Bill
HB 7463
Rebalances Rhode Island's Medicaid long-term care by shifting at least 50% of funding to home- and community-based services and creating a unified HCBS system.
Title: AN ACT RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- LONG-TERM CARE SERVICE AND FINANCE REFORM
Introduced: January 30, 2026
Referred to: House Finance
Sponsors: Shanley, Spears, Batista, Fogarty, Ajello, Craven (and co-sponsors Spears, Fogarty, Craven, Batista, Shanley, Ajello)
Effective date: Upon passage
Purpose and overall aim
- The bill seeks to reform Rhode Island’s long-term care (LTC) system to “rebalance” funding and services from institution-based care toward home- and community-based services (HCBS).
- The executive office of health and human services (EOHHS) would pursue federal waivers and state-plan amendments to implement a plan ensuring at least 50% of Medicaid LTC funding supports HCBS for individuals aged 65 and over and adults with disabilities, in addition to services for persons with developmental disabilities.
- The reform is framed as person-centered, promoting self-determination, family involvement, and a network of community-based supports to reduce reliance on long-term institutional care.
Key provisions and changes
Annual reporting to the state budget: share of funding by setting (institutional vs. HCBS), current and projected LTC waiting lists, and HCBS capacity.
Eligibility and care levels
Establishes a tiered eligibility framework for LTC services, to be developed with multiple state departments and, where feasible, consumer groups.
Creates a common standard of income eligibility for both institutional and HCBS.
Allows more stringent clinical/functional criteria for admission to nursing facilities, hospitals, or ICFs for individuals with intellectual disabilities, while preserving access to HCBS.
Protections to ensure access to the highest level of care for eligible individuals with failed community placements, with coordination with the Long-Term Care Ombudsperson.
Consolidation and scope of HCBS
Authorizes consolidation of all HCBS under a single HCBS system (per 42 U.S.C. § 1396n) with options for consumer direction and shared living.
Continuation of funding for certain assisted-living services financed by the Rhode Island Housing and Mortgage Finance Corporation, consistent with state law.
Optional services and access
Allows promulgation of rules for optional services (e.g., homemaker, home modifications, respite, PT evaluations) subject to available state funding.
Payment reform and wage increases
Reforms to payment methodologies to expand HCBS capacity, including:
Behavioral health and workforce enhancements
January 1, 2022: Behavioral healthcare enhancement of $0.39 per 15 minutes for qualifying workers (with at least 30% of direct-care staff trained in behavioral health).
Annual compliance reporting required to EOHHS.
Conflict-free case management
By January 1, 2024, implement a statewide conflict-free case management network for Medicaid HCBS, ensuring timely access and adherence to federal requirements, coordinating across multiple health and human services agencies.
Home-to-community transition and housing resources
Authority to fund transition/diversion services to move beneficiaries from institutional settings to community-based settings, subject to appropriations and federal matching funds (no per-person cap stated).
Resource eligibility limits
Increases resource eligibility limits for at-home LTC to $12,000 for single individuals and $18,000 for couples, enabling home-based beneficiaries to access services while preserving some assets.
Administrative and regulatory flexibility
Enables the secretary to seek 1115 waivers or state-plan amendments as needed to implement provisions and to coordinate with the Governor on policy direction.
Affected parties and impact
- Medicaid LTC beneficiaries: those aged 65+, adults with disabilities, and individuals with developmental disabilities; expansion of HCBS access and streamlined eligibility may shift some from institutional care to community-based settings.
- LTC providers: home-care agencies, CNAs, hospice, skilled nursing, adult day services, and assisted living facilities; wage increases and new payment methodologies affect funding and revenues.
- State agencies: EOHH S, Department of Health, Department of Human Services, and related bodies involved in HCBS and long-term care management; new reporting, waivers, and case-management requirements.
Timeline and procedural notes
- Key dates indicated for historical adjustments (rate changes effective 2018, 2019) and ongoing requirements through 2025 for inflation adjustments.
- January 1, 2024: start of statewide conflict-free case management network.
- January 1, 2026 and beyond: ongoing reporting and reform implementation to maintain HCBS funding balance.
- Act takes effect upon passage.
Bottom line
HB 7463 is a comprehensive LTC reform bill aimed at rebalancing Medicaid LTC funding toward home- and community-based services, establishing unified HCBS programs, strengthened case management, targeted wage/benefit improvements for direct-care workers, and a framework for streamlined eligibility and provider payment structures. It emphasizes cost containment, consumer choice, and the expansion of community-based care while maintaining protections for vulnerable populations.
Compiled from official sources — confirm details with the bill’s official record.
Sign in to ask a question.
