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H 7794Medical Services

Health and Safety - The Rhode Island Family Home - Visiting Act

This bill mandates increased state funding and Medicaid rate hikes to support and expand home-visiting programs for new families.

Held for study
Population
Affected
15
Email Legislator
Introduced Feb 12, 2026Committee House Finance

Plain-English Summary

This legislation amends the Rhode Island Family Home-Visiting Act to address funding shortfalls and service declines in programs like First Connections. It mandates that the state allocate sufficient funding to fully match available federal grants (MIECHV) for home-visiting services. Additionally, the bill directs the Executive Office of Health and Human Services to increase Medicaid payment rates for these services by October 1, 2026. It also expands annual reporting requirements for the Department of Health to include detailed data on program funding, family enrollment, and outcomes to ensure transparency and effectiveness.

For younger readers

This law is designed to help families who are having new babies. Rhode Island has programs where nurses and helpers visit homes to teach parents how to care for their infants. Recently, these programs haven't had enough money to help everyone. This new rule says the state must set aside more money to pay these helpers and get extra money from the federal government. It also requires the people in charge to write a report every year showing how many families were helped and how the money was spent to make sure the program is working well.

Who & Where It Applies

Impacted groups
Pregnant womenFamilies with infantsRegistered nursesSocial workersMedicaid recipients
Impacted communities
All

Constitutional & Fiscal Check

None Likely

Estimated cost
Amount unknown
Estimated revenue
None

Bill Analysis

Both viewpoints
For Progressives
  • Mandates the state to provide necessary matching funds to access maximum federal dollars, significantly expanding resources for the social safety net and vulnerable families.
  • Requires an increase in Medicaid payment rates for home visiting services, ensuring that social workers and nurses are compensated more fairly for their labor.
  • Prioritizes early intervention for at-risk populations, including adolescent parents and those with history of homelessness, promoting equity and long-term community welfare.
  • The implementation of Medicaid rate increases is delayed until October 2026, potentially leaving programs underfunded and struggling for another two years.
  • Heavily emphasizes "evidence-based models," which can sometimes create barriers to entry for smaller, community-led grassroots organizations that lack resources for expensive validation studies.
  • Does not explicitly guarantee coverage for undocumented families who may not qualify for Medicaid, potentially leaving a segment of the most vulnerable population behind.
For Conservatives
  • Implements strict annual reporting requirements on demographics, funding sources, and outcomes, ensuring high transparency and accountability for taxpayer dollars.
  • Focuses funding specifically on "evidence-based models" with proven track records, preventing waste on experimental or ineffective social programs.
  • Leverages federal matching funds, effectively using federal tax dollars already paid by residents to support state obligations rather than relying solely on new state taxes.
  • Mandates a statutory increase in state spending to chase federal grants, removing legislative flexibility in budgeting during lean economic years.
  • Expands the role of government in the private family sphere by increasing state-sponsored intervention in child-rearing and home life.
  • Dictates Medicaid rate increases which will result in higher long-term costs to the state taxpayers to support the healthcare industry.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 39 additions · 7 deletions

SECTION 1. Legislative findings. The general assembly hereby finds that:

(1) A child's first experiences and relationships set the foundation for development and learning that leads to success in school and in life.

(2) Voluntary, high-quality home-visiting programs help families learn about and connect to essential resources, adjust to parenthood, build parenting skills, and address challenges commonly faced by young families.

(3) For at least four (4) decades, Rhode Island’s First Connections program, overseen by the department of health and funded primarily through Medicaid billing, has been providing free, voluntary, statewide home-visiting to expectant mothers and families with newborns, infants, and toddlers. Families typically receive one to four (4) home visits. Between 2021 and 2024, the number of families receiving at least one First Connections visit declined by 42%. In 2024, 1,970 families received services, approximately 32% of those referred.

(4) Following the establishment of the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program in 2010, Rhode Island expanded home-visiting services to fund implementation of nationally-recognized evidence-based program models that connect pregnant and parenting families with a designated support person who guides them through the early stages of raising a family. Home visiting is voluntary, free, and tailored to meet families where they are and help them achieve their goals to raise healthy, happy children. Each of these proven models is designed to provide multi-year, consistent, flexible, relationship-based services to a family starting in the third trimester of pregnancy or soon after the birth of a child.

(5) In 2022, the federal MIECHV funding was reauthorized and now includes a twenty- five percent (25%) state match requirement to receive increased funds. Most states have been able to meet or exceed the state match and have received additional federal funds. In 2024 and 2025, the first two (2) years of the state match challenge, Rhode Island did not meet the full state match challenge and was unable to draw down the full federal MIECHV grant.

(6) Starting in 2023, the department of health began requiring all evidence-based family home visiting providers and programs to implement Medicaid fee-for-service billing for each encounter for every mother or child who has Medicaid insurance. Medicaid billing and other funding challenges led to a 32% decline in the number of families in Rhode Island receiving evidence-based home visiting services and the closure of 7 home visiting programs since 2021.

SECTION 2. Section 23-13.7-2 of the General Laws in Chapter 23-13.7 entitled "The Rhode Island Family Home-Visiting Act" is hereby amended to read as follows: 23-13.7-2. Home-visiting system components.

(a) The Rhode Island department of health shall coordinate the system of early childhood home-visiting services in Rhode Island and shall work with the department of human services and department of children, youth and families to identify effective, evidence-based, home-visiting models that meet the needs of vulnerable families with young children.

(b) The Rhode Island department of health shall implement a statewide home-visiting system that uses evidence-based models proven to improve child and family outcomes. Evidence- based, home-visiting programs must follow with fidelity a program model with comprehensive standards that ensure high-quality service delivery, use research-based curricula, and have demonstrated significant positive outcomes in at least two (2) of the following areas:

(1) Improved prenatal, maternal, infant, or child health outcomes;

(2) Improved safety and reduced child maltreatment and injury;

(3) Improved family economic security and self-sufficiency;

(4) Enhanced early childhood development (social-emotional, language, cognitive, physical) to improve children’s readiness to succeed in school.

(c) The Rhode Island department of health shall implement a system to identify and refer families prenatally, or as early after the birth of a child as possible, to voluntary, evidence-based, home-visiting programs. The referral system shall prioritize families for services based on risk factors known to impair child development, including:

(1) Adolescent parent(s);

(2) History of prenatal drug or alcohol abuse;

(3) History of child maltreatment, domestic abuse, or other types of violence;

(4) Incarcerated parent(s);

(5) Reduced parental cognitive functioning or significant disability;

(6) Insufficient financial resources to meet family needs;

(7) History of homelessness; or

(8) Other risk factors as determined by the department.

(d) The Rhode Island department of health shall issue a state home-visiting report due annually by March 1 of each year that outlines the components of the state’s family home-visiting system that shall, including state and federal funding amounts and sources. This report shall be shared with the general assembly and be made publicly available on the department’s website. The report shall include:

(1) The number of families served by First Connections, as defined by subsection (f) of this section, in each calendar year, and the number of families enrolled in each evidence-based family home-visiting model at a common point-in-time for each of the last five (5) years; and

(2) Demographic data on families served; and

(3) Duration of participation of families; and

(4) Cross-departmental coordination; and

(5) Outcomes related to prenatal, maternal, infant and child health, child maltreatment, family economic security, and child development and school readiness; and

(6) An annual estimate of the number of children born to Rhode Island families who face significant risk factors known to impair child development, and a plan including the fiscal costs and benefits to gradually expand access to First Connections and the existing evidence-based, family home-visiting programs in Rhode Island to all vulnerable families. The annual plan shall include a projected three (3) year estimate of the available federal MIECHV grant funds, the state match required to access the full federal MIECHV grant available, the projected Medicaid fee- for-service billing and/or other funding strategies to sustain the programs and to meet expansion targets. The annual plan shall be designed to maximize use of the federal MIECHV grant and ensure providers have adequate funds to recruit and retain qualified staff;

(7) The total annual federal MIECHV funding available, received, and spent by the state on direct home-visiting services by program model and the total spent on state administration for each of the last five (5) years;

(8) The total annual funding for each program model by source of funding to include Medicaid fee-for-service state and federal funding, MIECHV federal funding, MIECHV state match funding, and any other funding by source for each of the last five (5) years for all models; and

(9) Implementation successes and challenges, including those related to funding, provider contracts, provider staffing and turnover, and family enrollment and retention.

(e) State appropriations for this purpose shall be combined with federal dollars to fund the expansion of evidence-based, home-visiting programs, with the goal of offering the program to all the state’s pregnant and parenting teens; families with a history of involvement with the child welfare system; and other vulnerable families.

(f) First Connections, as used in this section, means the state-run home-visiting program administered by the department's office of family visiting and implemented by community nonprofit organizations providing rapid-response and short-term home visits for pregnant individuals and families with newborns and children up to age three (3). Families typically receive one to four (4) home visits delivered by registered nurses, community health workers and social workers. Home visiting staff assess medical, safety, and other family needs and connect families with services to meet their needs such as postpartum support, basic needs, and referrals to more comprehensive, multi-year, evidence-based home visiting and early intervention programs.

(g) The executive office of health and human services shall pursue a Medicaid state plan amendment and allocate sufficient state general revenue, to increase Medicaid payment rates for family home visiting services by the amount recommended in the 2025 social and human service programs review report by the Rhode Island office of the health insurance commissioner. Rate increases shall be implemented on or before October 1, 2026.

(h) Annually, the state shall allocate the minimum amount required to draw down maximum MIECHV federal dollars available for Rhode Island to the department, which shall be used for funding home-visiting services.

SECTION 3. This act shall take effect upon passage.