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S 2845Medical Services

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

This bill requires Rhode Island to increase funding and Medicaid payment rates to support and expand home-visiting programs for families.

Held for study
Population
Affected
15
Email Legislator
Introduced Mar 4, 2026Committee Senate Finance

Plain-English Summary

This legislation addresses the decline in early childhood home-visiting services in Rhode Island, specifically the "First Connections" program. It mandates that the state allocate sufficient funds to meet the matching requirements necessary to secure the maximum available federal grant money (MIECHV). Furthermore, the bill requires the Executive Office of Health and Human Services to pursue a Medicaid plan amendment to increase payment rates for home-visiting services by October 1, 2026. It also expands annual reporting requirements for the Department of Health to include detailed data on funding sources, family enrollment, and program outcomes.

For younger readers

This new rule helps families with babies and young children. Rhode Island has a program where helpers visit homes to teach parents how to care for their babies and stay healthy. Recently, there hasn't been enough money for this program, and some families couldn't get help. This rule says the state must pay these helpers more money so they can keep doing their jobs. It also makes sure the state spends enough of its own money to get extra bonus money from the main government in Washington, D.C., allowing them to help more families in need.

Who & Where It Applies

Impacted groups
Families with young childrenPregnant womenCommunity health workersNon-profit service providersMedicaid recipients
Impacted communities
All

Constitutional & Fiscal Check

None Likely

Estimated cost
Amount unknown
Estimated revenue
Amount unknown

Bill Analysis

Both viewpoints
For Progressives
  • Strengthens the social safety net by mandating the state allocate funds to maximize federal grants, ensuring more vulnerable families and at-risk children receive critical support services.
  • Requires an increase in Medicaid payment rates, which helps ensure fair compensation for social workers and community health workers while stabilizing the workforce that serves the poor.
  • Codifies a focus on equity by prioritizing services for marginalized groups, including adolescent parents, homeless families, and those with a history of domestic abuse or incarceration.
  • The mandated Medicaid rate increase does not take effect until October 2026, leaving a two-year gap where underfunded programs may continue to struggle or close, potentially harming current clients.
  • Continues to rely heavily on the Medicaid fee-for-service model, which the legislative findings admit has contributed to the decline in services due to billing challenges.
  • The solution remains tied to federal grant structures (MIECHV), making the stability of local social services dependent on the continuity of federal funding and congressional reauthorization.
For Conservatives
  • Ensures fiscal responsibility by mandating the state draw down the maximum amount of federal tax dollars already paid by Rhode Islanders, rather than leaving that money on the table.
  • Strictly mandates the use of "evidence-based" models, ensuring that taxpayer funding is restricted to programs with proven, data-driven results rather than experimental social programs.
  • Supports the traditional family unit by providing resources that help parents build skills to raise their children independently and successfully within the home environment.
  • Mandates an automatic increase in state government spending and Medicaid rates, removing legislative discretion and locking taxpayers into higher future costs.
  • Expands the reach of government into the private sanctity of the home, potentially increasing state monitoring of child-rearing practices.
  • Increases the state's dependence on federal funding streams and expands the Medicaid entitlement apparatus, growing the size and scope of the welfare state.

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.