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HB 8314

AN ACT RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- LONG-TERM CARE SERVICE AND FINANCE REFORM

2026 Regular Session Introduced by Matthew Dawson

Rhode Island aims to shift Medicaid long-term care funding at least 50% to home- and community-based services, standardize eligibility, and reform rates, with a 13% Tier C assisted

05/05/2026 Committee recommended measure be held for further study
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Bill Summary · HB 8314

Summary of HB 8314 (2026) – Rhode Island

AN ACT RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- LONG-TERM CARE SERVICE AND FINANCE REFORM

Introduced by: Representative Matthew S. Dawson
Referred to: House Finance
Date introduced: March 18, 2026
Effective date: Upon passage

This bill proposes a comprehensive reform of Rhode Island’s long-term care (LTC) system funded under Medicaid, with a strong emphasis on shifting care from institutional settings to home- and community-based services (HCBS), along with various financing, eligibility, and quality improvements. It authorizes federal waivers and state plan amendments to implement these changes and sets several programmatic and rate-related provisions. A key explicit provision is a 13% rate increase for Tier C services in assisted living facilities starting January 1, 2027.

1) Main purpose and intent

  • Rebalance Medicaid LTC funding toward home- and community-based care (HCBS) by aiming to allocate at least 50% of LTC funding to HCBS for:
    • Persons aged 65 and over
    • Adults with disabilities
    • In addition to services for people with developmental disabilities
  • Modernize and unify LTC eligibility and service delivery to promote person-centered planning, self-determination, family involvement, and conflict-free case management.
  • Expand and standardize HCBS through a consolidated system that could replace multiple existing programs under 42 U.S.C. § 1396n, while preserving certain existing funded supports (e.g., pre-2006 assisted living funding still covered).

2) Key provisions and changes

  • 50% HCBS funding goal (a) and reporting
    • EOHHS can seek waivers and state-plan amendments to achieve the 50% HCBS allocation target.
    • Annual reporting to the state budget on the share split between institutional and HCBS, plus waiting lists for LTC and HCBS.
  • Eligibility and care levels (c)
    • Create a tiered, consolidated eligibility framework for both institutional and HCBS, including clinical/functional criteria.
    • Maintain stricter eligibility for certain facilities (e.g., nursing facilities) but allow transitions to HCBS where appropriate.
    • Rules on level-of-care determinations and protections against abrupt denials of services.
  • Consolidation of HCBS (d)
    • Merge all HCBS under 42 U.S.C. § 1396n into a single HCBS system, including consumer direction and shared living.
    • Ensure continued funding for certain pre-2006 assisted living arrangements, subject to applicable laws.
  • Optional services (e) and care expansion (f)
    • Allow optional services (e.g., homemaker, home modifications, respite, PT evaluations) if funded.
    • Promote payment methodology reforms to increase access and quality, including acuity-based, tiered payment standards for adult day services (f)(2).
  • Rate reforms and wage incentives (f, g)
    • Several wage-related provisions to bolster the HCBS workforce:
    • Historically, proposed base-rate adjustments for home-care, home nursing, and hospice (2018-era language) are retained in concept to raise wages.
    • In 2021–2022, targeted wage enhancements for direct-care workers (shifts, behavioral health training) with requirements for employer pass-through to workers and annual compliance reporting.
    • A 13% rate increase for Tier C assisted-living services, effective January 1, 2027.
  • Conflict-free case management and transitions (h–i)
    • Establish a statewide, conflict-free case-management network for HCBS with person-centered planning and quality monitoring.
    • Coordinate across relevant agencies to ensure timely access and compliance with federal requirements.
  • Transition and housing support (j–k)
    • Authorize spending to transition/divert beneficiaries from institutional settings to home/community care and to cover certain housing-related costs for those living at home.
    • Seek waivers/state plan authorities to maximize federal funds for LMTC transition and stabilization services.
  • Long-term-care options counseling (h)
    • Implement a statewide LTC options counseling program for individuals and families, detailing LTC options, payment methods, and functional assessments.
  • Administrative authority (m)
    • Authority to seek waivers and adjust rules to implement these reforms, with discretion to meet directives.
  • Effective dates and implementation notes (n)
    • The LTC rate increase for Tier C assisted living is scheduled to take effect on January 1, 2027.
    • The act takes effect upon passage.

3) Who or what would be affected

  • Medicaid LTSS recipients in Rhode Island, including older adults, adults with disabilities, and those with developmental disabilities.
  • Nursing facilities, hospitals, and intermediate-care facilities for persons with intellectual disabilities (ICF/IID), as eligibility criteria could tighten or align with HCBS.
  • Home- and community-based service providers (home health, personal care, homemaker, adult day services, assisted living providers) and their wage structures.
  • Agencies administering LTC programs (EOHHS, Department of Health, Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Department of Human Services, Office of Healthy Aging).
  • Beneficiaries seeking LTC planning and counseling, as well as caregivers and family members.
  • The assisted living sector, due to the 13% Tier C rate increase starting 2027.

4) Procedural and timeline aspects

  • Waivers and amendments: EOHHS may apply for and obtain federal waivers and state-plan amendments as needed to implement the reforms.
  • Reporting: Annual reporting on budget, HCBS vs. institutional spending, and waiting lists.
  • Conflict-free case management: Implement statewide network by no later than January 1, 2024.
  • Transitions and transitional services: Authorization and funding mechanisms to support transitions/diversions from institutional settings, subject to appropriations and federal guidance.
  • Wage and rate changes: Several wage-related provisions are tied to federal/state funding cycles and compliance requirements; specific increases are phased in (e.g., 2021–2022 enhancements, 2019/2025 inflation-linked adjustments).
  • Final rate increase: Tier C assisted living reimbursement increase to 13% effective January 1, 2027.
  • Effective date: The act is effective upon passage.

Bottom-line

HB 8314 aims to modernize Rhode Island’s long-term care financing and delivery by accelerating the shift from institutional care to home- and community-based services, standardizing eligibility, consolidating HCBS programs, expanding optional services, and strengthening the workforce through targeted wage enhancements. It sets clear governance, reporting, and implementation milestones and includes a notable 13% rate increase for Tier C assisted living services beginning in 2027.

Compiled from official sources — confirm details with the bill’s official record.

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