Delivery of Care

As the world turns for Medicaid budget

New legislation suggests $200 million for budget increases in Medicaid rates

Photo courtesy of Rep. Tina Spears

Rep.Tina Spears.

By Richard Asinof
Posted 3/13/23
New legislation, H5987, introduced in the R.I. House, asks for a $200 million increase in Medicaid rates as a starting point for ongoing budget deliberations.
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PROVIDENCE -- As the process to enact the 2024 state budget winds its way through the labyrinth of committee hearings in the R.I. General Assembly, one of the more important decisions facing legislators this year will be figuring out how much money to invest in increasing Medicaid rates.

Based upon a law enacted during last year’s session, the R.I. Office of the Health Insurance Commissioner is now undertaking a comprehensive analysis of the rates for human and social services programs – and the rates paid for providers of those services, focused in large part on Medicaid.

The reporting by OHIC documenting the rates and spending trends for human and social services programs will produce data that will strongly influence the state budget decisions – and future Medicaid rates, a key driver linked to improving health care outcomes. It is very much an under-reported and not-well-understood story.

The key deadline is set for June 1, when OHIC will report its findings to the General Assembly. To help set the floor for the budget debate, H 5987 has been submitted by Representatives Julie Casimiro, Tina Spears, David Morales, Thomas Noret, and Jacquelyn Baginski, which calls for an increase of $200 million for home and community-based providers of health and human services.

ConvergenceRI recently spoke with Rep. Tina Spears, one of the sponsors, to talk with her about the thinking by the legislators behind the bill.

ConvergenceRI: How did you come up with the figure of $200 million to cover increases in Medicaid rates for providers? Can you explain the methodology?
SPEARS: First let me say, I am thrilled to co sponsor this bill with Rep. Julie Casimiro. She is a champion for the community and we are hopeful we will receive the same level of support we saw last year on this important issue.

To answer the question, $200 million is an estimate based on the work we’ve done so far. We'll refine that estimate as we go through the legislative process. It is difficult to target a specific dollar amount due to the wide range of rates. EOHHS and the MCOs might have additional information for you.

The rates will require a significant investment due to decades of under, and in some cases no adjustment to rates. The percent increase across the board to rates will ultimately determine the exact dollar amount. What I do know is that costs have gone up; higher wages are needed, and we need to make sure we invest in this community of need.

ConvergenceRI: I have heard that OHIC is lagging behind in its data gathering regarding capturing the trends for behavioral health costs. Is there a need to expedite this process?
SPEARS: OHIC is working hard to execute on the many deliverables in the statute. The General Assembly set an ambitious goal with tight deadlines. There is a need to act urgently; the system is failing, many are suffering and investments are needed. OHIC is moving forward and working hard to conduct the necessary analysis.

ConvergenceRI: How united are legislators in the House and the Senate in pushing for rate increases for Medicaid? Can you provide an example of how you are working together?
SPEARS: There is a lot of concern in both chambers about the health of the human service system. I have found both chambers are focused on issues that are impacting their communities and are motivated to get good policy passed and investments distributed where they are needed most.

ConvergenceRI: What do you see as the pressure points to build public support for H5987?
SPEARS: There are many issues we face as a state and we need to be responsible with taxpayer money. It isn't lack of support, or lack of empathy or understanding, it is truly a question of priority. There has been an imbalance in our state’s fiscal priorities over the last three decades. The result of that imbalance has created inequities and underinvestment in certain areas for far too long.

There is a community of advocates that has done a great job speaking up and elevating this issue. This advocacy needs to continue at a grassroots level and legislators need to know this is not an issue to be ignored. So in short, persistent and unrelenting advocacy, that is how we will get investments for the children, elderly, disabled, and marginalized communities in our state.

ConvergenceRI: How important is it to drum up public and financial support for the disabled community in RI?
SPEARS: It’s absolutely crucial. Our neighbors with disabilities deserve to live with dignity and we must do our part to support them.

Judy Huemenn, an activist for the civil rights of people with disabilities, shined a bright light on the utter failure of our government to protect the rights of people with disabilities in the 1970s. This work must continue.

Advocates must rise up to ensure all people with disabilities are considered equal in our communities and our government invests in the infrastructure to realize this truth.

ConvergenceRI: What is the best strategy to combat stigma when it comes to the uniquely abled community?
SPEARS: This is a complex question. I am a mother of a child with a disability, but I am not a person with a disability. So I cannot speak for or on behalf of a person with a disability. So, with that in mind, I can be an ally, a champion, and activist, and stand side-by-side to support anti-ableism. We all can.

What does this mean? This means we believe all people are equal, create paths for equity, support and listen to disability advocates, support accessibility, challenge discrimination of people with disabilities. Be an ally.

ConvergenceRI: How have the women legislative members of the General Assembly changed the dynamic around advocacy at the State House?
SPEARS: I cannot speak to change, because I only have the experience of today. But I am thrilled to see the collaboration, leadership and support among women in the General Assembly.

I am tremendously thankful for the many women in the House chamber who have supported and are mentoring me. Leadership in both chambers continues to diversify leadership positions and this is progress.

I just finished reading the Lesson in Chemistry by Bonnie Garmus. It is a great read, and I recommend it to your readers. To say that I am very grateful for the path that has been forged for me, by the women before me, is an understatement. This spirit of equality remains strong in the General Assembly among women legislators.

ConvergenceRI: What questions haven’t I asked, should I have asked, that you would like to talk about?
SPEARS: I think you did a good job, asking a lot of great questions! Thank you for your persistence and coverage of many important issues.

Rep. Tina Spears represents District 36 in the R.I. House of Representatives.

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