Rhode Island 2025 Regular Session

Rhode Island House Bill H6073 Compare Versions

Only one version of the bill is available at this time.

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5	5	2025 -- H 6073
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7	7	LC001650
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9	9	S T A T E O F R H O D E I S L A N D
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2025
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO HEALTH AND SAFETY -- THE RHODE ISLAND FAMILY HOME --
16	16	VISITING ACT
17	17	Introduced By: Representatives Giraldo, Potter, Stewart, Alzate, and Morales
18	18	Date Introduced: March 12, 2025
19	19	Referred To: House Finance
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22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Legislative findings. 1
24	24	The general assembly hereby finds that: 2
25	25	(1) A child's first experiences and relationships set the foundation for development and 3
26	26	learning that leads to success in school and in life. 4
27	27	(2) Voluntary, high-quality home-visiting programs help families learn about and connect 5
28	28	to essential resources, adjust to parenthood, build parenting skills, and address challenges 6
29	29	commonly faced by young families. 7
30	30	(3) For at least four (4) decades, Rhode Island’s First Connections program, overseen by 8
31	31	the department of health, has been providing free, voluntary, statewide home-visiting to expectant 9
32	32	mothers and families with newborns, infants, and toddlers, reaching about thirty-five percent (35%) 10
33	33	of families with new babies. Families typically receive one to four (4) home visits. 11
34	34	(4) Following the establishment of the federal Maternal, Infant, and Early Childhood Home 12
35	35	Visiting (MIECHV) program in 2010, Rhode Island expanded home-visiting services to fund 13
36	36	implementation of Healthy Families America, Nurse-Family Partnership, and Parents as Teachers 14
37	37	as nationally-recognized evidence-based program models that connect pregnant and parenting 15
38	38	families with a designated support person who guides them through the early stages of raising a 16
39	39	family. Home visiting is voluntary, free, and tailored to meet families where they are and help them 17
40	40	achieve their goals to raise healthy, happy children. Each of these proven models is designed to 18
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44	44	provide multi-year, consistent, flexible, relationship-based services to a family starting in the third 1
45	45	trimester of pregnancy or soon after the birth of a child. 2
46	46	(5) In 2022, the federal MIECHV funding was reauthorized and now includes a twenty-3
47	47	five percent (25%) state match requirement to receive increased funds. In 2024 when the state 4
48	48	match requirement went into effect, Rhode Island was one of only three (3) states and territories in 5
49	49	the U.S. that did not meet the full federal match and was unable to draw down the full federal 6
50	50	MIECHV grant. 7
51	51	(6) In 2023, Rhode Island revised contracts with the evidence-based family home visiting 8
52	52	providers and programs to implement Medicaid fee-for-service billing for each encounter for every 9
53	53	mother or child who has Medicaid insurance. About eighty-five percent (85%) of families enrolled. 10
54	54	Rhode Island reserved the federal MIECHV funding to pay for home visits for the fifteen percent 11
55	55	(15%) of enrolled families and children who have commercial insurance or no insurance. 12
56	56	(7) Between 2021 and 2024, the number of pregnant and parenting families enrolled in the 13
57	57	evidence-based home-visiting programs in Rhode Island fell by thirty-seven percent (37%) due to 14
58	58	staffing and financing challenges. In 2024 and 2025, four (4) agencies statewide stopped delivering 15
59	59	one or more of the evidence-based program models due to increased fiscal challenges resulting 16
60	60	from Medicaid fee-for-service billing. 17
61	61	SECTION 2. Section 23-13.7-2 of the General Laws in Chapter 23-13.7 entitled "The 18
62	62	Rhode Island Family Home-Visiting Act" is hereby amended to read as follows: 19
63	63	23-13.7-2. Home-visiting system components. 20
64	64	(a) The Rhode Island department of health shall coordinate the system of early childhood 21
65	65	home-visiting services in Rhode Island and shall work with the department of human services and 22
66	66	department of children, youth and families to identify effective, evidence-based, home-visiting 23
67	67	models that meet the needs of vulnerable families with young children. 24
68	68	(b) The Rhode Island department of health shall implement a statewide home-visiting 25
69	69	system that uses evidence-based models proven to improve child and family outcomes. Evidence-26
70	70	based, home-visiting programs must follow with fidelity a program model with comprehensive 27
71	71	standards that ensure high-quality service delivery, use research-based curricula, and have 28
72	72	demonstrated significant positive outcomes in at least two (2) of the following areas: 29
73	73	(1) Improved prenatal, maternal, infant, or child health outcomes; 30
74	74	(2) Improved safety and reduced child maltreatment and injury; 31
75	75	(3) Improved family economic security and self-sufficiency; 32
76	76	(4) Enhanced early childhood development (social-emotional, language, cognitive, 33
77	77	physical) to improve children’s readiness to succeed in school. 34
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81	81	(c) The Rhode Island department of health shall implement a system to identify and refer 1
82	82	families prenatally, or as early after the birth of a child as possible, to voluntary, evidence-based, 2
83	83	home-visiting programs. The referral system shall prioritize families for services based on risk 3
84	84	factors known to impair child development, including: 4
85	85	(1) Adolescent parent(s); 5
86	86	(2) History of prenatal drug or alcohol abuse; 6
87	87	(3) History of child maltreatment, domestic abuse, or other types of violence; 7
88	88	(4) Incarcerated parent(s); 8
89	89	(5) Reduced parental cognitive functioning or significant disability; 9
90	90	(6) Insufficient financial resources to meet family needs; 10
91	91	(7) History of homelessness; or 11
92	92	(8) Other risk factors as determined by the department. 12
93	93	(d) The Rhode Island department of health shall issue a state home-visiting report due 13
94	94	annually by March 1 of each year that outlines the components of the state’s family home-visiting 14
95	95	system, including state and federal funding amounts and sources. This report shall be shared with 15
96	96	the general assembly and that shall be made publicly available on the department’s website. The 16
97	97	report shall include: 17
98	98	(1) The number of families served by First Connections, as defined by subsection (f) of 18
99	99	this section, in each calendar year, and the number of families enrolled in each evidence-based 19
100	100	family home-visiting model at a common point-in-time for each of the last five (5) years; and 20
101	101	(2) Demographic data on families served; and 21
102	102	(3) Duration of participation of families; and 22
103	103	(4) Cross-departmental coordination; and 23
104	104	(5) Outcomes related to prenatal, maternal, infant and child health, child maltreatment, 24
105	105	family economic security, and child development and school readiness; and 25
106	106	(6) An annual estimate of the number of children born to Rhode Island families who face 26
107	107	significant risk factors known to impair child development, and a plan including the fiscal costs 27
108	108	and benefits to gradually expand access to the existing evidence-based, family home-visiting 28
109	109	programs in Rhode Island to all vulnerable families. The annual plan shall include a projected three 29
110	110	(3) year estimate of the available federal MIECHV grant funds, the state match required to access 30
111	111	the full federal MIECHV grant available, the projected Medicaid fee-for-service billing and/or 31
112	112	other funding strategies to sustain the programs and to meet expansion targets. The annual plan 32
113	113	shall be designed to maximize use of the federal MIECHV grant and ensure providers have 33
114	114	adequate funds to recruit and retain qualified staff; 34
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118	118	(7) The total annual federal MIECHV funding available, received, and spent by the state 1
119	119	on direct home-visiting services by program model and the total spent on state administration for 2
120	120	each of the last five (5) years; 3
121	121	(8) The total annual funding for each program model by source of funding to include 4
122	122	Medicaid fee-for-service state and federal funding, MIECHV federal funding, MIECHV state 5
123	123	match funding, and any other funding by source for each of the last five (5) years for all models; 6
124	124	(9) Implementation successes and challenges, including those related to funding, provider 7
125	125	contracts, provider staffing and turnover, and family enrollment and retention; and 8
126	126	(10) An analysis of how other states have combined Medicaid and MIECHV home-visiting 9
127	127	grants to support and sustain home-visiting programs, including an analysis of how other states use 10
128	128	Medicaid’s Targeted Case Management option. 11
129	129	(e) State appropriations for this purpose shall be combined with federal dollars to fund the 12
130	130	expansion of evidence-based, home-visiting programs, with the goal of offering the program to all 13
131	131	the state’s pregnant and parenting teens; families with a history of involvement with the child 14
132	132	welfare system; and other vulnerable families. 15
133	133	(f) First Connections, as used in this section, means the state-run home-visiting program 16
134	134	administered by the department's office of family visiting, and carried out by community nonprofit 17
135	135	organizations. 18
136	136	(g) Annually, the state shall allocate the minimum amount required to draw down 19
137	137	maximum MIECHV federal dollars available for Rhode Island to the department, which shall be 20
138	138	used for funding home-visiting services. 21
139	139	SECTION 3. This act shall take effect upon passage. 22
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146	146	EXPLANATION
147	147	BY THE LEGISLATIVE COUNCIL
148	148	OF
149	149	A N A C T
150	150	RELATING TO HEALTH AND SAFETY -- THE RHODE ISLAND FAMILY HOME --
151	151	VISITING ACT
152	152	***
153	153	This act would change the department of health’s annual reporting requirements regarding 1
154	154	the family home-visiting program. This act would also appropriate the minimum amount of general 2
155	155	revenue to access the maximum amount of federal MIECHV funds and the department to spend all 3
156	156	federally available funds. 4
157	157	This act would take effect upon passage. 5
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