PROVIDENCE – Rhode Islanders may owe Ben Shaffer, the former director of the R.I. Medicaid office, who has since found greener pastures as a principal at the Boston Consulting Group, a big “thank you.”

Shaffer had repeatedly cast doubt on the value of any legislative involvement in rate setting when it came to increasing the low Medicaid reimbursement rates for human service providers, when he appeared on Nov. 30, 2021, as a witness before the special legislative commission looking into the future structure of the R.I. Executive Office of Health and Human Services.

In a smug tone of voice, Shaffer had expressed his disdain, in a series of exchanges with the commission’s chair, Sen. Josh Miller, about the value of any potential direct legislative involvement in rate-setting activities. [See link below to ConvergenceRI story, “When do low Medicaid rates create a break glass emergency?”]

Translated, the takeaway is: You don’t tug on Superwoman’s cape – and you don’t dis legislators in their own house.

On Tuesday, March 8, at 3 p.m., in what appears to be a remarkable display of consensus by legislators and advocates, a news conference will be held in the Library of the State House to champion two new pieces of legislation, called the “Rate Review and Rate Setting Process Acts of 2022,” authorizing the R.I. General Assembly to review rates every two years.

The lead sponsors are Sen. Lou DiPalma [S2311] and Rep. Julie Casimiro [H7180]. These bills are focused on social and human services. In addition, there are bills focused on Medical and Clinical Services, [S2200] and [H7489], also being sponsored by both Sen. DiPalma and Rep. Casimiro, respectively.

How remarkable is the consensus that has been achieved? Every member of the Senate is a co-sponsor of the legislation being introduced by Sen. DiPalma, according to Senate President Dominick Ruggerio.

How focused are legislators and advocates on working to increase Medicaid rates? “Rhode Island’s reimbursement rates have been stagnant for far too long, which puts strain on our service providers and has negative consequences for the most vulnerable members of our communities,” said Senate President Ruggerio.

How might the R.I. Medicaid office be reorganized? “Medicaid should be elevated to a cabinet-level position,” according to Sen. Lou DiPalma

Given the high level of what some have labeled compassion fatigue, is there a consensus to overcome the inertia? “Unity of purpose for the people we support and our workers has resonated with our elected officials,” according to Tina Spears, executive director of the Community Provider Network of RI.

Is the Rhode Island news media finally paying attention to the issue of low Medicaid rates? Apparently. As WPRI’s Ted Nesi wrote in his weekly column on March 5, “Another interesting effect from the merger’s demise is a renewed focus on whether the state needs to increase its Medicaid reimbursement rates.” Stay tuned.

Speakers on the agenda
The list of speakers scheduled to appear at the March 8 news conference includes: R.I. Senate President Dominick Ruggerio; Tina Spears, executive director of the Community Provider Network of RI; Bill Flynn, executive director of the Senior Agenda Coalition of RI; Carrie Miranda, executive director of Looking Upwards; and Patrick Crowley, Secretary-Treasurer of the AFL-CIO of RI.

Questions and answers
In advance of the March 8 news conference, ConvergenceRI reached out to a number of key players involved in the effort to establish the precedent-setting, rate-setting legislation, asking each of them three questions. Here are the responses

 R.I. Senate President Dominick Ruggerio

ConvergenceRI: How important is it for the R.I General Assembly to address the long-term disparities in low Medicaid reimbursement rates? How will these two new laws fix the problem?
SENATE PRESIDENT RUGGERIO: This is an extremely important issue for us to address. Rhode Island’s reimbursement rates have been stagnant for far too long, which puts strain on our service providers and has negative consequences for the most vulnerable members of our communities.

Sen. Lou DiPalma’s proposals, which are co-sponsored by every member of the Senate, will help us bring our reimbursement rates where they need to be. They will also establish a regular review process in law to ensure that going forward, we don’t find ourselves back in this same situation.

ConvergenceRI: Is there an opportunity to increase the current proposed budget for FY 2023 to increase Medicaid rate funding for Early Intervention and Family Visiting — and Substance Use treatment services?
SENATE PRESIDENT RUGGERIO: I have enormous confidence in Chairman Ryan Pearson and the Senate Finance Committee as it works to review the budget and all related matters. Sen. Lou DiPalma serves as the committee’s First Vice Chairman, and his strong leadership around the reimbursement rate issue will be invaluable as the budget is reviewed and modified over the next several months.

ConvergenceRI: How closely are you following the deliberations of the special legislative commission on the future of RI EOHHS? Have you been briefed about the discussions?
SENATE PRESIDENT RUGGERIO: I have regular conversations with Sen. Josh Miller, who chairs the commission, and Sen. Lou DiPalma, who sponsored the resolution to create the commission and also serves as a member. The commission’s work is ongoing, and I look forward to reviewing its recommendations once they are finalized.

 Sen. Louis DiPalma, Chairman of the Senate Committee on Rules, Government Ethics, and Oversight; First Vice Chairman, Senate Committee on Finance; member, Senate Committee on Education: and a member of the Senate Special Legislative Commission looking into the structure of R.I. EOHHS.

ConvergenceRI: What do you see as the goals of these two bills?
SEN. DiPALMA: The ultimate goals of the set of bills are as follows:

• This legislation will ensure that hundreds of thousands of Rhode Islanders receive the supports for which they are eligible/approved for and authorized by the state. Today, thousands of Rhode Islanders are NOT receiving these much-needed services or only partially receiving services.

These goals are accomplished via the establishment of a comprehensive process for rate reimbursement review and setting, including follow-on biennial re-evaluation. For many, many years, the reimbursement rate for these services has been well below the actual cost of providing these services.

This led to that aforementioned reduction in services: it’s become difficult to keep experienced workers on and hire to replace those that leave, as wages haven’t kept pace. We cannot allow this to continue any longer. The time to act is now!

ConvergenceRI: In what ways is the legislation an outgrowth of the work being done by the special legislative commission?
SEN. DiPALMA: Really, it is just the opposite. Similar legislation was introduced in 2021. Work on the 2021 legislation informed the work of the Senate Special Legislative Commission.

The issue of rate reimbursement was certainly a topic that was front and center and discussed many, many times by many witnesses, who testified before the commission, as well as from commission members themselves. Expert witnesses from across the country also emphasized the need to address reimbursement rates.

ConvergenceRI: Do you think that there needs to be a new location and organization for the R.I. Medicaid office? What should that look like, in your opinion?
SEN. DiPALMA: Yes. I believe, from my 14 years as a member of the Senate Committee on Finance and as its Health and Human Services Sub-Committee Chair, Medicaid should be elevated to a cabinet-level position. Elevating Medicaid to a cabinet-level position would bring with it Senate advice and consent.

Additionally, as was discussed at the recent hearing of the Senate Special Legislative Commission, it could prove beneficial to integrate the Medicaid office into the Office of the Health Insurance Commissioner, and potentially also include HealthSourceRI into that same organizational structure.

 Tina Spears, executive director of the Community Provider Network of Rhode Island.

ConvergenceRI: What do you hope will be the immediate impact on the FY 2023 budget if these new laws are enacted?
SPEARS: First it will be an acknowledgment that reform must take place and the General Assembly is committing to addressing this problem. There is no immediate impact on the FY 2023 budget, and this bill essentially prescribes a structure by which the state will conduct a rate review in year one. This process will provide the General Assembly with sound information to inform their decisions on rate adjustments for the FY 2024 budget.

What is important to note: this bill will not provide resources to the system immediately; there is a need for fiscal investments in the system while the rate review process is undertaken.

We are asking the General Assembly to invest ARPA dollars toward the health and human service workforce crisis. These actions would ensure full, inclusive lives for all.

ConvergenceRI: Do you think that clients and providers are finally being heard through this process?
SPEARS: Yes, however, the communities that are most impacted by the lack of access to services are far too often underrepresented.

Certainly, we and our members – along with our coalition partners in the Health and Human Services coalition – have been able to get our voices across.

But those on the frontlines – the direct care workers and caregivers – are in crisis right now. That’s true across the entire HHS sector.

Part of what has allowed this crisis to stay under the radar is that the work has been all-consuming, so those directly experiencing it don’t have the time to raise the alarm.

We will continue to support strong advocacy across the provider and advocate community to ensure the problem is front-and-center at the State House this session. We’re seeing that with the support these bills have received; bipartisan co-sponsors in both chambers, and the unanimous support of the state Senate.

ConvergenceRI: Is there a compassion fatigue that has set in for many Rhode Islanders who are exhausted from dealing with COVID? What is a good way to reframe the issues, from your perspective?
SPEARS: Yes, we are all fatigued. Not only have we experienced a national public health emergency, we are also witnessing an international war, all while the political discord in our country is unprecedented.

This is a troubling time for our citizens and it weighs heavily on all of us. Trying to raise attention to an issue of injustice or neglect is difficult when legislators see mounting hardship and struggles in many areas.

To ensure an important issue gains the support and attention it needs, it is critical to clearly communicate the problem and create the solution that can be adopted. Our legislators want to support policies and programs that will actually help people.

Unity of purpose for the people we support and our workers has resonated with our elected officials. The marginalized communities that our coalition members represent independently are facing the same issue: a degradation of their workforce leading to loss of access to service for people.

But rather than working separately to achieve the same goal, we have built momentum by uniting together. If we work together, it’s easier to secure awareness around this issue, because [the collaboration] is many voices calling for the same thing: an end to the workforce crisis in the HHS sector so people can get the care they need. All acting separately masked the issue for policymakers.

All of this to say, it is incumbent upon providers and community advocates to educate and inform our policy makers so they can take action on important issues that impact our citizens. I believe the HHS coalition has “framed” the issue and the overwhelming majority of our state’s policymakers want to bring this crisis to an end and will pass S2311 and H7180.

No longer below the radar screen?
Although it seems as if ConvergenceRI has been harping on the problems created by low Medicaid rates for months if not years of reporting, the issue seems to have finally broken through the “awareness” barrier for some reporters, including WPRI’s Ted Nesi.

In his weekly column, “Nesi’s Notes, published on March 5, Nesi wrote: Another interesting effect from the merger’s demise is a renewed focus on whether the state needs to increase its Medicaid reimbursement rates. The AG highlighted those payments as a key problem for local hospitals, and interim R.I. Health Department Director Dr. Jim McDonald echoed him this week. “Medicaid rates are low in our state. They’re very low,” McDonald said. “That’s something that, quite frankly, we all as a state need to look at – why is that the case and is there anything we can do about that?”

The item continued: Women & Infants President Shannon Sullivan made a similar argument to my colleague Adriana Rozas Rivera, saying, “If people have historically felt very invested in having one of the country’s most premier women’s health institutions in this state, but we don’t get paid for the cost of care that we provide here -- and Medicaid’s the biggest proportion of that – if Rhode Island wants to continue to have a hospital of this caliber, Medicaid rates need to be looked at.”

When demographic, political realities collide
The photograph used to illustrate this story was taken at the ribbon-cutting ceremony held on Monday, Feb. 28, at the opening of the new health care facility by the Providence Community Health Centers in Olneyville, at the site of the former Providence Boys & Girls Club location. The event featured both Lt. Governor Sabina Matos and Providence Mayor Jorge Elorza as speakers, in what the Mayor likened to a “homecoming” of sorts – both were from the neighborhood. It was a testament to the political reality of the changing demographics of Rhode Island. The financial reality of the new health care facility is that some 70 percent of the 14,000 clients who will be served will be Medicaid members

A few blocks away, on the very same day, cranes were hoisting pre-fabricated affordable housing units into place on Bowdoin Street, the site where three structures had been destroyed in a fire in 2017. The pre-fab housing project is being developed by ONE Neighborhood Builders.