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SB 2378

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

2026 Regular Session Introduced by Pete Appollonio and 9 co-sponsors

Rhode Island will move at least 50% of Medicaid long-term care funding to home- and community-based services, expanding HCBS options and reforming access and payments.

04/28/2026 Committee recommended measure be held for further study
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Bill Summary · SB 2378

Summary of SB 2378 (Rhode Island, 2026) – Long-Term Care Service and Finance Reform

Note: This summary distills the bill’s main purpose, key provisions, who is affected, and notable procedural/timeline aspects.

Purpose and overarching goal

  • The bill seeks to reform Rhode Island’s long-term care (LTC) system with a strong emphasis on shifting Medicaid-funded LTC services from predominantly institutional care to home- and community-based services (HCBS).
  • A central objective is to allocate at least 50% of Medicaid LTC funding to HCBS for:
    • persons age 65 and older,
    • adults with disabilities,
    • and in addition to services for persons with developmental disabilities.
  • The reform aims to support person-centered planning, self-determination, family involvement, and a broader array of community-based options, while maintaining the integrity and financial viability of existing LTC services.

Key provisions and changes

Eligibility, access, and level-of-care rules

  • The Executive Office of Health and Human Services (EOHHS) may seek federal waivers and state-plan amendments to implement the 50% HCBS funding goal.
  • Establishment of a tiered, criteria-based system to determine eligibility for LTC services, covering:
    • nursing facilities, hospitals, and intermediate-care facilities for persons with intellectual disabilities (ICF/IID),
    • HCBS options.
  • Development of common income eligibility standards for institutional and HCBS care, with more stringent clinical/functional criteria for certain higher-acuity settings.
  • Rules on level-of-care: for current recipients eligible as of April 1, 2021, retention of existing criteria unless transitioning to HCBS or choosing HCBS; protection for “failed community placements,” ensuring access to the highest level of care when appropriate; protections against inappropriate wait-lists.
  • Provisions to ensure that a recipient who voluntarily leaves an institutional setting for HCBS does not face unnecessary HCBS wait lists.

Consolidation and funding rules

  • Authorized consolidation of all HCBS under 42 U.S.C. § 1396n into a single HCBS system (with continued funding for existing assisted-living arrangements financed prior to 2006, and compliance with related statutes).
  • Rules allowing optional services (e.g., homemaker services, home modifications, respite, PT evaluations) subject to state funding.

Payment reforms and workforce

  • Authorized reforms to payment methodologies to expand access to HCBS and incentivize quality outcomes, including:
    • Acuity-based, tiered payments for adult day services;
    • Certification standards for providers of assisted living and adult day services, with reporting requirements beginning July 1, 2026.
  • Wage-related provisions to address home-care worker shortages:
    • A one-time base-rate increase for home-care and home nursing providers (with phased future inflation adjustments through 2025, linked to NE-CPI for medical care costs).
    • Specific wage enhancements:
    • A shift differential increase to be passed through to direct-care workers (with annual compliance reporting starting by July 1, 2022).
    • A behavioral-health enhancement (effective Jan 1, 2022) for workers certified in behavioral health training, with required pass-throughs to qualifying employees and compliance reporting by 2023.
  • Aimed at raising wages for personal care attendants and home health aides to improve recruitment and retention.

Additional program elements

  • Long-term-care-options counseling program to inform individuals and families about LTC options, payment sources, and functional assessments.
  • Implementation of a statewide, conflict-free case management network by no later than January 1, 2024, to ensure coordinated, non-conflicted service planning and access in HCBS.
  • Authority for the secretary to seek waivers or plan amendments to maximize federal funds for HCBS transition and stabilization services, within funding constraints.
  • Authorized expansion of resource limits for housing-related costs to help individuals stay living at home (increasing resource eligibility to $12,000 for singles and $18,000 for couples).

Affected parties

  • Medicaid beneficiaries needing LTC services (aging individuals, adults with disabilities, and some with developmental disabilities).
  • Current and prospective residents of nursing facilities, hospitals, ICF/IID settings, as well as HCBS participants.
  • HCBS providers, including home-health, homemaker, adult day services, and assisted-living providers.
  • Direct-care workers (CNAs, home health aides, and related staff) whose wages may be affected by the proposed pay-rate changes.
  • The Rhode Island EOHHCS and related health and human services agencies, plus the long-term-care ombudsperson.

Procedural and timeline aspects

  • Takes effect upon passage.
  • Several provisions reference actions over the 2021–2026 period, including reporting requirements starting in 2022–2026 and semi-annual reporting by certain providers beginning July 1, 2026.
  • Requires the EOHHCS to work with state departments, consumer groups, and advisory entities to implement uniform eligibility criteria and the conflict-free case management network.
  • The bill authorizes the secretary to pursue waivers and state plan amendments as needed to meet implementation deadlines and effectiveness, with discretion to align with federal requirements.

Bottom line

SB 2378 is a comprehensive LTC reform bill focused on expanding HCBS, harmonizing eligibility, consolidating services under a unified HCBS system, reforming payment standards with a focus on quality and outcomes, and addressing workforce wage pressures—while preserving essential services and ensuring conflict-free case management and consumer choice.

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

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