Tag Archives for Nursing Home Staffing and Quality Care Act

RI’s New Budget Considered a Win for Older Adults

Published in RINewstoday on June 15, 2026

As the 2026 legislative session wraps up, lawmakers approved a $15.2 billion state budget for Fiscal Year 2027. The budget blueprint (H 7127 Aaa) aims to provide economic relief, improve education and health care, and advance government reforms without raising broad-based taxes or fees.

According to House Communications Director Larry Berman, the House floor debate began at 3:35 p.m. on Friday, June 5, and lasted 3 hours and 45 minutes.  House lawmakers offered 16 amendments, and 10 were approved (none of these targeted aging programs and services). At 7:20 p.m., the budget passed on a vote of 65 to 10, with 64 Democrats and one independent voting in favor, while all 10 Republicans opposed it.

Greg Pare, Senate Communications Director notes: “On Tuesday, June 9, 2026, the upper chamber debated the House proposal for two hours and 17 minutes, beginning at 4:20 p.m. and concluding at 6:37 p.m. Senators considered 12 amendments, but none were approved. The Fiscal Year 2027 budget passed 32-6 without changes. Senators Samuel W. Bell (D-Dist. 5, Providence) and Leonidas “Lou” Raptakis (D-Dist. 33, East Greenwich and West Greenwich) joined the four Republican Senators in opposing passage of the budget proposal.”

Three days later, Gov. Dan McKee signed the 393-page Rhode Island General Assembly Fiscal year 2027 budget proposal at 10:30 a.m. at Children’s Friend in Providence.

While much of the attention surrounding the Fiscal Year 2027 budget focused on programs and services, lawmakers also approved several significant policy changes and revenue measures. Chief among them is a new tax on annual income exceeding $1 million. The phased-in surtax is expected to generate approximately $142 million annually when fully implemented, providing additional revenue to help support state services and offset potential reductions in federal funding.

The state’s budget also creates an independent Office of Inspector General to strengthen government accountability and oversight. In addition, the Rhode Island General Assembly approved increased funding for hospitals, behavioral health and home-care providers, child welfare programs, public transit, and higher education, while authorizing an audit of the Rhode Island Department of Transportation.

Investing in Rhode Island’s Aging Programs and Services

Although these initiatives will affect Rhode Islanders across all age groups, the budget also contains provisions that directly impact older adults, caregivers, and aging-service providers throughout the Ocean State.

The Fiscal Year 2027 budget expands eligibility for exempting Social Security income from state taxation by removing the age threshold. Under current law, taxpayers who have reached full Social Security retirement age (67 or older) and have incomes below $107,000 for individuals and $133,750 for joint filers are exempt from paying state income tax on their Social Security benefits. With the passage of the budget, the age requirement has been eliminated.

The state budget also increases funding by $200,000, bringing total funding for senior services grants to $1.8 million.

Meals on Wheels, which provides nutrition services to older adults, was also on lawmakers’ radar. The budget increases funding for the program by $50,000, bringing total state support to $730,000.

The Rhode Island General Assembly’s approved budget allocates $4.1 million to fund the “Eat Well, Be Well” program for Supplemental Nutrition Assistance Program (SNAP) recipients. This funding will help older Rhode Islanders struggling with the high cost of groceries.

Under the program, eligible SNAP households will receive an incentive of 50 cents for every dollar spent on fruits and vegetables, with the benefit loaded onto their electronic benefits transfer (EBT) cards, up to a maximum amount to be determined by the Rhode Island Department of Human Services.

The budget also increases funding for the Rhode Island Community Food Bank by $1 million, bringing total state support to $2.95 million to address food insecurity among families, including older adults.

In response to a significant increase in complaints regarding care, the budget provides additional funding to the state’s Office of Healthy Aging to support the Long-Term Care Ombudsman Program, administered by the Alliance for Better Long-Term Care.

The budget allocates funding for full cost-of-living increases in nursing home reimbursement rates, with 80 percent of the increase directed toward direct-care staff compensation. Gov. McKee’s proposed budget had limited the increase to 2.5 percent.

As for the state’s nursing facility minimum staffing requirements, the budget includes $200,000 to implement the Nursing Home Staffing and Quality Care Act. The provision requires the Rhode Island Department of Health to enforce staffing requirements at all nursing homes. The funding will support contracted services to collect and analyze data and calculate penalties for noncompliant facilities.

The state budget also includes $3.1 million to begin a phased opening of new beds at the Rhode Island Veterans Home. The funding is expected to increase capacity by 16 beds in each of the next two years, bringing the facility to its maximum capacity of 192 residents.

Assisted living facilities will see increased Medicaid reimbursement rates for caring for residents with dementia and those with higher personal-care needs. Advocates say the increase will help facilities accept and care for these residents while reducing premature nursing home placements.

The Fiscal Year 2027 budget also doubles the amount of assets that Medicaid home-care recipients may retain, helping older adults cope with rising housing costs and other basic needs.

Several provisions within the budget are intended to address the growing shortage of primary care providers, including assisting providers with medical school costs and seed funding for a new medical school at the University of Rhode Island (both of which were components of the Senate’s package of priority health care bills).

In addition, the budget fully funds rate increases for home- and community-based services recommended by an Office of Health Insurance study. The governor’s budget proposal had funded only half of the recommended increases. SACRI says the additional funding should improve worker compensation and help prevent waiting lists for services.

A nursing home behavioral health per diem add-on included in the budget provides additional resources for facilities caring for residents with both nursing and behavioral health needs, helping to avoid unnecessary transfers to acute-care settings.

Finally, an additional $13.5 million was included in the Fiscal Year 2027 budget to help the Rhode Island Public Transit Authority maintain services and avoid service reductions.

The Aftermath: Lawmakers and Aging Groups Debate Budget Proposals’ Impact

“I am proud of this budget, which addresses the concerns and struggles of everyday Rhode Islanders, including our older residents, who need access to health care, who need to be able to pay their bills, and who need to know that their government is honest and effective,” said Christopher R. Blazejewski.  “This budget is the result of months of listening, prioritizing, and identifying ways to fix what isn’t working, he stated.

“It provides relief today while being fiscally responsible and putting our state in a better position in the years to come,” notes Blazejewski.

“This budget reflects many of the Senate’s priorities, including funding health care initiatives and supporting seniors and Rhode Islanders in need,” said Senate President Valarie J. Lawson (D-Dist. 14, East Providence). “This is a responsible, balanced budget that provides relief for Rhode Islanders, including our older residents, while investing in and strengthening programs that support seniors, she says, noting that it complements other legislation the Senate passed this year to support older adults. She sponsored legislation to protect against the growing national threat of deed theft, a scam by which thieves defraud seniors of their real estate.

“These budget decisions reflect real progress for Rhode Islanders who rely on long-term services and community supports,” said Executive Director Carol Anne Costa. “We are encouraged to see the state make investments that strengthen care, support the workforce, and help older adults remain in the settings that best meet their needs.”

According to Costa, “SACRI fully intends to return in the next session to pursue the Medicare Saving Program’s asset test removal, the creation of the Office of the Elder Advocate, and secure a tax credit for caregivers. “These efforts do not come with huge price tags and in fact, infuse money back into the RI economy,” says Costa.

Costa emphasizes that Rhode Island’s aging population and adults with disabilities deserve nothing less, as the organization continues to be the voice for progress on their behalf.

“As the cost of food continues to skyrocket, our seniors, those with long-term care, and other Rhode Islanders living on a fixed income are being further squeezed. This budget helps ensure they can still get the healthy meals they need through targeted investments in SNAP and organizations like Meals on Wheels and the RI Community Food Bank. This budget brings us closer to ensuring food security for all Rhode Islanders,” says Lt. Gov. Sabrina Mattos, says  Lt. Gov. Sabina Matos, chair of the state’s Long-Term Care Coordinating Council.

“We appreciate the legislature’s commitment to strengthening Rhode Island’s long-term services and supports through this year’s budget,” says Mag Morelli, president of LeadingAge Connecticut & Rhode Island. “The investments in assisted living, community-based services, and nursing home care recognize the growing needs of older adults.

By supporting Medicaid reimbursement rates that more closely reflect the cost of care, this budget helps providers deliver essential services while promoting stability, access, and choice for aging Rhode Islanders.”

Hopes Dashed: Budget Fails Rhode Island’s Caregivers

Meredith L. Sheehan, Director of Public Policy, Alzheimer’s Association, Rhode Island Chapter: “More than 22,000 Rhode Islanders live with Alzheimer’s disease, and 37,000 serve as caregivers. We applaud budget investments in senior centers, the Long-Term Care Ombudsman Program, and assisted living providers, but are disappointed funding was not included for a Dementia Services Coordinator, a dedicated position needed to develop a coordinated statewide response to dementia.”

“I am encouraged by the 2027 budget’s funding that strengthens our support for people with Alzheimer’s disease and related dementia (ADRD) and their caregivers, including increased Medicaid reimbursement for specialized assisted living and for nursing home care,” says Chris Gadbois, DNP, RN, chair of RI’s Council on ADRD.

“People’s ability to remain safely in their homes will be supported by increased rates for home and community-based services and an increase in the asset limits,” notes Gadbois.

However, like Sheehan, Gadbois expressed disappointment that funding for a state Dementia Service Coordinator within the Rhode Island Department of Health was not advanced in the past budget proposal, adding, “We will continue to collaborate with state leadership for this critical position, as well as reintroduce legislation to ensure healthcare providers’ and facilities’ competency in caring for individuals with dementia.”

“The Office of Healthy Aging appreciates Governor McKee’s continued commitment to older Rhode Islanders and to the systems of support that help people age with dignity, connection, and independence. We remain focused on working with state and community partners to strengthen access to services and supports for older adults, caregivers, and families across Rhode Island,” says Maria E. Cimini, MSW, Director, RI Office of Healthy Aging.

Lori Light, the state’s long-term care ombudsman, welcomes FY 2027 budget investments in aging-in-place programs. “It strengthens our advocacy for nursing home and assisted living residents,” Light said. She urges continued funding to expand ombudsman services, allowing the agency to handle increasingly complex complaints and ensure all residents receive timely support.

To view all provisions of  H 7127Aaa, the state’s enacted 2027 Fiscal Year Budget proposal, go HERE – https://webserver.rilegislature.gov/BillText26/HouseText26/H7127Aaa.pdf

Rhode Island nursing home bill veto response

Published in RINewsToday on July 1, 2024

With the adjourning of the General Assembly on the early morning of June 14, out of thousands of bills thrown into the legislative hopper in this year’s legislative session, 249 bills passed both chambers.  At press time, Gov. Dan McKee has vetoed five bills, including one to create a Rhode Island Nursing Home Workforce Standards Advisory Board (WSB).

Just weeks after the General Assembly overwhelmingly approved the establishment of a 13-member advisory board to keep state leaders informed on current market conditions, wages, benefits and working conditions in Rhode Island’s nursing home industry, McKee vetoed the legislation. The final vote count for H 7733 A was 63-7 in the House and 37-0 in the Senate for S 2621 A.

WSB would advise the General Assembly and the RI Department of Labor and Training on market conditions, wages, benefits and working conditions in the nursing home industry; recommend minimum statewide compensation and working standards for nursing home workers; propose minimum standards for nursing home training programs and assist in ensuring compliance by employers with the recommended standards.

This advisory board would consist of three members representing nursing home employers, three representing nursing home workers, two representing community organizations that work with the Medicaid population, one member representing a joint labor-management multi-employer nonprofit training fund, and representatives of the Health and Human Services secretary, the Department of Labor and Training, the Department of Health and the Long-Term Care State Ombudsman.

Reasons Gov. wielded his veto pen

On June 26, Gov. McKee’s 2-page veto message to House Speaker K. Joseph Shekarchi (D-Dist. 13, Warwick) and Senate President Dominick Ruggerio (D- Dist. 4, Providence, North Providence) outlined his objections to creating the WSB.   

“Rhode Island needs comprehensive solutions to resolve its critical nursing home emergency and support residents, workers and the long-term care facilities,” stated McKee, stressing that the Act didn’t meet that need.

McKee noted that letters submitted by nursing homes and assisted living facilities opposing this legislation charged that the Act didn’t address real issues faced by facilities, including “years of underfunding, increased costs and the lack of available workforce in the state.”

The Board created by the Act focused narrowly on only working conditions and wages without consideration for the key constraints such as reimbursement, the governor told lawmakers.  This will not “generate the comprehensive solutions Rhode Island needs to address the nursing home emergency,” he added.

Aging advocacy groups call for an override of the veto

“Governor McKee’s veto of legislation to create the WSB is a significant setback in our efforts to improve the quality of care in Rhode Island’s nursing homes and to find a way out of the nursing home crisis,” charges Kathleen Gerard, Director of Advocates for Better Care in Rhode Island (ABC-RI) in a statement quickly released after the governor’s veto.

“The veto yet again underscores the reality that the McKee administration has created no framework or plan to stabilize our state’s broken nursing home system,” says Gerard. “Instead of once again catering to the concerns of for-profit facility owners, Governor McKee must prioritize the needs of thousands of nursing home residents and caregivers who continue to suffer from the staffing crisis,” she adds.

According to Gerard, Governor McKee says that the WSB is not a sufficiently comprehensive solution, but the governor himself has proposed no alternative solutions. “In fact, when convening his own closed-door nursing home advisory board, he initially included only industry representatives, then perfunctorily invited union representatives for the final meeting, but failed to include consumer advocates, Long Term Care Ombudsmen, or Medicaid experts,” charged Gerard.  

Gerard notes that the only recommendation from the industry members in this group was to indefinitely suspend enforcement of the Nursing Home Staffing and Quality Care Act—a course of inaction which lacked any basis in evidence and did nothing to ameliorate any of the critical problems with care in Rhode Island nursing homes. “In fact, that course only hurt the facilities that were consistently meeting minimum staffing requirements,” she says.

“Governor McKee’s veto of the WSB is a devastating blow to the residents of Rhode Island’s nursing homes,” says Raise the Bar on Resident Care Coalition in a released statement. Currently, 34 out of 74 nursing homes are rated by the Centers for Medicare & Medicaid Services at two CMS stars or lower, indicating a dire need for improvement in care standards, notes the resident advocacy coalition. 

According to WSB, the legislation creating the Nursing Home Workforce Standards Board would have ensured better training and working conditions for caregivers, which are essential for enhancing the quality of resident care. Rhode Island ranked second in the nation for serious nursing home deficiencies in the last three years, highlighting the urgent need for comprehensive solutions that prioritize the health and safety of residents.

Raise the Bar urges the Rhode Island General Assembly to override McKee’s veto. “The WSB bill was a necessary step towards ensuring better wages, benefits, and training for caregivers, and higher quality care for residents,” says the advocacy coalition, calling on the McKee administration “to remember its promises and create a comprehensive plan to end the nursing home crisis in Rhode Island.”

“The Senior Agenda Coalition of RI (SACRI) is extremely disappointed with Governor Dan McKee’s veto of the legislation passed by the House and Senate to create a Nursing Home Workforce Standards Advisory Board, andn we are calling for the general assembly to override the veto”, said Diane Santos, SACRI’s Chair, in a statement.

There are significant issues impacting the state’s nursing homes from how they are financed; the adequacy of staffing levels, training and wages; and the quality monitoring process, stated Santos. “As the state’s population grows older there will be an ongoing need to provide quality nursing home care for those with high support needs. It is critical that the many issues facing the nursing home industry be addressed,” she said.

ABC-RI and Raise the Bar strongly urge the Rhode Island General Assembly to override McKee’s veto and allow the creation of the WSB. 

In response to the aging advocacy groups calling for a veto override, House Speaker Shekarchi and Senate President Ruggerio issued statements pledging to review the Governor’s veto messages and to confer with each other and lawmakers to determine their response.  

Provider groups give thumbs-up to Gov. McKee’s veto

The state’s largest nursing home provider group agrees with Gov. McKee’s veto of the Workforce Standards Advisory Board, says John E. Gage, President and CEO of the Rhode Island Health Care Association. “This legislation would have set a precedent, establishing an Advisory Board with a narrow and ill-defined mission that failed to recognize the myriad of challenges facing nursing homes in Rhode Island and across the nation,” says Gage,  “these challenges include chronic Medicaid underfunding, skyrocketing costs, a historic workforce shortage, and the existing staffing mandate that is unfunded and fails to address the workforce crisis and includes draconian fines and penalties.”

According to Gage, S 2621A and H 7733A would also have replicated the many layers of existing oversight authority that exists at both state and federal levels – including CMS, the Occupational Safety & Health Administration, the RI Executive Office of Health & Human Services, the RI Department of Health, and the RI Department of Labor & Training, among others.

“There needs to be a comprehensive solution to the current environment of care facing Rhode Island’s nursing homes,” says Gage, stressing that this strategy should include workforce training programs, student loan forgiveness for RI nursing home professionals including RNs, LPNs and CNAs who are trained and choose to remain in RI to work in long-term care settings.

“In addition, reimbursement from Medicaid must become and remain adequate to cover the increasing cost of care in all settings, and changes are needed to address the staffing mandate passed back in 2021,” says Gage, noting that the bill was passed in the midst of the Covid-19 pandemic without addressing the workforce crisis and failing to provide sufficient funding that would be needed to layer in sufficient staff to meet the metrics, if those staff could be found.

Gage says that if fully implemented and enforced, fines would amount to $100 million in the first full year of enforcement – closing the majority of facilities, displacing thousands of vulnerable residents from their homes and devastating access to care for Rhode Island seniors.

LeadingAge RI agrees with RIHCA’s detailed observations about this issue and the Governor’s veto message, which highlight the myriad of entities already in place to oversee and enforce nursing home care, says James Nyberg, Executive Director of LeadingAgeRI. “Furthermore, the Governor noted the need for a more comprehensive solution to the nursing home emergency, and steps are already being taken or are in place towards this goal,” he said.

According to Nyberg, the Governor and General Assembly just made a significant investment in the chronically underfunded industry in this year’s budget, which will benefit all residents and staff.  In addition, the industry has regular meetings with the Health Department and Centers for Medicare & Medicaid Services to  discuss any quality-of-care issues and how to mitigate and resolve them immediately, he says, noting that these meetings are frank and productive. 

Nyberg noted that the industry, and individual nursing homes, also provide countless hours of educational programming to support and improve quality of care.  “All nursing home providers are working to overcome the challenges facing the industry, and demonizing them is disrespectful to the thousands of individuals who work 24/7/365 to care for our older Rhode Islanders,” he says.

As the dust settles…

Last Monday, Gov. McKee’s veto message was sent to House Speaker Shekarchi and Senate President Ruggerio to notify them of his veto. Now they can either let the veto stand or allow it to die.  Overriding the veto can occur if three-fifths of members in both chambers vote to affirm the bill’s passage. This vote would need to take place before the start of the new law-making session in January.

As the dust settles after McKee’s vetoing of legislation to create a WSB, with the overwhelming support of the General Assembly and the lobbying of resident advocacy groups opposing McKee’s veto, will the General Assembly have the political will to act and override the governor’s veto, especially during a time when lawmakers are just beginning their political campaigns? 

We’ll see…