2023 -- H 5810
========
LC001745
========
S TATE OF RHODE IS LAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2023
____________
A N A C T
RELATING TO HEALTH AND SAFETY -- THE RHODE ISLAND FAMILY HOME-
VISITING ACT
Introduced By: Representatives Giraldo, Morales, Cruz, and Potter
Date Introduced: February 22, 2023
Referred To: House Finance
It is enacted by the General Assembly as follows:
SECTION 1. Legislative findings. 1
The general assembly hereby finds that: 2
(1) A child's first experiences and relationships set the foundation for development and 3
learning that leads to success in school and in life. 4
(2) Voluntary, high-quality home-visiting programs help families learn about and connect 5
to essential resources, adjust to parenthood, build parenting skills, and address challenges 6
commonly faced by young families. 7
(3) For at least four (4) decades, Rhode Island’s first connections program, overseen by the 8
department of health, has been providing free, voluntary, statewide home-visiting to pregnant 9
women and to families with newborns, infants, and toddlers, reaching about thirty-five (35%) of 10
families with new babies. Families typically receive one to four (4) home visits. The program is 11
staffed with nurses, social workers, and community health workers and is funded with federal 12
Individuals with Disabilities Education Act Part C resources, Medicaid billing, and other federal 13
grants. 14
Prior to a temporary, one-year increase in state fiscal year 2023, the Medicaid rates for first 15
connections services have not increased since 2000. Inadequate funding had resulted in significant 16
program staffing challenges and an average operating loss for first connections programs of one 17
hundred thirty-six dollars and seventy cents ($136.70) per visit. The temporary, one-year Medicaid 18
LC001745 - Page 2 of 5
rate increase will expire on June 30, 2023. In 2022, South County Home Health terminated their 1
contract with the state to deliver first connections services, citing lack of sufficient resources to 2
adequately staff the program. 3
(4) Following the establishment of the federal Maternal, Infant, and Early Childhood Home 4
Visiting program in 2010, Rhode Island expanded home-visiting services to include several longer-5
term, comprehensive, and evidence-based program models with strong evidence they improve 6
short-term and long-term outcomes for children and families. In 2022, the federal funding was 7
reauthorized and now includes a twenty-five percent (25%) state match requirement to receive base 8
federal funding to sustain existing programs and new expansion funds. The state match requirement 9
will go into effect in federal fiscal year 2024. 10
(5) By enacting this law, the general assembly recognizes the short-term and long-term 11
benefits of voluntary, high quality, culturally responsive home-visiting services to pregnant and 12
parenting families with newborns, infants, and toddlers. 13
SECTION 2. Section 23-13.7-2 of the General Laws in Chapter 23-13.7 entitled "The 14
Rhode Island Family Home-Visiting Act" is hereby amended to read as follows: 15
23-13.7-2. Home-visiting system components. 16
(a) The Rhode Island department of health shall coordinate the system of early childhood 17
home-visiting services in Rhode Island and shall work with the department of human services and 18
department of children, youth and families to identify effective, evidence-based, home-visiting 19
models that meet the needs of vulnerable families with young children, including the most 20
vulnerable families. 21
(b) The Rhode Island department of health shall implement a statewide home-visiting 22
system that uses evidence-based models proven to improve child and family outcomes. Evidence-23
based, home-visiting programs must follow with fidelity a program model with comprehensive 24
standards that ensure high-quality service delivery, use research-based curricula, and have 25
demonstrated significant positive outcomes in at least two (2) of the following areas: 26
(1) Improved prenatal, maternal, infant, or child health outcomes; 27
(2) Improved safety and reduced child maltreatment and injury; 28
(3) Improved family economic security and self-sufficiency; 29
(4) Enhanced early childhood development (social-emotional, language, cognitive, 30
physical) to improve children’s readiness to succeed in school. 31
(c) The Rhode Island department of health shall implement a system to identify and refer 32
families prenatally, or as early after the birth of a child as possible, to voluntary, evidence-based, 33
home-visiting programs. The referral system shall prioritize families for services based on risk 34
LC001745 - Page 3 of 5
factors known to impair child development, including: 1
(1) Adolescent parent(s); 2
(2) History of prenatal drug or alcohol abuse; 3
(3) History of child maltreatment, domestic abuse, or other types of violence; 4
(4) Incarcerated parent(s); 5
(5) Reduced parental cognitive functioning or significant disability; 6
(6) Insufficient financial resources to meet family needs; 7
(7) History of homelessness; or 8
(8) Other risk factors as determined by the department. 9
(d) The Medicaid rate increase authorized for the first connections program in state fiscal 10
year 2023 shall be made permanent. 11
(e) Beginning on or before October 1, 2016, and annually thereafter, the Rhode Island 12
department of health shall issue a state home-visiting report that outlines the components of the 13
state’s family home-visiting system that shall be shared with the governor, speaker of the house, 14
and senate president, made publicly available on the department’s website, and sent to members of 15
the children’s cabinet, the RI early learning council, and the RI family home visiting council. The 16
report shall include: 17
(1) The number of families served by first connections and each evidence-based family 18
home-visiting model; and 19
(2) Demographic data on families served; and 20
(3) Duration of participation of families; and 21
(4) Cross-departmental coordination; and 22
(5) Outcomes related to prenatal, maternal, infant and child health, child maltreatment, 23
family economic security, and child development and school readiness; and 24
(6) Implementation challenges, including challenges related to funding and program 25
operations, and problems recruiting and retaining qualified and effective home-visiting program 26
staff; and 27
(7) An annual estimate of the number of children born to Rhode Island families who would 28
benefit from a universal, voluntary, short-term home visiting program and the number who face 29
significant risk factors known to impair child development and who would benefit from the 30
comprehensive, long-term, evidence-based home visiting services; and, and a plan including the 31
fiscal costs and benefits 32
(8) An annual estimate of the available federal funding and the state general revenue needed 33
to sustain high-quality home-visiting services statewide and to gradually expand access to the 34
LC001745 - Page 4 of 5
existing voluntary, evidence-based, family home-visiting programs in Rhode Island to all 1
vulnerable families who would benefit. 2
(e)(f) The October 1, 2024 family home-visiting report shall include a plan with cost 3
estimates to expand home-visiting services over five (5) years to offer universal, voluntary family 4
home-visiting services statewide. The department shall review the progress made in other states 5
and municipalities that are making family home-visiting universally available, including 6
Connecticut, New Jersey, and Oregon. This report shall also include recommendations from the 7
department about the feasibility, advantages, and disadvantages of adopting and integrating the 8
evidence-based family connects universal newborn home-visiting model into the state’s service 9
array. 10
(f)(g) State appropriations for this purpose shall be combined with federal dollars to fund 11
the expansion of voluntary, evidence-based, home-visiting programs, to all families who would 12
benefit with the goal of offering the program to all the state’s pregnant and parenting teens; families 13
with a history of involvement with the child welfare system; and other vulnerable families. 14
SECTION 3. This act shall take effect upon passage. 15
========
LC001745
========
LC001745 - Page 5 of 5
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO HEALTH AND SAFETY -- THE RHODE ISLAND FAM ILY HOME-
VISITING ACT
***
This act would make the Medicaid rate increase permanent for the first connections family 1
home-visiting program, require additional information to be added to the annual family home-2
visiting report, and direct the department of health to develop a plan with federal and state cost 3
estimates to phase-in expansion of voluntary home-visiting services to reach all families who would 4
benefit. 5
This act would take effect upon passage. 6
========
LC001745
========