2025 -- H 5988

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LC001642

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- HEALTH CARE FOR

CHILDREN AND PREGNANT WOMEN

     Introduced By: Representatives Tanzi, Handy, Ajello, McGaw, Kislak, Hull, Carson,
Morales, Potter, and Cortvriend

     Date Introduced: February 28, 2025

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

     SECTION 1. Legislative findings. The general assembly finds and declares:

     (1) Rhode Island pediatricians are facing a major workforce crisis which is causing

decreased healthcare access for children. Without significant intervention, the situation is expected

to worsen and negatively impact not only the health or our children, but the long-term health of the

adults in our state.

     (2) According to a 2024 survey of Rhode Island pediatricians, less than fifty percent (50%)

of pediatric primary care offices were accepting new or transfer patients other than newborns or

siblings of current patients. Families that move to Rhode Island to work, or those whose pediatric

providers retire, cannot find a doctor to care for their child.

     (3) The same survey showed that forty-two (42) of one hundred fifty-six (156), twenty-six

and nine-tenths percent (26.9%) of respondents, stated that they plan to retire within the next six

(6) years. This correlates to a potential loss of seventy-one (71) providers when applied to the two

hundred sixty-two (262) pediatricians who are currently practicing primary care in Rhode Island,

and a projected net loss of forty (40) to forty-five (45) providers by 2030. Current providers do not

have the capacity to increase panel size to accommodate more patients as most are working with

full patient loads.

     (4) Rhode Island also suffers from shortages in pediatric subspecialists and child

psychiatrists, causing unnecessary delays in care for children. The American Academy of Pediatrics

has predicted that despite increasing medical complexity of American children, the supply of

specialists will continue to decline without significant investments in the workforce. In Rhode

Island, current Medicaid payment rates for pediatric specialists is lower than that for general

pediatricians, as they were not included in the last rate increase in the governor’s budget.

     (5) On average, Medicaid payment rates in Rhode Island are approximately twenty-five

percent (25%) lower than those in Massachusetts and Connecticut, which causes significant

difficulty in recruiting new pediatric providers to our state.

     (6) Medicaid rates have a significant impact on the availability of pediatric health care to

children statewide, regardless of income. Nationally and in Rhode Island, pediatric health care

providers are more dependent on Medicaid than adult health care providers to keep their practices

open and operating because Medicaid covers a large portion of children’s health care. In Rhode

Island in 2022, fifty-eight percent (58%) of children under age seven (7), and fifty-four percent

(54%) of children ages zero to eighteen (18) were covered by Medicaid insurance. Only eight

percent (8%) of Rhode Islanders over age nineteen (19) were covered by Medicaid. In 2019,

children represented about twenty-five percent (25%) of the U.S. population, yet received less than

ten percent (10%) of total health care spending.

     (7) Spending on health care during childhood has been documented to improve health into

adulthood, thereby reducing future costs. Investments in children’s health care can produce

improved outcomes in subsequent generations.

     SECTION 2. Chapter 42-12.3 of the General Laws entitled "Health Care for Children and

Pregnant Women" is hereby amended by adding thereto the following section:

     42-12.3-17. Access to pediatric health care.

     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 to

equal one hundred thirty percent (130%) of Medicare rates for all payment codes for outpatient

clinical services rendered to patients under nineteen (19) years old on or before October 1, 2025 to

ensure rates allow pediatric providers to provide adequate services for their current patient panels.

Increased rates will allow practices to recruit and retain pediatric providers to include, but not be

limited to, pediatricians, pediatric specialists, child psychiatrists, family medicine physicians, nurse

practitioners, and physician’s assistants to improve the current workforce shortage, and offset the

projected shortfall in replacing physicians who plan to retire.

     SECTION 3. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- HEALTH CARE FOR

CHILDREN AND PREGNANT WOMEN

***

     This act would require the executive office of health and human services to amend the state

Medicaid plan and secure sufficient state general revenue to increase Medicaid payment rates to an

amount equal to one hundred thirty percent (130%) of Medicare rates for outpatient clinical

pediatric services.

     This act would take effect upon passage.

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