Published in Blackstone Valley Call & Times on October 6, 2026
Democratic gubernatorial candidate Helena Buonanno 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.
Opening the forum, Carol Anne Costa, SACRI’s Executive Director, noted that Republican candidate Aaron Guckian, who had committed to attend, failed to show up after notifying organizers at 3 p.m. that same day. “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,” she said.
Introducing the Candidates
Foulkes, 62, a Providence resident, emphasized her 25 years at CVS, ultimately becoming president of CVS Pharmacy, where she worked on employment initiatives for people with disabilities and special needs. She said she doesn’t need to be “the smartest person in the room,” but wants to leverage community expertise. She highlighted her relationships with other governors, including Maryland Gov. Wes Moore, as sources of policy ideas. Her policy priorities include housing affordability and healthcare access, and she called for creating a “whole-of-government” approach to senior services.
Block, 60, a Barrington software engineer who founded Simpatico Software Systems, political reformer and author, is an independent candidate who describes himself as an “operational manager” with experience helping large multinational companies reimagine their business operations, contracting and delivery of complicated computer systems. He emphasizes a data-driven approach to problem-solving and decision-making and has firsthand experience with healthcare and aging issues as a caregiver for his mother, who had early-onset Alzheimer’s, and helping his in-laws with aging-in-place challenges.
Block, like Foulkes, has actively sought information from advocacy groups on aging and disability issues throughout his campaign. He focuses heavily on government efficiency, transparency and fixing “friction points” in state operations.
The forum, held at Rhodes on the Pawtuxet in Cranston, was sponsored by the Senior Agenda Coalition of Rhode Island (SACRI), AccessPoint Rhode Island and the Mental Health Association of Rhode Island.
Unlike many gubernatorial forums held throughout the Ocean State that focus heavily on taxes, housing, education and the economy, SACRI’s 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.
Spanning more than an hour, the two candidates fielded questions on strengthening the state’s Office of Healthy Aging, creating a multi-sector plan on aging, establishing a state advocate’s office and expanding long-term care. They also discussed unpaid family caregivers, workforce shortages, accessible housing, the 988 Suicide & Crisis Lifeline, economic security for older adults and transparency in human services.
Where They Stand
During opening remarks, Foulkes emphasized that seniors are an “untapped resource” of wisdom and expertise. She proposed creating a “senior corps”-style effort and intergenerational mentoring programs. Block shared personal caregiving experiences involving his parents and now his in-laws in their 80s, stressing the importance of advocacy organizations in helping families find needed resources and support.
At that point, the two candidates addressed a multitude of topics during the forum. Here is a sampling.
The SACRI forum highlighted that Rhode Island’s 2009 law setting a 50% goal for Medicaid home and community-based services remains unmet, with general home and community services reaching only 20.1%. The state ranks 44th nationally in community support spending for older adults at $28 per adult age 60 and older, compared with the $53 U.S. average and $222 in Massachusetts.
Regarding long-term care, Block called for cost-effective alternatives to nursing homes for residents with lower care needs, including housing options. He also recognized the possibility of severe budget pressures, including potential Medicaid cuts.
Foulkes highlighted the staffing crisis, fueled by low wages and lack of health insurance for many home-care workers. She also raised concerns about the impact of federal immigration policies on the pool of workers available to provide care.
The candidates were asked about a long-term care workforce crisis that includes 512 nursing assistant openings and only 132 trained applicants; Medicaid reimbursement rates; support for unpaid family caregivers who provide an estimated $2.8 billion in annual care; and the need for accessible housing throughout Rhode Island, with only 85 of 2,194 units under development being handicapped accessible.
Block supported elevating the state’s Office of Healthy Aging (OHA) to a cabinet-level position to ensure seniors have a direct voice to the governor. His rationale: A substantial portion of the Ocean State’s population has interests that align directly with OHA.
Foulkes advocates for a “whole-of-government approach” to providing senior services, with a potential cabinet-level position for aging, looking to Maryland as a model.
Foulkes emphasized the need for creating a master plan on aging with accountability and deadlines. Block also pledged to either issue an executive order or support legislation to develop the state’s aging policies, programs and services.
The candidates split on how to provide sustainable funding for the 988 Suicide & Crisis Lifeline. Rhode Island’s 988 system has handled nearly 75,000 calls since its launch while maintaining a 98% answer rate.
Block explained his opposition to using a telephone fee to fund the program, citing the regressive burden such fees place on low-income residents. He has no opposition to the program itself. Foulkes supported a small monthly telephone fee, similar to 911 funding, to provide a dedicated funding source for the state’s 988 response system.
Both candidates emphasized government inefficiency and data-access problems. Block described himself as “an operational manager” who specializes in “understanding where an organization doesn’t work well” and called Rhode Island government “a target rich environment.”
He expressed frustration with “Rhode Island state government’s ability to provide data” and promised “dashboards and other things that will ultimately really let us understand much better than we can now where we’re spending the money.”
Foulkes similarly stated, “we need way more transparency everywhere in the state” and endorsed the Inspector General concept to track how government funds are spent.
Direct-care workforce challenges appeared across multiple questions. Foulkes identified “the gap in terms of the number of community healthcare workers” and how “low paid” the work is, noting that “most of them that I speak to don’t even have healthcare insurance themselves.”
Foulkes connected federal immigration policy to the state’s capacity to provide care, raising concerns about home-care providers and healthcare workers who are immigrants. Block pointed again to the nursing assistant shortage during the lightning round.
Foulkes proposed creating a state website to assist families in navigating the long-term care continuum, acknowledging “it’s really hard right now” to find appropriate services. She also called for helping Rhode Islanders at risk of losing Medicaid coverage, proposing a “Medicaid navigator system” using faith-based communities and senior centers to help people complete eligibility paperwork.
Both candidates warned about the severe stress on Rhode Island’s healthcare system. Block noted that Roger Williams Medical Center and Our Lady of Fatima Hospital were “on life support,” stressing their importance to the state’s healthcare system. Foulkes pointed to Rhode Island’s more than $156 million first-year federal Rural Health Transformation Program award as an opportunity to strengthen healthcare delivery.
Foulkes and Block also supported creating a dementia services coordinator position at the Department of Health. They supported continuing the overdose task force’s progress and having dedicated substance-use and mental-health policy staff in the governor’s office.
Finally, in lightning-round responses, both candidates supported continuing Medicaid reimbursement rate efforts for direct-care staff; using 30% of state housing bond funds for accessible housing for older adults and people with disabilities; creating an Office of the Elder Advocate; and developing a multi-sector plan on aging.
While Foulkes supports eliminating the Medicare Savings Program asset limit and providing an annual cost-of-living adjustment to the state’s SSI supplemental payment, Block gave no answer because he did not have a cost estimate.
Here’s the Bottom Line
With federal funding uncertainty, the state’s ongoing structural budget deficit and fiscal limitations, will Foulkes and Block be able to make good on their policy commitments?
Block repeatedly declined to make specific funding promises on a number of policies, stating, “I don’t know what’s coming at us” and “my answer to you, with all sincere respect, is I just don’t know.”
Foulkes also acknowledged Block’s concerns about reduced federal funding and the fiscal limitations facing the next governor. “I need to understand at the end of the day what all of this costs and make sure that I’m not making promises to you that I can’t keep,” she said.
For older Rhode Islanders, people with disabilities and behavioral health issues, family caregivers and the organizations that serve them, that may ultimately be the most important question coming out of SACRI’s forum: not just what the candidates promise to do, but whether the next governor will have the resources and political will to do it.
Stay tuned.
Tag Archives for Medicaid reimbursement rate
Hail Mary PR Effort Puts Spotlight on Inadequate RI Nursing Home Medicaid Plan
Published in RINewsToday on December 4, 2023
Last week, a campaign by Linn Health & Rehabilitation told of its efforts to keep its doors open. With no immediate state reimbursement fix in sight, the nonprofit nursing home, established 52 years ago, launched a savvy PR move, calling it a “Hail Mary” effort to find its Christmas miracle donors and funding to prevent it from closing or forcing the displacement of 71 residents and the laying off of 150 staff members. A clever twist on the message resulted in a story on Rhode Island television stations, talk radio, and pick up by other media outlets.
For over 10 years, Linn Health, which had only recently been named a 2024 “Best Nursing Home” and “High-Performing” short-term rehabilitation home in the nation by U.S. News & World Report, has been fighting rampant inflation, rising food and utility costs, high temporary staffing agency rates, and low state Medicaid reimbursement rates that haven’t kept pace with increasing expenses – as most nursing homes have been as well.
Linn Health & Rehabilitation is currently losing $100,000 a month, notes Richard Gamache, MS, FACHCA, chief executive officer of Aldersbridge Communities which is the nonprofit that operates the nursing facility, senior housing, affordable assisted living, and outpatient rehab for older Rhode Islanders.
“For years, we’ve operated with a slight loss, but the other Aldersbridge entities were able to subsidize that loss. As a mission-driven provider for low-income people and those on Medicaid, we aren’t here to make money, we’re here to serve our community’s needs,” he says, noting that the gap between the facility’s costs and its daily Medicaid rate is now just too great.
“Bleeding Cash” drastically impacts facility’s bottom line
Gamache noted that Aldersbridge Communities had been able to support its nursing home but it has now reached a “tipping point.” During COVID the federal and state governments were very generous with grants. “That’s no longer an option, and the money is running out quickly,” he says.
“We’re in dire straits, financially,” admits the seasoned CEO, who has been in the long-term care field for over 43 years. “We’re struggling. We have some vendors who understand and are being patient with us, and others who tack on charges if we don’t pay on time,” he says.
“Eighty-two percent of our residents are on Medicaid and don’t have families who can take care of them. We are their family and support system, and some have been discharged from other assisted living communities because they ran out of money,” he says.
In recent months, Gamache reports he has meet with peers, East Providence lawmakers, state officials, and even nursing facility trade groups seeking a viable solution to the state’s Medicaid reimbursement issues. “I have proposed options such as bridge funding and higher Medicaid reimbursement rates, as many other states have done, to address this nationwide problem. It seems only nursing home residents, their families, employees, leaders of surviving homes that are hanging by their fingernails, and some advocacy groups care about the financial predicament we are in. We’ve made everyone aware and we will not stop fighting for funding that we need,” he says.
According to Jamie L. Sanford, LNHA, LCSW, administrator of Linn Health & Rehabilitation, since 2022, six nursing homes in Rhode Island have shut their doors permanently, not counting the four that closed prior to the COVID-19 pandemic. Three more have filed for bankruptcy, she says, noting that many nursing homes throughout the nation are in the same financial predicament.
“Linn’s Medicaid reimbursement rate averages $255 per patient per day, and it costs $411 to care for each patient per day,” states Sanford. “The general population thinks that nursing homes make a lot of money. Perhaps that’s true in some for-profit organizations where they are owned by large corporations, but nonprofit homes are robbing Peter to pay Paul. These are the homes – like us – that are on life support, operationally speaking,” she notes.
Joseph Wendelken of the RI Department of Health says that the state is attempting to ease the financial burden of facilities providing care to Rhode Island nursing facility residents. “Nursing homes in Rhode Island received an increase in Medicaid reimbursement rates on October 1, 2023. The increase varied by facility, but it was approximately 6.9%. Per Rhode Island legislation, there is a mandatory review of nursing home expenses every three years called the ‘re-array.’ The current re-array is in progress and any potential increase in the nursing home rates would begin as of October 1, 2024,” he noted.
But facilities can’t wait a year for the state’s Medicaid adjustment to kick-in and immediate action must be taken. “Essentially, the state is breaking its own law by not conducting the re-array every three years, which was put in place to keep up with the national nursing home inflation index. The last re-array was in October of 2012. Even with an increase next fall, it won’t be enough to help close the funding gap now,” charges Michael Cole, vice president of the Board of Trustees for Aldersbridge Communities.
It’s time for a savvy PR campaign
With no immediate financial solutions in sight, Gamache and his management team staff have been working on their own grassroots PR campaign, calling it a “Hail Mary” effort, to save Linn Health from having to displace its staff and residents.
Linn Health’s PR campaign was seen as the next logical step to quickly tackle its financial problems, after months of alerting staff officials of the need for action.
“Everyone with the authority to do something to help has all the information they need. Now we need action. I often hear, ‘there’s not enough money in the budget’ but the fact is, these are policy decisions. It’s about priorities,” says Gamache.
“Do we value our older adults enough to provide for their basic needs? What kind of values do we have as a state and as a society?” asks Gamache.
“Now it’s time to get the story into the public domain. Many people feel that nursing homes are making money hand over fist and that we’re all diverting funds to pay for yachts,” says Gamache. “Although it’s true that there are some bad apples in this profession, I believe most of us want to do what’s right, and for Linn Health and Aldersbridge Communities, a mission-driven non-profit, we’ve always cared more about better outcomes for our people than more income. We just can’t afford to operate much longer,” he warns.
The residents and staff at Linn are doing everything they can, including holding baked goods sales to raise funds. “No one wants to leave Linn, and no one wants us to be sold to another organization,” Sanford comments. “During this season of holiday miracles, we’re working to find donors who believe in what we’re doing now, and for our future. There must be a donor out there who can help us fight the proverbial ‘grinch’ that is causing nursing homes to disappear throughout the country and in our state. All we want for Christmas is to keep caring for our residents who depend on us,” she says.
“This situation exemplifies the dire straits that RI nursing homes are in, especially the community-based ones like non-profit providers. We have been working with state officials, including the Governor’s office, EOHHS, the Health Department, and other stakeholders to highlight the crisis and the need for immediate action,” says James Nyberg, president and CEO of LeadingAge Rhode Island. LeadingAge, founded in 1989, is a not-for-profit membership organization of not-for-profit providers of aging services, including not-for-profit nursing homes, assisted living residences, and senior housing providers, and adult day health services.
“They have recognized our concerns and we are hopeful that some action will be taken ASAP to provide an infusion of funding. Any nursing home closure has profound and disruptive consequences for residents, staff, families, and the broader community. With six nursing homes closing and three in receivership, how many more proverbial canaries in the coal mine do we need?” adds Nyberg.
“Unfortunately, Linn Health’s story is emblematic of a wider crisis facing Rhode Island nursing facilities. Nursing facilities are facing unprecedented increases in nearly all aspects of providing care – staffing costs, energy prices, inflation on food, medical supplies, etc. At the same time, Medicaid rates have not kept pace,” says John Gage, president and CEO of the Rhode Island Health Care Association. In 2023, RI’s nursing homes are being paid by Medicaid based on the actual allowable cost of care from 2011 with an average of approximately 1% increase annually,” he said. RIHCA was founded in 1972, and has 63 skilled nursing facilities who are members.
Finally, Maureen Maigret, former Director of the RI Department of Elderly Affairs who serves as a member of the Long-Term Care Coordinating Council and chair of its Aging in Community Subcommittee, weighs in. “The financial challenges faced by Linn Health are worrisome and point to a need for the State to take a very close look at the financial status of Rhode Island nursing homes in general,” she said, noting that few persons can afford privately paid nursing home care at an average cost of $113,000 per year.
“So unless skilled care is paid by Medicare, Medicaid becomes the payer for a large percent of nursing home care in Rhode Island and rates must be adequate to provide the quality care we expect our loved ones to receive if they need the round the clock care provided in nursing homes,” Maigret adds.
Linn is asking that interested charitable organization and donors willing to help Linn Health & Rehabilitation’s financial situation to contact Aldersbridge Communities Director of Development, Elise Strom at estrom@aldersbridge.org, 401-438-4456 ext. 136.
