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While Rhode Island’s nursing homes have consistently been rated among the best in the country, RI Medicaid has serially slashed reimbursement. 2022 Medicaid rates are based on 2011 historical expenses, and reimbursement has increased, on average, by just 1% per year since then rather than the statutory 2.5%, on average. These sequential cuts over the last ten years equate to a $250,000,000 underpayment to RI nursing homes by Medicaid. During this same decade, costs have increased exponentially. RI nursing homes are currently underfunded by Medicaid by an estimated $50 Million per year – and this was pre-pandemic and before the implementation of the minimum staffing mandate.

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The pandemic has had a devastating impact on nursing homes, and staff at these facilities have been and continue to be heroes. That said, our workforce has been decimated. Those who remain are exhausted. Homes are supplementing their staff with overtime, bonuses and an unprecedented reliance on temporary nursing service agencies that has quadrupled – much at rates that amount to price gouging. Despite all these efforts, 90%+ of RI nursing homes simply cannot meet the staffing standards contained in the staffing mandate. We’re in the midst of a prolonged pandemic and experiencing an historic and deepening labor crisis across the country.

In November 2021, nursing homes reported 1,920 open positions – 1,484 of which were clinical openings. According to the RI Department of Health (RIDOH) compliance would require an additional 475 staff at an estimated added cost to nursing homes to comply with the first year of the mandate is $20.9 million. The 0.5% funding for the first year equates to just $2 million (funds required to be effective October 1, 2021 that have never been paid). In other words the minimum staffing statute represents an $18.9 million unfunded mandate. Even if fully funded, there simply is not enough applicants in the workforce to enable us to meet the mandate. RIDOH then estimates that the first quarter’s fines and penalties would be $8.3 million.

The intent of the minimum staffing bill was to enhance quality of care in RI nursing homes. Instead, the unfunded mandate and the resulting fines will have just the opposite impact – negatively impacting people’s access to care and forcing more nursing homes to close their doors and go out of business.

RIHCA agrees that “there needs to be a long term workforce stabilization strategy to recruit and retain more qualified care givers to care for the rapidly expanding elderly population in our state.” There also needs to be appropriate funding to cover these efforts. RI Medicaid must also fund nursing homes appropriately. The government sets our reimbursement. Meaningful Medicaid rate reform is necessary to restore years of cuts, and any staffing mandate must be fully funded to have any chance of being successful. This is the only real solution to enable RI nursing homes to compete more effectively with other areas of the healthcare arena with improved wages and proper staffing levels. The workforce crisis is showing no signs of stabilizing any time soon.

RIHCA renews our request for at least a one year delay in the implementation of the unfunded staffing mandate and will work with all stakeholders to advocate for RI Medicaid reimbursement that will enable enhanced wages and staffing in RI nursing homes.