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SB 3153

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

2026 Regular Session Introduced by Pete Appollonio and 6 co-sponsors

Rhode Island aims to shift at least half of Medicaid long-term care funding from institutions to home- and community-based services through waivers, reforms, and unified eligibilit

06/05/2026 Referred to House Finance
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WeVote Research Nonpartisan
Bill Summary · SB 3153

Summary of SB 3153 (Rhode Island, 2026) – AN ACT RELATING TO HUMAN SERVICES — MEDICAL ASSISTANCE — LONG-TERM CARE SERVICE AND FINANCE REFORM

Date Introduced: March 27, 2026 | Referred to: Senate Finance

Sections covered: 40-8.9-9 and related long-term care reform provisions

Status: Scheduled for hearing/consideration as of May 1, 2026

1) Purpose and Intent

  • The bill aims to reform Rhode Island’s long-term care (LTC) system to rebalance funding toward home- and community-based services (HCBS) and away from traditional institutional care (e.g., nursing facilities, skilled nursing facilities, behavioral health residential facilities).
  • It envisions a person-centered, self-directed, and collaborative approach that expands access to a broad range of community-based supports for individuals with varying levels of disability or medical need, including those with severe behavioral, physical, or developmental conditions.
  • The state would pursue federal waivers and state plan amendments to implement these changes and would report annual progress on the share of LTC funding allocated to HCBS versus institutional care, as well as waiting lists for LTC services.

2) Key Provisions and Changes

A. LTC System Rebalancing Goal (50% HCBS)

  • The Executive Office of Health and Human Services (EOHHS) is authorized and directed to obtain waivers/state plan amendments to ensure at least 50% of Medicaid LTC funding supports home- and community-based care for:
    • Persons aged 65+ and adults with disabilities
    • In addition to services for individuals with developmental disabilities
  • EOHHS must annually report the distribution between institutional and HCBS by population, and current/projected HCBS waiting lists.
  • Priority emphasis on expanding HCBS while maintaining existing LTC services’ integrity and financial viability.

B. Person-Centered and Flexible Service Delivery

  • LTC services should be tailored, with self-determination, family involvement, interagency collaboration, and a wide range of community-based supports.
  • Emphasis on reducing or preventing lengthy institutional stays by enabling safer home- and community-based options.

C. Unified Eligibility and Assessment Framework

  • Authorized to adopt a tiered set of eligibility criteria for LTC services, consolidating institutional and HCBS determinations into a common income eligibility standard where feasible.
  • Potentially more stringent clinical/functional criteria for access to higher-cost institutional settings than for HCBS, with rules governing reassessments and eligibility transitions.
  • Provisions to maintain access to the highest level of care if a recipient experiences a failed community placement, and to prevent unwarranted removal from a facility without lawful process.

D. Consolidation of HCBS Programs

  • Authorized to consolidate all HCBS programs under 42 U.S.C. § 1396n into a single HCBS system (including consumer direction and shared living). This would supersede existing § 1396n programs when fully implemented.
  • Continued funding for certain pre-2006 assisted-living services, subject to applicable law.

E. Optional Services and Provider Capacity

  • Rules may permit optional services (e.g., homemaker services, home modifications, respite, PT evaluations) if state funding allows.
  • Payment reforms to expand HCBS capacity, including:
    • Revised certification standards for providers and a tiered, acuity-based payment system
    • Distinct standards for state-authorized adult day services
  • One-time and ongoing wage adjustments for home-care workers to address turnover and shortages:
    • FY 2019 base-rate increases for personal care, home health aides, and related services
    • Inflation-based annual rate adjustments through 2025 (with the note that no annual increase after 2025)

F. Wages and Supplements for Direct-Care Workers

  • 2021–2022 wage enhancement measures to increase direct-care compensation:
    • Shift differential increases ($0.19 per 15 minutes) with 100% pass-through to workers and annual compliance reporting.
    • Behavioral healthcare enhancement starting Jan 1, 2022 for workers with 30% of staff certified in behavioral health training.
  • Annual reporting requirements for compliance and training program utilization.

G. LTC Options Counseling and Conflict-Free Case Management

  • Implementation of a statewide long-term care options counseling program providing information on LTC options, payment sources, and functional assessments.
  • By Jan 1, 2024, establishment of a statewide conflict-free case-management network for HCBS, ensuring timely access and adherence to federal requirements.

H. Transition and Housing Resilience

  • Subject to funding, the Secretary may fund LTC-related transitions or diverts from institutional settings to home/community settings, with caps on spending per person and per year.
  • Higher resource eligibility limits for at-home LTC beneficiaries: up to $12,000 for singles and $18,000 for couples (to help cover housing-related costs).

I. Authority to Seek Waivers/State Plan Changes

  • The Secretary of EOHHSS may pursue 1115 waivers and state plan amendments as needed to implement these reforms, with discretion in coordination with the Governor.

3) Who/What Is Affected

  • Medicaid LTC program beneficiaries (across institutional and HCBS settings), including:
    • Older adults (65+)
    • Adults with disabilities, including those with developmental disabilities
    • Individuals eligible for nursing facilities, hospitals, or intermediate care facilities for persons with intellectual disabilities
  • LTC providers: home-care agencies, personal care attendants, home health agencies, skilled nursing providers, assisted living facilities (to the extent funded), and adult day service providers
  • State agencies: EOHHSS, along with related health and human services departments (behavioral health, developmental disabilities, hospitals, human services, healthy aging)
  • Beneficiaries and families will experience changes in eligibility processing, service options, and care management

4) Procedural and Timeline Aspects

  • Take effect: Upon passage of the act.
  • Ongoing reporting: Annual submission of LTC funding mix and waiting lists as part of the state budget process.
  • Healthcare workforce reforms: Implemented via phased wage adjustments and compliance reporting, with specific dates tied to 2018–2025 in the text (some provisions reference past dates; the bill’s effective date is immediate on passage, with further steps as funded).
  • Conflict-free case management network: Statewide rollout targeted for no later than January 1, 2024.
  • Resource limit adjustments: Authority to adjust home-care resource limits up to $12,000 single / $18,000 couple (no fixed date specified beyond authority).

5) Key Notes and Considerations

  • Substantive aim: Shift Medicaid LTC funding toward HCBS to promote independence and community living.
  • Federal alignment: Requires waivers/state plan amendments and adherence to federal requirements; includes potential 1115 waivers.
  • Fiscal implications: The bill references funding authority and the need for appropriations to support wage enhancements and new HCBS capacity, implying budgetary impact to be determined through the normal appropriations process.
  • Oversight: Annual reporting to track progress, waiting lists, and program integrity.

If you’d like, I can provide a district-by-district impact briefing or a comparison to current Rhode Island LTC programs to illustrate concrete changes.

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

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