Pandemic Lessons: “Essential Caregivers Act” Can’t Wait. A Merciful, Bipartisan Bill for a Voiceless Population

Published in RINewsToday on January 19, 2026

As COVID-19 spread rapidly across the country in March 2020—entering nursing homes largely through community transmission and staff movement—the Centers for Medicare & Medicaid Services (CMS) issued guidance calling for nationwide visitor bans in nursing homes. These strict restrictions barred all visitors and non-essential health care personnel, with limited exceptions for hospice care.

According to March 29, 2025 article, “Changes in Federal and State Policies on Visitation Restrictions in Nursing Homes During the COVID-19 Pandemic,” published in the Journal of Applied Gerontology, 31 states enacted statewide indoor visitation bans through executive orders between March 9 and April 6, 2020, and the end dates were between 6/15/2020 and 3/24/2021. CMS would later relax its guidance, permitting indoor visitation when facilities reported no new COVID-19 cases for 14 days and community positivity rates were low.

Charlie Galligan, a licensed criminal defense investigator in Rhode Island, knows firsthand the toll those restrictions took. He and his wife, Kerry, provided daily care for his parents for 13 years—his father, Jack, who died from Alzheimer’s disease in 2022, and his mother, Audrey, who lives with a traumatic brain injury. Balancing work with caregiving became the catalyst that pushed Galligan to lobby Congress to prevent the prolonged and unnecessary isolation of nursing home residents during future pandemics, including advocating for policies that allow designated family caregivers to visit.

“Long-term care lockdowns continued well after humane safety measures were established and family caregivers had been vaccinated,” Galligan claimed, noting that countless residents died alone as a result. “Daughters were forced to say goodbye to mothers with Alzheimer’s over FaceTime—often staring at their phones as exhausted staff struggled to provide even minimal connection.”

A Legislative Effort Revisited

The initial legislative proposal—the Essential Caregivers Act (H.R. 3733)—was introduced in June 2021 to reaffirm and enforce the right of nursing home residents to receive visits from family and friends during declared emergencies. When that proposal stalled due to the absence of a Senate companion bill, a second attempt followed the next year with the introduction of S. 4280/ H.R. 8331.  Political insiders say that these bills stalled due to the legislative process, timing, and competing priorities not because Congress rejected the process. Most recently, the Essential Caregivers Act of 2025 was reintroduced last month.

On Dec. 16, 2025, U.S. Senator Richard Blumenthal (D-CT) and U.S. Representative Claudia Tenney (R-NY) introduced bipartisan legislation in their respective chambers to prevent a repeat of the prolonged isolation and reduced care nursing home residents faced during the COVID-19 pandemic. U.S. Senator John Cornyn (R-TX) and U.S. Representative John B. Larson (D-CT) joined them in cosponsoring the Essential Caregivers Act.

The Senate bill, S. 3492, currently with seven cosponsors, was referred to the Senate Finance Committee. That same day, the companion measure, H.R. 6766, with 35 cosponsors, was introduced in the House and referred to the Ways and Means Committee and the Energy and Commerce Committee.

“Our movement to enact the Essential Caregivers Act is not led by professionals or lobbyists,” Galligan said. “We are simply a determined group of family caregivers—primarily brilliant, tenacious women from across the country, and one token guy from Rhode Island—who love our mothers and fathers and refuse to accept silence and separation as acceptable standards of care.”

Congressional Supporters Call for Passage

“During the COVID-19 pandemic, we experienced how dangerous and inhumane it is to isolate seniors and vulnerable patients from the people who care for them the most, say Rep. Tenney, in a statement announcing the introduction of the bill.  “Families were locked out, residents declined rapidly, and farm to many suffered alone,” she said.

“The Essential Caregivers Act ensures that this never happens again,” says Rep. Tenney, noting that they are loved ones, not visitors.  “They are caregivers, advocates, and lifelines. This bipartisan legislation protects dignity, safeguards patient rights, and makes sure compassion and comment sense guide our response during an future emergency,” she adds.

Sen. Blumenthal emphasized the bill’s bipartisan intent. “By allowing at least one designated essential caregiver to have safe, in-person access to their loved ones during an emergency, our legislation ensures that residents will never again face the devastating isolation experienced by so many during COVID-19,” he said.

Rhode Island Sen. Jack Reed, a cosponsor of the Senate bill, echoed that sentiment. “We want to keep people safe from germs, but we also want to keep them connected—because isolation can take a real toll on health,” Reed said. “Essential Caregivers Act would ensure that even during limited visitation, residents can still have in-person contact with a loved one.”

Sen. Sheldon Whitehouse has expressed support and is on a waiting list to cosponsor it – cosponsors are being added in bipartisan pairs. “Loneliness can take a real toll on residents of long-term care facilities,” he said. “This legislation recognizes the critical role loved ones play in supporting residents’ well-being, even during public health emergencies.”

Not yet committed to cosponsoring are Rhode Island’s two Representatives

At press time, Rep. Gabe Amo, had not yet committed to cosponsoring the bill. “I am reviewing the Essential Caregivers Act of 2025,” Amo said. “Family caregivers are the backbone of our long-term care system, and I remain committed to advancing policies that support patients, caregivers, families, and health care providers.”

Like his House colleague, Rep. Seth Magaziner (D-RI), has not yet committed to sponsoring the bill. Magaziner acknowledges the importance of allowing nursing home residents access to their loved ones and is open to considering the legislation. However, he is also working to understand what safeguards would be in place to ensure resident safety during emergencies, according to Noah Boucher, the lawmaker’s communications director.

The Nuts and Bolts

Recognizing that family members are essential to residents’ care and well-being, S. 3492 and H.R. 6766 aim to prevent the emotional, psychological, and physical harm caused by prolonged separation during public health emergencies.  This bill strikes a balance protecting public health while safeguarding the wellness of residents.

The Essential Caregivers Act requires nursing facilities receiving Medicare or Medicaid funding to participate. It guarantees that at least one designated essential caregiver may access a resident during periods of restricted visitation, provided the caregiver follows the same safety protocols as facility staff. If a resident is unable to designate a caregiver, a representative may do so on the resident’s behalf.

The legislation also affirms caregivers’ rights to advocate for residents, participate in care planning, and ensure residents’ civil rights are protected. Additional provisions address roommate rights, as well as exemptions for end-of-life and compassionate care.

Facilities must provide written justification if caregiver access is denied, with appeals overseen by state survey agencies.

The bill has been endorsed by the AARP and Consumer Voice.

Rhode Island Advocates Call for Passage

Calling for passage of the legislation, Rhode Island Long-Term Care Ombudsman Lori Light said the COVID-19 pandemic made painfully clear how critical family caregivers are to residents’ health, safety, and well-being.

“During extended lockdowns, we witnessed firsthand the profound impact isolation had on residents, including increased depression, anxiety, cognitive decline, weight loss, and loss of engagement in daily life. For many residents, family members are not simply visitors—they are essential partners in care – they provide emotional support, help residents communicate their needs, notice subtle changes in medical conditions, and advocate when something doesn’t seem right. When access was cut off, residents lost a vital layer of protection and connection. The lessons we learned during COVID-19 must guide future policy decisions,” Light said. “No resident should ever again experience prolonged isolation from the people who know them best,” said Light.

According to Deb Burton, MS, executive director of RI Elder, the isolation imposed on long-term care residents during the pandemic was devastating. While infection control was essential, she said, the complete separation of residents from their families caused profound and lasting harm. Burton, a gerontologist, noted that residents experienced rapid physical, cognitive, and emotional decline.

“Families endured anguish knowing their loved ones were frightened, confused, and alone during the most vulnerable moments of their lives. Family members are not simply visitors—they truly are essential caregivers. They provide a familiar face, a steady hand to hold, and an understanding of a resident’s routines, preferences, and communication needs. This is especially true for individuals living with dementia or other forms of memory loss, for whom familiarity and connection are critical to well-being and safety,” Burton said.

Comments from the American Health Care Association 

While expressing support for family involvement, the nursing home industry has raised concerns about certain provisions of the bill.

From Holly Harmon, senior vice president of quality, regulatory, and clinical services at the American Health Care Association: “While we wholeheartedly support family members taking an active role in their loved one’s care, there are certain provisions of this bill where we have concerns. Mainly, we believe each situation, including public health emergencies, requires a collaborative process among public health officials and stakeholders to determine the most appropriate way to keep residents safe and loved ones connected, rather than implementing a blanket, inflexible process for all situations. We hope to work with lawmakers to make improvements to these proposals as the engagement of loved ones is critical to our residents’ wellbeing.

“Despite our caregivers doing everything they could to step in for family members during the pandemic, we were deeply concerned about the prolonged isolation of our residents. Public health officials were put between a rock and a hard place on how to best protect those in long term care, and due to the vicious nature of the virus on our resident population, it was determined best to restrict visitors and social interactions. Nursing homes were required to follow these restrictions until March 2021, and even then, CMS and CDC had strict guidelines due to the ongoing spread of the virus.

“The best way to prevent this global tragedy again is for officials to prioritize long term care residents and staff during public health emergencies, so that they can remain protected, active, and engaged with their loved ones and the community.”

A Final Note…

The best way to prevent another tragedy is to prioritize long-term care residents and staff during public health emergencies, so they can remain protected, active, and connected to loved ones. We must learn from the painful lessons of COVID-19. No one should be forced to decline alone, grieve alone, or die alone because of a lack of clear policy, RIElder’s Burton added. She noted that the Essential Caregivers Act ensures that in the next public health emergency” when it could be any one of us in a facility” we will not be separated from the person who knows us best and stands ready to advocate for us.

Caregiver Galligan remains hopeful. “This is simply a merciful bill for a voiceless population”, he said.

(updated 1-21-26)

Aging Policy in 2025: Rhode Island Legislative Wins and What’s Missing

Published in RINewsToday.com, July 14, 2025 

On June 24, 2025, with a 35-2 vote in the Senate, the Rhode Island General Assembly has given its approval to a $13.963 billion budget for the 2026 fiscal year that directs additional funding toward addressing the state’s housing and homelessness crisis, improving access to health care, supporting municipalities through increased revenue sharing, more funding for the state’s Rhode Island Public Transit Authority, extending childcare subsidies for toddlers and infants, and increasing Medicaid reimbursement to primary care providers, nursing homes and hospitals, among its directives.

Faced with a slowing economy and impending federal budget cuts, lawmakers were tasked with closing a $250 million deficit without resorting to broad tax hikes or cuts to essential services. To generate revenue, they implemented new electric vehicle (EV) registration fees, adjustments to the gas tax, and increases in real estate conveyance and hotel taxes. Additionally, tolls on large trucks (18-wheelers), which were approved in 2016 but delayed due to litigation from the trucking industry, are now set to be implemented following the state’s legal victory. The FY 2026 budget includes revenue from these tolls, which are scheduled to take effect.

According to Larry Berman, House Director of Communications, when the dust settled at the conclusion of this year’s 164-day legislative session, lawmakers introduced 1,430 bills and resolutions in the House and 1,165 in the Senate. Of those, the Governor signed 384 House and Senate bills into law, while another 125 became law without his signature.

The Governor is not required to act on resolutions. During the session, the House passed 238 resolutions and the Senate passed 127, most of which expressed congratulations or condolences, says Berman.

As Rhode Island’s population continues to age, advocacy organizations urged lawmakers to consider an array of legislation aimed at enhancing the delivery of state programs and services for older residents—and strengthening protections for their health, safety, financial security, and overall well-being.

Below is a selection of key laws enacted, organized by category:

Healthcare and Insurance

Lawmakers increased insurance coverage for hearing aids from $1,500 to $1,750 per ear, applicable to all ages. Additionally, the new law allows for hearing aid purchases every year, rather than every three years. Sponsored by Rep. Carol Hagan McEntee (D-Dist. 33, South Kingstown, Narragansett), H 5218,  and Sen. Leonidas P. Raptakis (D-Dist. 33, Coventry, West Greenwich, S 0120, this legislation has been signed by the Governor.

The General Assembly passed S 0610B introduced by Senate President Valarie J. Lawson (D-Dist. 14, East Providence) and Rep. Kathleen A. Fogarty’s (D-Dist. 35, South Kingston), bill, H 5494A.  The new law provides new consumer protections for Medicare Supplement Insurance (Medigap) and aligns Rhode  Island’s market with neighboring states. Additionally, the budget expanded the Medicare Savings Program, helping more beneficiaries with premiums and co-pays.

With the passage of S 0169A  sponsored by Sen. Jacob E. Bissaillon (D-Dist. 1, Providence) and H 5184A by Rep. Mary Ann Shallcross Smith (D-Dist. 46, Lincoln, Pawtucket), the new law protects homeowners from medical debt-related liens on their primary residence. Medical bills are among the top reasons underlying bankruptcy among Americans. This law takes effect on Jan. 1.

Senate President Lawson and Rep. Joshua J. Giraldo (D-Dist. 56, Central Falls) sponsored S 0974aa and H 6066A to expand paid family leave under the Temporary Care Insurance (TCI) program. Starting in January 2027, the TCI wage replacement rate will increase from 60% to 70%, and then to 75% in January 2028. This expansion is funded through a modest increase in the payroll contribution cap, which will not impact the state budget.

Consumer Protections and Financial Legislation

The General Assembly passed S 0016A and H 5121A, introduced by Senate Artificial Intelligence & Emerging Technologies Committee Chairwoman Victoria Gu (D-Dist. 38, Westerly, Charlestown, South Kingstown) and Rep. Julie A. Casimiro (D-Dist. 31, North Kingston, Exeter). Signed by the Governor, the new law aims to prevent scams involving cryptocurrency ATMs, a growing fraud scheme in Rhode Island. 

According to AARP, recently 11 states have passed laws or regulations that put key consumer fraud protections on cryptocurrency ATMs in place. Americans lost more than $246 million to crypto ATM fraud and scams in 2024 alone, and older adults are disproportionately targeted by criminals.

With the passage of H 5042A and S 0229A, sponsored by Rep. Karen Alzate (D-Dist. 60, Pawtucket, Central Falls) and Sen. Ana B. Quezada (D-Dist. 2, Providence), a new law eliminates the special exemption that allowed payday lenders to charge exorbitant interest rates of up to 260% APR. This reform helps protect consumers from falling into predatory debt cycles.

Lawmakers passed H 5185A and S 0133A sponsored by Rep. Susan R. Donovan (D-Dist. 69, Bristol, Portsmouth) and Sen. Matthew L. LaMountain (D-Dist. 31, Warwick, Cranston).  Signed into law by Gov. Dan McKee, it prohibits predatory real estate practices that often target older homeowners, preventing them from facing liens or other issues related to their properties.  The bill is based on model legislation that has been adopted in 30 other states. The legislation was backed by AARP, the American Land Title Association and the National Association of Realtors.

Support for Vulnerable Populations

Rep. Tina L. Spears (D-Dist. 36, Charlestown, New Shoreham, South Kingstown, Westerly) and Sen. Todd M. Patalano (D-Dist. 26, Cranston) sponsored H 6165A and S 0983A to create the PURPLE Alert system. Signed into law, this new initiative is designed to quickly locate missing adults with serious disabilities whose health and safety are at risk.

Legislation (S 0381A / H 5833A), sponsored by Senate Majority Leader Frank A. Ciccone III (D-Dist. 7, Providence, Johnston) and Rep. Mary Ann Shallcross Smith, now law, allows licensed hairdressers to provide in-home services to individuals with special needs or sensory-related disorders. This new law ensures that such services are provided in accordance with individual care plans verified by a licensed healthcare professional.

Now law, (H 5017A/ S 0884), sponsored by Rep. Samuel A. Azzinaro (D-Dist. 37, Westerly),  and Sen. Walter S. Felag Jr. (D-Dist. 10, Warren, Bristol, Tiverton), protects veterans from improper conduct or excessive fees by individuals assisting them in filing disability claims with the Department of Veterans Affairs, except as authorized by federal law, and it imposes penalities under the deceptive trade practices provisions.

The General Assembly passed legislation (S 0884 / H 5017A) that grants people the right to repair their own complex power wheelchairs and mobility aids. Sponsored by Sen. Mark McKenney (D-Dist. 30, Warwick) and Rep. Grace Diaz (D-Dist. 11, Providence), this new law requires manufacturers to provide independent service providers with the necessary tools and repair information. Under the new law, manufacturers are prohibited from using parts that would prevent installation of any non-manufacturer-approved replacement part or component. Also, a health plan’s coverage and payment is not allowed to require any form of prior authorization or medical documentation to complete repairs for consumer-owned complex rehabilitation technology.

Deputy Majority Whip Mia A. Ackerman (D-Dist. 45, Cumberland, Lincoln) and Sen. Pamela J. Lauria (D-Dist. 32, Barrington, Bristol, East Providence) introduced H 5619 and S 0481, directing the Department of Health to collaborate with the state’s advisory council on Alzheimer’s to distribute educational materials. With the bill’s passage, signed into law, these resources will help  educate both the public and medical providers on prevention, early detection, and management of Alzheimer’s and dementia.

Legislative Changes and Reforms

Sen. Melissa Murray (D-Dist. 24, Woonsocket, North Smithfield) and Rep. Brandon Potter (D-Dist. 16, Cranston) sponsored legislation (S 0120, H 5218) to create a three-year pilot program to remove prior authorization requirements for medically necessary care ordered by primary care providers.  Now law, the program is designed to reduce administrative delays and improve patient access to timely care.

Two bills sponsored by Sen. Pamela Lauria and Rep. Michelle McGaw (D-Dist. 71, Portsmouth, Tiverton, Little Compton) improve pharmacy flexibility. The first (H 5633, S 0483aa) allows pharmacists to dispense a one-time refill for up to 100 days if the prescriber is unavailable. The second bill (S 0482A H 5855A) simplifies the process for substituting therapeutically equivalent prescription drugs or devises. Such substitutions typically occur at the request of an insurer, and the current process requires the pharmacist to contact the patient’s prescriber for approval before filling it.

Observations from Aging Advocates:

Lori Light, the state’s Long-Term Care Ombudsman, frequently observes that facility staff accused of abuse are often terminated from one facility only to be rehired by another, with the new administrator unaware of the prior allegations. “While it is important not to penalize individuals based on unproven claims, we believe that repeated allegations involving the same staff member across multiple facilities are unlikely to be coincidental and suggest a recurring issue,” she says.

To address this, H 5303 was introduced to make the complaint histories of licensed care staff accessible to prospective employers. Light expressed disappointment that this bill did not become law and hopes to work closely with the state’s Department of Health to revise and reintroduce it next year.

“We were pleased to see that the Safe Staffing and Quality Care Act, initially passed in 2021, was amended by the state budget to allow for enforcement,” says Light. While she acknowledges that the revised law may not provide the same level of benefit to nursing home residents as originally intended, she recognizes it as a step forward.

Light also expressed disappointment that the Assisted Living Resident Empowerment Act (H5169, S484) did not pass. “Assisted living facilities remain under-regulated, with fewer resident rights despite high monthly costs and regular rate increases,” she said. The unsuccessful legislative change would have strengthened resident and family councils and improved financial transparency within these facilities.

“It’s unclear why the Department of Health’s legislation (H5426, S789), which would have increased financial transparency in nursing homes and limited equity extraction, failed to advance this year, despite having the governor’s support,” says Light. She notes that this is the second year the bill has been introduced.

“With more out-of-state investor groups acquiring facilities, it is critical to ensure that public Medicaid dollars are spent on resident care, not diverted to investors,” she emphasizes, recognizing that the bill represented a modest but essential step in that direction. “We anticipate that RIDOH will reintroduce the bill next session, and we remain committed to supporting it,” she says.

Carol Anne Costa, executive director of the Senior Agenda Coalition of RI (SACRI), notes, “SACRI worked closely with many agencies and individuals in the aging network to advance our legislative agenda. Collaboration is always beneficial for passing good laws, and more importantly, it strengthens the fabric of the coalition,” she says.

Costa continues, “SACRI fully intends to resume pushing for the passage of unsuccessful legislation in the next session, including expanded accessibility in new housing, the development of more housing for older adults, nursing home patient welfare, and assisted living resident councils. Additionally, SACRI will be closely monitoring the impact of the Trump’s Reconciliation Bill on Rhode Island.”

SACRI Policy Advisor Maureen Maigret adds, “It was absolutely wonderful to see the FY 2026 bill include a provision to increase the income eligibility for the Medicare Savings Programs (MSP), which was SACRI’s top legislative priority for 2025.”

Maigret notes that SACRI has worked tirelessly since 2013 to expand the MSP program. “These efforts finally paid off, thanks to the incredible support from community partners and legislative champions, including House Speaker  K. Joseph Shekarchi (D-Dist. 23, Warwick), lead sponsors Sen. Louis DiPalma and Rep. Karen Alzate, and many legislative co-sponsors.”

“Once eligibility is increased, as called for in the budget, potentially several thousand current MSP participants will have their co-payments covered, and thousands more Medicare enrollees will no longer have to pay for their Part B premiums (currently $185/month). These savings will help pay for other basic needs, such as food,” says Maigret.

Rhode Island’s 2025 legislative session brought meaningful advances for older adults, including expanded healthcare coverage, stronger consumer protections, and new programs supporting vulnerable populations.  Despite these successes, important bills on long-term care staff accountability, assisted living oversight, and nursing home financial transparency did not pass, leaving critical issues unresolved.

Expect committed aging organizations and advocates to return next year to advance these and other unfinished legislative priorities including promoting development of accessible housing for those with mobility impairments and caregiver tax credits to help ease the financial burden on unpaid family caregivers.

For a reporting of the provisions in the FY 2026 Rhode Island budget, visit https://rinewstoday.com/house-finance-committees-fy-26-budget-boosts-support-for-older-rhode-islanders-herb-weiss/.

House Finance Committee’s FY 26 Budget boosts support for older Rhode Islanders

Published in RiNewsToday on June 16, 2025

Last Wednesday evening, the House Finance Committee voted 11–3 to approve a balanced $14.33 billion budget for fiscal year 2026—approximately $500 million less than the current year’s budget.

Lawmakers were tasked with closing a $250 million deficit without resorting to broad tax hikes or cuts to essential services. Faced with a slowing state economy and looming federal funding reductions, they focused squarely on bridging the budget gap while improving access to health care, increasing reimbursement rates for primary care providers, nursing homes, and hospitals, and addressing the state’s housing crisis.

The budget proposal also boosts funding for housing and homelessness services, supports municipalities through increased revenue sharing, expands Rhode Island Public Transit Authority (a.k.a. RIPTA) funding, invests in education, imposes new EV registration fees, restores highway tolls, and extends childcare subsidies while setting distinct rates for toddlers and infants.

“Despite the very significant challenges we face in this fiscal year, this budget reflects our commitment to our priorities: not only protecting, but strengthening the vital Medicaid programs that provide health and safety to Rhode Island’s seniors, children, individuals with disabilities, and working families; supporting our health care system, particularly the hard-working primary care providers and frontline caregivers; and addressing our housing crisis,” said House Speaker K. Joseph Shekarchi (D-Dist. 23, Warwick), in a statement announcing the budget’s passage by the House Finance Committee.

Vote Set

According to House Communications Director Larry Berman, the 435-page budget proposal (2025-H 5076A) now moves to the full House for a vote scheduled for Tuesday, June 17, at 3:30 p.m. If passed, the budget will be sent to the Senate, where action is expected by the end of next week as the legislative session concludes.

If the Senate makes no changes, the bill will go directly to Governor Dan McKee for his signature. However, if revisions are made, it must return to the House for final approval before being sent to the Governor.

Berman and his Senate counterpart, Greg Paré, Director of Senate Communications, do not anticipate any major issues—but note that nothing is ever guaranteed.

Funding Aging Programs and Services

The Senior Agenda Coalition of Rhode Island (SACRI) and its allied aging advocacy groups didn’t get everything they lobbied for —but they made progress, according to SACRI Executive Director Carol Anne Costa, who praised the proposal as a “moral budget.”

“This budget represents a moral compass pointing toward a healthier, more equitable Rhode Island,” said Costa, crediting the group’s advocacy efforts, particularly those of SACRI Policy Advisor Maureen Maigret.

Costa highlighted new language in Article 8 that expands the Medicare Savings Programs, enhancing healthcare access for vulnerable older adults and individuals with disabilities. The House Finance Committee recommended adding $7.1 million—$700,000 of that from general revenues—for this critical expansion.

Unlike a narrower 2024 Assembly proposal that faced implementation barriers, the FY 2026 budget expands eligibility to 125% of the federal poverty level for the Qualified Medicare Beneficiary (QMB) group and up to 168% for the Qualified Individuals (QI) group.

“This crucial change is estimated to assist thousands of Medicare enrollees, helping them cover burdensome co-payments and deductibles, and potentially saving them at least the $185 monthly Part B premium—which can now go toward food and other essentials. For many, this means the difference between delaying care and receiving timely treatment,” Costa noted.

Strengthening Primary Care Access

“The state’s primary care system is at a crisis point. We’ve heard that our reimbursement rates are low, and that’s the main cause of the health care shortage. We wanted to address that immediately,” said Speaker Shekarchi.

SACRI applauded the Speaker’s efforts to address both the shortage of primary care physicians and the funding shortfall for direct-care staff in nursing homes. “This budget recognizes the critical importance of primary care—especially for older adults and those managing chronic conditions—and addresses provider rate increases through several key initiatives,” said Costa.

The proposal includes over $40 million—$15 million from the state and the rest from federal funds—to increase Medicaid reimbursement rates for primary care providers, currently lower than in neighboring states.

Additionally, the budget proposes a new healthcare assessment similar to the state’s immunization program assessments. This broad-based assessment, applied per member per month to all covered lives (including self-insured plans), is expected to raise $30 million annually to support primary care and related services. The estimated state cost is $1.4 million, including $800,000 in general revenues.

The committee also recommended $26.4 million ($8.3 million in general revenue) to raise Medicaid primary care rates to 100% of Medicare rates beginning Oct. 1, 2025. This significant increase aims to incentivize providers to serve more Medicaid patients and improve access to foundational care.

Furthermore, the Office of the Health Insurance Commissioner (OHIC) must submit a one-time report by September 2026 to recommend further adjustments to primary care reimbursement rates.

“To address fiscal challenges facing our community health centers, the budget also includes $10.5 million—$4 million of that from general revenues,” Costa added.

Attacking Persistent Staffing Issues in Rhode Island’s Nursing Homes

SACRI, the Rhode Island Health Care Association (RIHCA), SEIU 1199NE, and the state’s Long-Term Care Ombudsman praised the House Finance Committee’s decision to allocate funds aimed at addressing persistent staffing issues in Rhode Island’s 73 nursing homes. The committee approved a $12 million funding package—including $5 million from general revenues—for a base rate staffing adjustment to improve compensation, wages, benefits, and employer costs for direct-care staff. These investments are designed to enhance the quality of resident care and improve workforce stability.

According to John E. Gage, President and CEO of RIHCA, following months of negotiations, RIHCA and SEIU 1199NE reached a compromise to amend the 2021 nursing home staffing law. The revised agreement establishes a more achievable staffing target of 3.58 hours of care per resident per day and adjusts penalties to support facilities in reaching consistent compliance. It also introduces flexibility for high-performing facilities and those with site-specific challenges. “The state budget passed by the House Finance Committee invests $5 million, which unlocks an additional $7 million in federal matching funds,” noted Gage.

“On behalf of RIHCA and its members, we are pleased that the Speaker and House Finance Committee members recognized the dire conditions facing the industry,” Gage added. “We are encouraged that their actions will help stabilize Rhode Island’s nursing facilities and ensure access to high-quality care and services.”

Rhode Island currently ranks second in the nation for “Immediate Jeopardy” violations—the most serious federal nursing home deficiencies. Both SEIU 1199NE and RIHCA believe the budget provisions will help reverse this alarming trend.

SEIU 1199NE’s Patrick Quinn and SACRI’s Costa praised the inclusion of the $12 million investment in the FY 2026 budget, viewing it as a crucial step in helping nursing homes recruit and retain essential staff.

Lori Light, Rhode Island’s State Long-Term Care Ombudsman, also commended House lawmakers for allocating new funding to improve pay and staffing levels—critical measures for enhancing care quality and creating safer, more stable environments for vulnerable residents. “These are issues our office has consistently advocated for, and we’re encouraged to see real movement in the right direction,” she said.

Finally, the budget proposal also includes an increase of $1.86 million for the Office of Healthy Aging, raising its funding from $37,091,920 to $38,948,518. This includes:

  • A $200,000 boost for Senior Services Support (from $1.4 million to $1.6 million)
  • A $50,000 increase for Meals on Wheels (from $630,000 to $680,000)
  • $325,000 to provide elder services, including respite care, through the Diocese of Providence
  • $40,000 to fund ombudsman services provided by the Alliance for Long Term Care

The Missing Millionaire’s Tax

SACRI and progressive advocacy groups had hoped the budget would include HB 5473, introduced by Rep. Karen Alzate (D-Dist. 60, Pawtucket, Central Falls) on Feb. 12, 2025 and S329 introduced on by Sen. Melissa Murray (D-Dist. 24, Woonsocket, North Smithfield, on February 21, 2025. The bill proposed a 3% surtax on taxable income above $625,000—on top of the existing 5.99% rate—targeting the top 1% of Rhode Island filers. The tax was projected to raise roughly $190 million annually and impact only 5,700 of the state’s 500,000 taxpayers.

But the surtax didn’t make it into the final budget.

Asked why, Speaker Shekarchi explained: “There is still a great deal of uncertainty at the federal level. We don’t know what changes are going to be made in the federal tax code. We felt comfortable enough to move forward with the non-owner-occupied property tax on homes valued at over $1 million, and we will revisit the millionaire’s tax when we have more clarity from Washington.”

While Costa wished the surtax had been included to fund additional initiatives, she said, “The bottom line is the budget is balanced and people-focused. In particular, older adult concerns were seriously considered.” As the session winds down, SACRI will continue to monitor remaining legislative proposals that affect Rhode Island’s older residents.