PROVIDENCE – Several hundred rounds were fired at police from a man barricaded in his home early Thursday morning, Feb. 10, according to Providence Public Safety Commissioner Steven Pare, in an interview with WPRO’s Steve Klamkin.

Pare, looking gaunt and sounding emotionally spent after the standoff, which ended with the death of the suspect, pronounced that “the Lord was on our side” – because no police officers had been shot during the encounter. The interview by Klamkin was an example of great reporting – allowing Pare to tell the story, in his own words, about what had happened during a difficult engagement.

But, the context had been missing – not just from Klamkin’s excellent on-the-scene reporting but from most of the other media coverage. What had not been on the side of police officers – and neighbors – was the failure by the R.I. General Assembly to enact new gun safety laws to regulate high-capacity magazines, a change in the law being sought by R.I. Attorney General Peter Neronha.

“The number of rounds being fired at these [crime] scenes is in the high teens, the low 20s. You will see what look like yellow tent cards, if you watch the television news, at the crime scene, but they are plastic, and they are numbered, but each one marks a particular shell casing,” Neronha said, during a recent interview with ConvergenceRI. [See link below to ConvergenceRI story, “To keep telling the truth.”]

“There are a lot of guns, firing a lot of rounds in the air,” Neronha had continued. “The individuals who are firing these weapons are not particularly good shots, they are not going to the range and training like a police officer. But when you put 23 bullets in the air, as opposed to five, the odds of hitting someone are obviously much higher. That is what I think is driving violence here [in Rhode Island] and across the country.”

What can you do to prevent hundreds of bullets being fired? For Neronha, the solution was clear: The need by the R.I General Assembly to regulate – to limit – high-capacity magazines. “When you can get off 20, 30, 40, 50 rounds without ever changing the magazine, the odds of you causing real damage are significantly higher,” the R.I. Attorney General said. “Because it is the high-capacity magazines that we are seeing in the hands of bad guys, literally all the time now, and it is those high capacity magazines that allow them to get a lot of rounds in the air very, very quickly.”

Translated, the gun battle that erupted in the early morning hours on the streets of Providence, with “several hundred rounds” fired by one individual, resulted in sensational news coverage by many media outlets in Rhode Island. What had not been mentioned in any of the subsequent stories, however, was the pending legislation being pushed again in the current legislative session by Attorney General Neronha to regulate high-capacity gun magazines.

There were phone videos and even “exclusive” surveillance footage from doorbell cameras broadcast on air to capture the shock and awe of the sounds of hundreds of rounds being fired, first fired by the individual, and then by the police in response. But there was no mention of the potential solution to the problem that had put so many lives needlessly in danger. Why was that?

On the precipice
That same day as hundreds of shots rang out in the early morning on the streets of Providence, Boston Globe columnist Dan McGowan published one of his insightful stories, in the best tradition of Jimmy Breslin, portraying the life of an “underpaid, overworked social worker in Providence,” Travis Wiggins, and his daily struggle on behalf of troubled youth who were teetering on the edge of the precipice.

Wiggins works for Tides Family Services, a nonprofit community agency headquartered in West Warwick that, according to McGowan, receives more than 80 percent of its annual revenue from contracts from the state through the R.I. Department of Children, Youth, and Families. Beth Lemme-Bixby, the CEO, told McGowan that for the first time in its 39-year history, the agency had been forced to put some of its clients on a waitlist for services.

Wiggns, after 22 years on the job, was still making less than $50,000, according to McGowan. Many of Wiggins’ colleagues have left their job working in social services, opting for less stressful work, according to Lemme-Bixby, as reported by McGowan. “People have left to work at Lowe’s. They make just as much,” Lemme-Bixby told McGowan.

The problem has been the consistent failure by the R.I. General Assembly and the state to raise its rates to pay providers for the delivery of such “human” services – a problem that had been examined in great detail by a Senate legislative commission chaired by Sen. Joshua Miller for the last four months, looking at the future role of the R.I. Executive Office of Health and Human Services. Commission members have sought answers to why there had been a failure to raise Medicaid rates for providers, particularly during a time of pandemic.

McGowan’s story, however, makes no reference to reporting on the ongoing legislative commission hearing. Why is that?

At the Nov. 30, 2021, Commission hearing, ConvergenceRI captured the lengthy exchange between outgoing R.I. Medicaid Director Ben Shaffer and Sen. Josh Miller, fencing over the issue of raising Medicaid rates. [See link below to ConvergenceRI story, “When do low Medicaid rates create a break glass emergency?”]

Here is what was “missing” from the narrative of McGowan’s story:

MILLER: To have a service that went out of business because the rates were too low, to have it exist again, would we consider raising the rates?

SHAFFER: Once again…

MILLER: [interrupting] Is closure a threshold that should be met?

SHAFFER: It depends on how many other providers are in that particular system, [whether] it is a “break glass” in terms of an emergency kind of situation.

MILLER: Zero services? Is that a threshold?

SHAFFER: Zero services is certainly a threshold. I am not sure what services you are referring to.

MILLER: There are no current providers for residential services for teenage girls in the state.

SHAFFER: I think the answer to that is that we are actively working on, in this particular case, we are [seeking] to add new services.

MILLER: I really tried to stay away from the 24-hour news cycle, but it was brought up to me that people are being inappropriately placed in hospital settings, children are being placed inappropriately in hospital settings, because there are not enough providers for the appropriate setting in outpatient care. Does that meet that threshold?

SHAFFER: I...[long pause]

MILLER: It is also a budget item; it is multiple times more expensive [to place patients] in hospitals, rather than if the Medicaid reimbursement rates supported [outpatient] providers.

MILLER: [continuing] Early Intervention is closed. One of the reasons is because they cannot function or operate, they cannot hire for the services; they cannot fund the services under the current Medicaid-funded reimbursement rates.

Therefore, they are closed, and therefore, Medicaid is paying for hospitalization at triple the current Medicaid reimbursement rate, and for whatever reason, the reimbursement rate is not being re-evaluated to maybe go up to 50 percent compared to hospitalization, so that the provider could survive.

And, inversely, those of us who are trying to legislate around the procurement over managed care organizations, their reimbursement takes over 90 days for a vulnerable provider to get reimbursed for services. Because there are so many examples, during and post-COVID, where those services are falling apart. [The example of] the lack of accessibility of residential care for teenage girls has been used a lot by this Commission.

How long do we have to hear from providers, or to hear from patients, that they don’t have access to services because the Medicaid rate is too low?

It even applies to commercial insurance rates, because the same payer is basing their rate on Medicaid rates, and therefore, [the system of reimbursement] is broken not only though Medicaid, but through commercial insurance rates, because the Medicaid rate is reflected in commercial rates.

[Editor’s Note: Shaffer has moved on from his position as R.I. Medicaid director to become a principal at Boston Consulting Group, the consulting firm that was paid $3.72 million by the state of Rhode Island beginning in 2020 in fighting the COVID pandemic. See link below to ConvergenceRI story, “How many millions?”]

Gaps in the news narrative
On the very same morning that the barrage of “several hundred rounds” of gunfire occurred, and The Boston Globe published Dan McGowan’s column about the travails of Travis Wiggins, an overworked, underpaid social worker, Rhode Island Kids Count attempted to lay out the details showing exactly how bare the cupboard was, in its analysis of Gov. Dan McKee’s proposed FY 2023 state budget on the funding of state programs to support children and families, in advance of legislative budget hearings. Here are excerpts from the R.I. Kids Count briefing document:

• Early Intervention: The proposed FY2023 budget does not include funds to support a Medicaid rate increase [emphasis added] for Early Intervention.

• Family Home Visiting: The proposed FY 2023 budget does not include funds to increase Medicaid rates [emphasis added] for the First Connections home visiting program [which acts as the state’s Child Find for Early Intervention] or for evidence-based Family Home Visiting Programs [Healthy Families, Nurse-Family Partnership, and Parents as Teachers] that provide comprehensive, long-term services to pregnant and parenting families with infants and young children.

• RI Pre-K: The proposed FY 2023 budget maintains $14.9 million in state general revenues to support operation of existing RI Pre-K classrooms. No funds are included in the budget to expand RI Pre-K for 2022-2023 [emphasis added]. The state will need to identify $7.6 million in FY 2024, when some key federal grants expire, to maintain existing RI Pre-K classrooms and additional funding for further expansion.

Translated, in Rhode Island, kids don’t seem to count. Medicaid reimbursements for the community service providers for Early Intervention and Family Home Visiting will continue to be frozen under Gov. McKee’s proposed budget. Further, even in a time of great surplus and abundance of federal funds, Gov. McKee’s proposed budget offers no additional support for existing Rhode Island Pre-K classrooms, and worse, fails to identify a source for $7.6 million needed next year when key federal grants expire just to maintain the existing number of Pre-K classrooms.

Despite more than a billion dollars in new federal funds under the American Rescue Plan Act – and even a projected budget surplus by the state of Rhode Island of some $650 million, children and families – and the community-based service providers who attempt to keep them from falling off the precipice – find themselves getting the shaft.

Across the great policy/budget divide
The question that needed to asked – but was not addressed in McGowan’s story – is this: What is the position of the R.I. General Assembly moving forward on increasing Medicaid reimbursements? What, for instance, does the Senate Policy Director recommend?

An intrepid reporter might also have asked: What have other states done to address chronic budget shortfalls in children’s services? Tides CEO Lemme-Bixby offered the following “research” suggestions to ConvergenceRI:

• Ohio is launching the OhioRISE [Resilience through Integrated Systems and Excellence] program. It is a managed care program specifically for multi-system youth – and for behavioral health services. [See link below to website, including a stakeholder presentation that provides a detailed overview.]

• Illinois settled a lawsuit in 2018 that required the state to cover and provide comprehensive behavioral health services to Medicaid-enrolled youth. [See link below to the agreement. In response, Illinois has created a Pathways To Success program.

• Massachusetts, from 2007 through 2021, implemented the Child Behavioral Health Initiative [CBHI] in response to the Rosie D lawsuit – similar to Illinois lawsuit. The Centers for Public Representation [CPR] brought the suit against the Commonwealth. [See link below to the website that provides information on the case and data outcomes achieved as a result of the change in response to the lawsuit.

There is also an active lawsuit now in the courts in Pennsylvania, which CEO Lemme-Bixby said had similarities to what is happening in Rhode Island.

To mask, or not to mask, that is the distraction
There is no such thing as coincidence, according to Sigmund Freud – or was it Carl Jung who made the observation. Everything is connected, Jung believed. He called it synchronicity, where circumstances appear to be meaningfully related yet lack a causal connection. Mask on or mask off, the reality is that the COVID virus is, as Jim Hummel once proudly described himself to me in an interview, an equal opportunity ambusher.

It had been one of those “bad health” weeks for me, when my legs were just not cooperating. The thought of trying to stumble my way across the football-field length of the brick and marble entrance to the State House dissuaded me from attempting to cover the Governor’s news conference on Wednesday, Feb. 9, during which Gov. Dan McKee announced his plans to end the current state mask mandate – telling the news media he did not have any plans to reinstate the mandate if the number of cases and hospitalizations were to start to rise rapidly.

Call it a false spring. For those of us who are immuno-compromised, the reality is that keeping our masks on in public– and for me, being double-masked – is a matter of survival, of life and death.

The day before, newly declared Congressional Democratic candidate Joy Fox encountered her potential Republican opponent, former Cranston Mayor Allan Fung [he would declare his candidacy just three days later], on a visit to the Atwood Grill in Johnston, which some of the media labeled “the most Rhode Island thing ever.” Was the allegedly unplanned meeting serendipity, synchronicity, or a well-executed media strategy?

Two days  after the Governor’s news conference, R.I. Education Commissioner Angélica Infante-Green announced that the Providence public schools would maintain the indoor masking requirement, because the rate of vaccinations for Providence students was still too low – around 34 percent.

“We’re at 34 percent, and what that means is we have some schools that are at 10 percent, that are very low, and we don’t feel comfortable removing masks at this point,” Infante-Green said during a remote appearance on WPRI’s Newsmakers program, hosted by Tim White and Ted Nesi. Indeed, Infante-Green was the only state official who did not remove her mask while speaking at the Governor’s news conference on Wednesday, Feb. 9.

What was somewhat surprising in the Newsmakers interview was the apparent unwillingness by Nesi and White to delve into the topic of their continuing investigative series revolving around the $5.2 million ILO contract that had been shepherded through by Gov. McKee, with the support of the Governor’s confidante, Michael Magee, involving former employees of Chiefs for Change.

• Infante-Green has been an active supporter and participant in Chiefs for Change. Her former number-two person, Harrison Peters, the ex- Providence Public Schools Superintendent, who had his contract terminated in May of 2021, was also affiliated with Chiefs for Change.

• In the Governor’s proposed budget for FY 2023, there is a line item to support municipal learning centers, recommending a total investment of $15 million in federal American Rescue Plan Act funds from FY 2023 through 2027, to establish 11 such centers operated by municipalities to provide early education and out-of-school time programming year-round, according to the budget analysis conducted by Rhode Island Kids Count. Programs would be available for free or through a fee-for-service rate structure.

The proposed municipal learning centers were a key component of the state contract with ILO. Not to ask Infante-Green about her potential relationship to the ILO contract, and not to ask about her potential involvement in designing the plans for the municipal learning centers, seems to be a strange omission.