and Fatima. We made a deal to keep them alive earlier in the year, but there’s still a real risk in those hospitals.

We have the federal government, which is just ruthlessly attacking people around healthcare in this country, with 40,000 Rhode Islanders who are going to lose access to Medicaid starting in January.

It’s so cruel. It’s so inhumane.

So a big thing that I’ve been focused on, in all honesty, is: how do we make sure people don’t get kicked off of Medicaid?

I want to use the faith-based community. I want to use senior centers. I want to go into some of the high-rises where seniors are living and bring the paperwork and resources to people, because the really sneaky thing about President Donald Trump and what he did with H.R. 1 is he’s making the paperwork so complicated that people won’t get through it and will give up.

I think healthcare will be the tsunami that will hit the next governor.

  • Ken Block (Independent):

I’m really glad Rhode Island cannot mint its own currency, because it would let politicians overcommit.

One of the easiest things for someone like me sitting here facing a room with people like you, on every question that asks, “Can you fund us? Can you fund us? Can you fund us?” The simple question always has the simplest answer, and the one you want to give as a candidate is, “I’ve got you.”

In this circumstance, I can’t tell you that I’ve got you. The General Assembly can’t tell you that they’ve got you. We don’t know what is coming at us.

So what I will tell you is I fully understand the need. I understand completely how important the program is. I get it. I really do.

But what I can’t tell you right now is, because I don’t know what’s coming, to make a promise now that I don’t keep is something that I really want to avoid.

I don’t want to be the guy who said, “Yep, absolutely.” And two months after I get into office, it’s like, “Oh my God, I can’t keep any of the promises that I made.”

My answer to you, with all sincere respect, is I don’t know.

  1. What role should Eleanor Slater Hospital play in meeting the long-term care needs of older Rhode Islanders and persons with disabilities?
  • Helena Foulkes (Democrat):

From talking to folks in the community, I know this sector of healthcare has been under a lot of strain for quite some time.

Getting people together and thinking about a holistic healthcare strategy in our state is a big priority of mine.

I think we’ve been putting Band-Aids on a lot of problems, but not really stepping back and asking: how do you serve people, and what assets do we have in the state that can help us do a good job for folks?

And Eleanor Slater is one component of that.

  • Ken Block (Independent):

I’m definitely open to using any existing resources that we have to address the issue.

So the direct answer to your question is I’m open to it. Yes.

  1. What steps would you take to implement Rhode Island’s 2025–2028 State Plan for Family Caregivers, including respite services, the Temporary Caregiver Insurance Program and a family caregiver tax credit?
  • Helena Foulkes (Democrat):

I think this relates to having a really solid plan that I talked about at the beginning and, in each one of these, understanding what is required. What’s the community’s priority?

If we can’t get everything done, what do you all see as most important?

It’s an incredibly stressful extra job that caregivers take on. I’ve spoken with many, many caregivers in the same generation, who are obviously working themselves, taking care of kids, and having parents.

And then you talk about the economic stress of just not being able to take time off.

I absolutely believe we need to expand caregiver assistance and support, but I need to understand, at the end of the day, what all of this costs and make sure I’m not making promises I can’t keep.

I won’t do that.

What are your mission-critical issues, and how do we actually work to get them done?

  • Ken Block (Independent):

I watched and participated firsthand in my relative’s home healthcare.

My mom was diagnosed with early-onset Alzheimer’s at age 61. We moved them to Providence, to an independent living facility. And my dad was my mom’s caregiver, and I watched the toll that it took on him.

One day I got a phone call, and he said, “Ken, your mom just kind of slumped down.”

I was like, “Oh my God.”

And he’s like, “No, she’s okay. She just slumped down, but she can’t get up, and I can’t lift her, and I don’t want to call anybody at the facility because they’re going to kick us out.”

I raced over, lifted her onto the bed, and that was it.

I realized right at that moment that my dad’s ability to care for my mom had ended.

The emotional and physical toll on caregivers is enormous. Enormous. I’ve watched it.

My dad aged 40 years while he cared for my mom.

And one of the things that I think the state has to watch out for, especially if we’re going to begin subsidizing people to provide care at home, is: how are we going to make sure that we are not putting many more people at risk because they want to take advantage of the money without regard to what the toll is really for both the patient as well as the caregiver?

We have to make sure that we are smart about it.

  1. How would you help older Rhode Islanders and persons with disabilities pay for long-term services without having to rely on Medicaid or sell their homes?
  • Helena Foulkes (Democrat):

This is a really hard problem, and I’ve met lots of families who have been put in this situation of selling the family home to put a loved one in a nursing facility.

I believe we need to raise Medicaid rates in the state. Our state has an older, poorer population than most of New England.

And Medicare, unfortunately, is fixed. The federal government sets it. It’d be great if it went up, but we can’t plan on that.

Medicaid: we have an opportunity to raise Medicaid rates by $70 million, and this last session we could have gotten a $126 million federal match. And that would make a real difference in the healthcare system.

I’ve met so many healthcare providers who live in this state and work in Connecticut and Massachusetts every day because they can make 20 or 30% more just by crossing the border.

I will also make sure someone on my team is dedicated to getting every single dollar of federal funds that we can.

And so, the needs are quite great, but a big part of it starts around funding Medicaid the way we need to.

  • Ken Block (Independent):

Medicaid is at the root of a lot of our healthcare challenges.

And in this case, the cost of assisted living is dramatically raised because the same facilities that provide higher-end services, like full-on nursing and memory care, are under-reimbursed by Medicaid, and they make up for that shortfall by sticking it to the private people who are paying for assisted living.

Everyone has to recoup costs, and we see this repeat in many different areas throughout our healthcare system over time.

So, interestingly, the answer to your question is that we have to figure out how to raise reimbursements for both Medicaid and Medicare.

If we do that, in theory, assisted-living costs should come down.

We spend a lot of money. Many different people have told me some of the money’s being well spent, some of the money’s not being well spent, and we have to make some hard decisions and assessments.

So I don’t think we can take the Medicaid budget from $5 billion to $7 billion. We don’t have the capacity for that.

But in that $5 billion, let’s make sure every penny is spent right. And the pennies that aren’t spent right, then we have to put them towards the things that solve the most problems.

  1. Would you support Medicaid reimbursement rates that reflect the cost of care and fair compensation for direct-care workers, while helping build and sustain the long-term care and behavioral health workforce?
  • Helena Foulkes (Democrat): Yes.
  • Ken Block (Independent): Yes.
  1. Would you support using 30% of state housing bond funds for older adults and persons with disabilities, increasing accessible housing units, and publicly tracking accessible and supportive housing?
  • Helena Foulkes (Democrat): Yes.
  • Ken Block (Independent): No.
  1. Would you support a small monthly telephone fee, similar to 911 funding, to sustainably fund Rhode Island’s 988 Suicide & Crisis Lifeline and broader behavioral health crisis response system?
  • Helena Foulkes (Democrat): Yes.
  • Ken Block (Independent): No (opposed burying another fee in the utility bill. Supports program but not the proposed way to pay for it.)
  1. Would you support eliminating the Medicare Savings Program asset limit and providing an annual cost-of-living adjustment to the state’s SSI Supplemental payment?
  • Helena Foulkes (Democrat): Yes.
  • Ken Block (Independent): No answer given because he didn’t have a cost estimate.
  1. Would you support developing and providing resources for a Rhode Island Multi-Sector Plan on Aging?
  • Helena Foulkes (Democrat): Yes.
  • Ken Block (Independent): Yes.
  1. Would you support legislation creating an Office of Elder Advocate?
  • Helena Foulkes (Democrat): Yes.
  • Ken Block (Independent): Yes.
  1. What would you do to improve transparency and accountability in the delivery of human services?
  • Helena Foulkes (Democrat):

Yes, we need much more transparency across the state.

Think about bridges and roads, the lack of transparency there. And it really breeds mistrust.

One thing I feel deeply, as I’ve been listening to people over the last few years, is that people have lost faith in government. They’ve lost faith that those of us who are working in government are committed to making life better.

And I know there are so many dedicated public servants, but it is so trust-corroding when we’re hiding information.

So I support anything we can do to increase transparency and make sure people have access to the information.

What programs are working really well? What programs aren’t working?

I was also a big proponent of the Inspector General because I thought, look at the billions of dollars that we got during the Biden administration. We don’t even know where that money went.

What worked? What didn’t work? What should we keep doing? What should we stop doing?

Those are really basic questions we’re not answering today, and I’m very committed to transparency.

  • Ken Block (Independent):

Pretty much my entire adult life has been spent following the data and letting it take me wherever it leads.

I’ve been more frustrated than happy with Rhode Island state government’s ability to provide data. And I know many people have asked the state for information.

They’ve been frustrated, and sometimes people within government can’t even get the data that they need to make decisions.

So this is an area where I literally eat—this is what I do professionally.

I’d like to see a whole—this is really nerdy stuff—but I want to see a bunch of dashboards and other tools that will ultimately help us understand much better than we can now where we’re spending the money and where the data is, so we can make informed decisions.

We can’t make good decisions without the underlying information to tell us what to do.

The challenges that are in front of us are daunting, but they’re fixable. We have seen other states tackle hard problems. We can tackle hard problems.

On the transparency side of things, we have not covered ourselves in glory, and I’ll issue executive orders immediately upon becoming governor that get right at the issue of transparency and make sure that, moving forward, our government is accountable to you.

Government doesn’t serve itself. Government serves, temporarily, the people who elected it into power.

Closing Remarks

  • Helena Foulkes (Democrat):

Thank you all so much for being here, for the great questions, and for your time and energy on these topics.

I want to be a governor for everyone. One reason I did so well in the Democratic primary is that I know Rhode Islanders are ready for change. They’re hurting. Everywhere I go, people talk about how much pain there is in this state, but at the same time, how much people love it here.

I’m optimistic we can do great things together.

When I think about our state, I want it to be a place where our children and grandchildren can live a good life.

I want this to be a place where people can afford healthcare. They can send their kids to a good school. They can have bridges and roads that actually work for them.

So many basic things aren’t working, and I think people lose hope. They lose faith that government can work.

Last night I was talking to a young man, and I always say, “What do you want the next governor to do?” And he said, “I want someone who will be honest with us.”

I’ve never thought I was the smartest person in the room. I will absolutely be leveraging your expertise. You can expect to hear from me, and I’ll be an advocate and a champion for the people that you’re serving.

  • Ken Block (Independent):

Thank you for the opportunity to come here tonight, and thank you for the advocacy work that you do. Thank you for the services that you provide. Thank you for caring so much about the issues that have come out here.

Our government doesn’t work without people outside government making sure it doesn’t forget what it’s supposed to do.

You have seen in both of us tonight the hesitancy and the challenge when we talk about the funding and what’s coming at us.

We’re all feeling the pinch throughout the healthcare system. We are under tremendous stress from the physicians, the providers, all the way across.

For me, as someone looking to buy private health insurance, it’s probably close to $4,000 a month for my family of four.

That is unaffordable for the vast majority of Rhode Islanders. That’s way more than most Rhode Islanders pay on the mortgage.

So, we have what I lovingly call a mess.

And a problem of this magnitude requires a detailed thinker, somebody who’s going to pull the experts together and drive the conversation, and look to provide some structure on something that’s very unstructured right now.

And we have to find savings wherever we can, and put that money to better use.

Medicare and Medicaid at 60: Historic Milestones, Looming Changes

Published in RINewstoday on August 4, 2025

As 68 million Medicare beneficiaries recognize the 60th anniversary of Medicare, changes are coming to these landmark programs. Presented as efforts to slash costs and combat fraud, the thought of change to Medicare in almost any way leaves many older Americans feeling threatened that their health and financial security will be impacted in a negative way.

A Legacy Under Threat – or Repair?

On July 30, 1965, President Lyndon B. Johnson signed H.R. 6675 into law during a ceremony at the Truman Library in Independence, Missouri. Lasting between 45 and 60 minutes, the event marked the official creation of Medicare and extended guaranteed health coverage to 16 million Americans aged 65 and older—coverage that had not previously existed.

Former President Harry Truman, who had fought for national health insurance two decades earlier, was present for the ceremony. He was enrolled as Medicare’s first beneficiary and received the first Medicare card at the event.

Speaking at the bill signing, President Johnson declared, “No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime… No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents.” Johnson concluded, “When the final chapter of this generation is written, it will be said that we met the needs of the old, and that we did not abandon them to the despair and loneliness and hardship that comes when illness strikes the aged.”

Today, Medicare provides universal health coverage to Americans age 65 and older—though, as the National Committee to Preserve Social Security and Medicare (NCPSSM) humorously noted in its blog, “Ironically, the program is not yet old enough to qualify for itself.”

 The law created Part A to provide hospital insurance funded through payroll taxes and Part B to cover doctor visits and outpatient services on a voluntary basis. Part C, known as Medicare Advantage, offers a privatized, for-profit alternative to traditional Medicare. Part D (coverage through private, for-profit insurers rather than through the traditional Medicare program), added in 2003, provides coverage for prescription drugs. Over the years, Medicare has evolved to offer a wider range of services, yet it still falls short in some areas. Efforts to expand coverage to include essential benefits like dental, hearing, and vision have repeatedly failed to pass Congress.

Medicaid is a federal-state program that offers health coverage to low-income individuals, including children, pregnant people, and those with disabilities — in addition to covering long-term care for eligible seniors. It is a key funding source for U.S. safety net healthcare providers.

NCPSSM’s President and CEO, Max Richtman said that, “We should take a moment to marvel at the fact that — like Social Security — Medicare was created by national leaders who had a vision of a more just society, where, instead of leaving older people to get sick and die in poor houses or becoming a burden to their children, America would commit itself to providing basic health (and financial) security to our most vulnerable citizens.  Through the foresight of Franklin D. Roosevelt and Lyndon Johnson, these benefits (Medicare Part A and Social Security) would be earned through workers’ payroll contributions, giving Americans a true stake in insuring themselves against the hardships of aging.”

What’s at Stake

Despite Medicare’s broad support, it has frequently come under political attack, often rationalized by concerns over its long-term financial viability. The most recent Medicare Trustees report projects that the program’s Part A trust fund could be depleted by 2033 if Congress does not act. At this point the fund’s reserves would only be able to pay 90% of the total scheduled benefits in what there is to spend on Part A.

In 2025, following weeks of political discourse, the “Big Beautiful Bill” was signed into law on July 4, 2025. Known formally as H.R. 1, the sweeping 900-page legislation passed the House on May 22 by the razor-thin margin of 215–214–1. Every House Democrat opposed the measure. Two Republicans joined them. Freedom Caucus Chair Andy Harris of Maryland voted “present.” Two Republican members abstained.

Richtman, sharply criticized the law, saying it “rips health coverage away from as many as 16 million Americans and food assistance from millions more.” Its Richtman’s opinion to warn that 7.2 million seniors who are dually enrolled in Medicare and Medicaid, and another 6.5 million who rely on SNAP (Supplemental Nutrition Assistance Program), stand to lose vital support for health care and nutrition.

The Center for Medicare Advocacy (CMA) also raised serious concerns. CMA is a national, non-profit law organization, working to advance access to Medicare and quality health care through advocacy on behalf of older and disabled people. They warn that Medicare is being steadily privatized. More than half of all beneficiaries now receive their care through Medicare Advantage plans, which costs taxpayers approximately 20 percent more than traditional Medicare. These plans often restrict access to care through networks and pre-authorization requirements. CMA estimates that the $84 billion in overpayments to Medicare Advantage plans this year alone could instead have funded comprehensive dental, vision, and hearing coverage for every Medicare recipient.

CMA further maintains that H.R. 1 strips Medicare coverage from certain lawfully present immigrants who had earned eligibility through their work histories. Undocumented immigrants are not eligible for Medicare. It also blocks implementation of enhancements to the Medicare Savings Program that would have helped low-income beneficiaries afford care, stops new federal nursing home staffing standards estimated to have the potential to save 13,000 lives per year, and limits Medicare’s ability to negotiate lower drug prices for some of the most expensive medications.

Medicaid, enacted alongside Medicare in 1965 to serve low-income individuals and families, faces even steeper reductions under H.R. 1. The law’s new eligibility restrictions are projected to cause from 10-16 million people to lose coverage.

Medicaid Fraud, Waste, and Abuse

Medicaid fraud, like other forms of healthcare fraud, involves intentionally submitting false information to receive payment for services not rendered, unnecessary services, or inflated claims. This fraudulent activity has serious consequences, harming patients, honest providers, and taxpayers. In 2024, the national Medicaid improper payment rate was estimated at 5.09%, translating to $31.1 billion in federal Medicaid improper payments. Medicaid Fraud Control Units (MFCUs) recovered $1.4 billion in FY 2024, representing a return of $3.46 for every $1 spent. Criminal recoveries in FY 2024 were the highest in 10 years, reaching $961 million, more than double the five-year average.

In 2024, 8% of Medicaid claims were deemed improper payments due to fraudulent practices. Fraudulent billing for services not rendered or exaggerated in complexity (upcoding or ghost billing) was a common theme in 2024 fraud cases. Misuse of telehealth and the involvement of third-party billing firms were also notable trends in Medicaid fraud cases in 2024. Prescription drug scams, especially involving opioids and controlled substances, remain among the most significant Medicaid fraud cases. Medicaid fraud in managed care settings increased by 30% in the past five years.

Examples of recipient fraud include lending or sharing a Medicaid Identification card; forging or altering a prescription or fiscal order, using multiple Medicaid ID cards, re-selling items provided by the Medicaid program, and selling or trading the card or number for money, gifts or non-Medicaid services.

Examples of provider Fraud, Waste, and Abuse include billing for Medicaid services that were not provided or for unnecessary services, selling prescriptions, intentionally billing for a more expensive treatment than was provided, giving money or gifts to patients in return for agreeing to get medical care, and accepting kickbacks for patient referrals.

Rhode Island Senators React 

In response to the changes in H.R. 1, Rhode Island’s U.S. Senators Jack Reed and Sheldon Whitehouse joined the entire Senate Democratic caucus to introduce S. 2556 on July 30, the 60th anniversary of Medicare and Medicaid. This three-page bill seeks to repeal the health care cuts included in H.R. 1 and permanently extend the Affordable Care Act’s enhanced tax credits, which are set to expire at the end of 2025. Full Democratic caucus sponsorship of legislation—led in this case by Senate Minority Leader Chuck Schumer—is exceptionally rare and underscores their urgent need to call out the Big Beautiful Bill for its healthcare changes.

S 2556 has been referred to the Senate Finance Committee and at press time no House companion measure has been introduced.

Senator Reed emphasized the wide-reaching impact of H.R. 1, saying that millions of people are expected to lose health coverage under the combined effects of the bill’s Medicaid and ACA cuts. The repercussions, he said, will be felt by health clinics, hospitals, seniors, nursing homes, and patients across the country.

According to an analysis by KFF (formerly the Kaiser Family Foundation) 43,000 Rhode Islanders could lose health coverage due to the bill. Of those, 38,000 would lose insurance as a result of Medicaid cuts, and another 5,500 due to changes in the Affordable Care Act. The same analysis projected that Rhode Island would lose $3 to 5 billion in federal Medicaid funding over the next decade due to the law’s provisions.

Reed also noted that the bill includes cuts to the SNAP (food stamps) program—reducing federal funding by 20 percent through 2034. States would have the option to pick up the difference using their own funds.  In Rhode Island, where 1/3 of the population is on social welfare assistance of some kind, including Medicaid and SNAP, an estimated 144,000 Rhode Islanders are expected to lose SNAP benefits entirely. To maintain SNAP provisions in Rhode Island, the estimated cost could be as high as $51 million.

Reed explained that without ACA premium tax credits, younger workers will also face rising health insurance premiums beginning in 2026, putting additional financial strain on working families. When people lose access to health insurance, they are more likely to delay or skip care, leading to poorer health outcomes and higher overall costs. Federal law would still require hospitals to provide emergency care, meaning hospitals will absorb the financial burden when patients cannot pay. There are also new limits on how medical costs can be held against individuals, especially in Rhode Island, with provisions against destroyed credit ratings, liens, and bankruptcy moves.

BBB Supporters Say It’s a Pill We May Need

According to supporters of H.R. 1, recent changes to Medicare, Medicaid, and SNAP may be seen as fearful, but positive, because they improve affordability, access, and long-term health outcomes.  They says that H.R. 1. Medicare’s new $2,000 cap on drug costs protects seniors from crushing out‑of‑pocket expenses. Medicaid’s pilot coverage for obesity treatments like GLP‑1 drugs supports preventative care and could reduce chronic illness. Meanwhile, efforts to modernize SNAP enrollment and target benefits more effectively aim to reduce administrative waste and better serve low‑income families. However, the introduction of new SNAP work requirements, while controversial, is intended to encourage workforce or volunteer participation among beneficiaries. These reforms reflect a broader commitment to updating essential safety net programs, making them more efficient, equitable, and responsive to today’s health and economic realities—without sacrificing core benefits, supporters add.

A New Reality

As aging advocates and policymakers mark the 60th anniversaries of Medicare and Medicaid, they are forced to address a new reality in both programs. Rather than continually expanding to meet growing needs of older adults, these programs now face reductions that could lead to challenges in access, lower quality care, increased paperwork, disruption in treatment, higher premiums, and fewer covered services. Provider reimbursements are also expected to be cut, which may further limit access to care.

Instead of being a milestone for celebration, the 60th anniversary of Medicare and Medicaid has become a turning point for aging advocate groups—marking not progress, but threat for millions of older Americans who depend on these essential programs to live with dignity, independence, and health.

Trump’s Big Bill, Big Promises – But a Bust for Seniors

Pubished in Blackstone Valley Call & Times on July 8, 2025

After 48 relentless days of political maneuvering—marked by cajoling, backroom bargaining, strategic threats, and last-minute incentives to win over stubborn holdouts—President Donald Trump finally got his wish: Congress passed his prized “One Big Beautiful Bill” (H.R. 1), which he triumphantly signed into law on July 4, 2025.

On May 22, 2025, the House narrowly approved the sweeping 900-page bill by a vote of 215–214–1. Every House Democrat opposed the measure. Two Republicans, Reps. Thomas Massie (R-KY) and Warren Davidson (R-OH), joined the opposition, while Freedom Caucus Chair Andy Harris (R-MD) voted “present.” Two GOP lawmakers did not vote.

What’s In the Bill: Tax Breaks Up, Safety Nets Down

The legislation extends the 2017 individual tax cuts and adds new deductions for tips, overtime pay, auto loan interest, and “Trump Accounts” for children. It raises the SALT deduction cap to $40,000 for five years, increases the child tax credit, imposes a remittance levy, and taxes college endowment income.

On the spending side, H.R. 1 raises the debt ceiling by $5 trillion, slashes over $1 trillion from Medicaid and Medicare, expands work requirements for  Supplemental Nutrition Assistance Program (SNAP) recipients, and allocates $150 billion each to defense and border enforcement—boosting ICE funding to over $100 billion by 2029.

Senate Republicans spent more than five weeks reviewing the House bill’s provisions to comply with the Byrd Rule, walking a tightrope between deficit hawks and moderates. After a marathon “vote-a-rama” that saw 46 amendment votes (only six of which passed), the Senate approved the bill 51–50 on July 1, with Vice President J.D. Vance casting the tie-breaking vote.

The reconciliation process allowed the Senate to pass the bill with a simple majority rather than the standard 60-vote threshold. When the bill returned to the House Speaker Mike Johnson and President Trump personally lobbied holdouts, linking support to other legislative priorities and negotiating procedural rules. Early on July 3, the House adopted the Senate version in a 218–214 vote, with only Reps. Brian Fitzpatrick (R-PA) and Thomas Massie (R-KY) voting with Democrats. The bill was sent to the White House and signed into law the following day.

Despite Republican praise, public reaction to Trump’s “One Big Beautiful Bill” has been largely negative. A KFF Health Tracking Poll found that 64% of Americans view H.R. 1 unfavorably, compared to 35% in support.

President Trump and GOP leaders hailed the bill as a historic conservative win that fulfills “America First” promises—cutting taxes, slashing regulations, boosting border security, promoting energy independence, and reducing federal spending. “This is a major victory for hardworking families,” said Rhode Island GOP Chair Joe Powers in a statement, praising the bill for delivering middle-class tax relief and real border control.

But Congressman Gabe Amo (D-RI), representing Rhode Island’s 1st Congressional District, sees it differently and warns of the devastating consequences to aging programs and services.

“Trump’s big, ugly bill” shows that Republican lawmakers, following Trump’s marching orders, voted for “the largest theft in American history to further enrich the richest among us,” he says.

“Simply put, because of this horrific legislation, Americans will be poorer, sicker, hungrier, and further away from economic opportunity,” says the Rhode Island Congressman.

Deep Cuts and Dire Warnings from Aging Advocates

SACRI Policy Advisor Maureen Maigret emphasized the need for swift action in Rhode Island, stating, “It is crucial for the Secretary of the Executive Office of Health and Human Services to promptly convene the advisory group outlined in Section 8 of the state’s FY 2026 budget bill.”

“For years, SACRI has worked to ensure a balanced system of long-term services—supporting quality nursing home care, expanding access to affordable home and community-based services, and collaborating with the Office of Healthy Aging and other aging advocacy groups to promote healthy aging,” says Maigret.

SACRI, a statewide coalition advocating for older Rhode Islanders, has partnered with other organizations to make significant strides in these areas, according to Executive Director Carol Anne Costa. “We cannot allow this progress to be reversed, especially as older adults are the fastest-growing segment of the state’s population,” Costa says.

“We have sent a letter to Secretary Charest requesting that SACRI be included in the advisory group established by Article 8 of the state’s FY 2026 budget bill.”

Now accounting for nearly 20 percent of the total population, the number of Americans age 65 and older is steadily increasing.

“Make no mistake: this harmful, cold-hearted bill will wreak havoc on our country’s fragile aging services infrastructure—at a time when demand for the Medicare and Medicaid-supported services it delivers is growing,” warns Katie Smith Sloan, president and CEO of LeadingAge.

“This legislation deals a significant blow to a core element of our country’s social safety net: Medicaid,” adds Sloan, emphasizing that the consequences “will not be pretty.”

She further warns, “Due to the level of deficit this bill will create, Medicare payments to providers may be reduced by 4% for the next ten years.”

According to Sloan, the bandaids included in H.R. 1—such as freezing (but not reducing) nursing home provider taxes and creating a rural health transformation fund, both touted as protections for older adults and aging services providers—will soon prove ill-equipped to prevent the bill’s damage. As states begin to grapple with budget shortfalls caused by reduced federal Medicaid contributions, the suffering, she says, will begin.

Max Richtman, President & CEO of the National Committee to Preserve Social Security and Medicare, warned that 16 million Americans may lose health coverage, and millions more could lose access to food assistance. He stressed the bill’s devastating effects on the 7.2 million seniors dually enrolled in Medicare and Medicaid and the 6.5 million older adults who rely on SNAP benefits.

“These beneficiaries are some of the most vulnerable members of our society — and Republicans have put them at risk in order to pay for another tax cut mainly for the rich,” he says.

AARP: Safety Nets Shredded, Protections Undermined

Although AARP expressed strong opposition to many provisions in the reconciliation bill, the organization did support several key measures. These included increased investment in affordable housing through the Low-Income Housing Tax Credit, raising the additional senior standard deduction to $6,000, and expanding the Section 45S tax credit for paid family and medical leave.

Executive Vice President Nancy LeaMond criticized the bill’s cuts to Medicaid, ACA Marketplace coverage, and food assistance, calling them particularly harmful to older adults, rural residents, and family caregivers. She emphasized that over 17 million Americans aged 50 and older rely on Medicaid to remain in their homes and manage chronic health conditions.

“This is a moment to strengthen—not weaken—the supports that help people stay in their homes, access needed health care, and live with dignity and independence,” said LeaMond, representing nearly 38 million members nationwide.

She stressed that AARP remained strongly opposed to Senate provisions that would slash Medicaid, Marketplace coverage, and food assistance, making it harder for older adults to get by.

“More than 17 million Americans age 50 and older rely on Medicaid as a critical safety net to stay in their homes, manage chronic conditions, and afford long-term care,” says LeaMond. “By limiting how states fund their Medicaid programs, the new law threatens health care access—particularly for people in rural and underserved areas and through safety-net providers,” she adds.

LeaMond also expressed concern over delayed implementation of nursing home staffing standards, which are estimated to save 13,000 lives annually, and provisions allowing drug companies to continue charging high prices for certain orphan drugs—even while selling the same medicines overseas at far lower costs.

AARP opposes H.R. 1’s new burdens that could cost people their health care or food assistance when they are unable to work due to age discrimination, caregiving responsibilities, or chronic illness. “This will only make it harder for many older adults to access needed health care and to put food on the table,” she says.

She also warns that the new SNAP cost-sharing formula could shift billions in expenses to state budgets, forcing states to restrict eligibility, reduce benefits, or withdraw from the program entirely.

Finally, AARP strongly opposed the bill’s 10-year moratorium on state and local regulation of artificial intelligence (AI), arguing that it undermines consumer protections in employment, housing, and health care—leaving older adults more vulnerable to harm from biased or untested AI systems.

For additional information on H.R. 1’s impact on senior programs and service, visit: aarp.org/advocacy/fight-senate-cuts-medicaid-snap
aarp.org/advocacy/support-budget-bill-tax-proposals