2025 -- H 6073

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LC001650

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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 HEALTH AND SAFETY -- THE RHODE ISLAND FAMILY HOME --

VISITING ACT

     Introduced By: Representatives Giraldo, Potter, Stewart, Alzate, and Morales

     Date Introduced: March 12, 2025

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

     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, has been providing free, voluntary, statewide home-visiting to expectant

mothers and families with newborns, infants, and toddlers, reaching about thirty-five percent (35%)

of families with new babies. Families typically receive one to four (4) home visits.

     (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 Healthy Families America, Nurse-Family Partnership, and Parents as Teachers

as 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. In 2024 when the state

match requirement went into effect, Rhode Island was one of only three (3) states and territories in

the U.S. that did not meet the full federal match and was unable to draw down the full federal

MIECHV grant.

     (6) In 2023, Rhode Island revised contracts with the 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. About eighty-five percent (85%) of families enrolled.

Rhode Island reserved the federal MIECHV funding to pay for home visits for the fifteen percent

(15%) of enrolled families and children who have commercial insurance or no insurance.

     (7) Between 2021 and 2024, the number of pregnant and parenting families enrolled in the

evidence-based home-visiting programs in Rhode Island fell by thirty-seven percent (37%) due to

staffing and financing challenges. In 2024 and 2025, four (4) agencies statewide stopped delivering

one or more of the evidence-based program models due to increased fiscal challenges resulting

from Medicaid fee-for-service billing.

     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.

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     (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, including state and federal funding amounts and sources. This report shall be shared with

the general assembly and that shall 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 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;

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     (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;

     (9) Implementation successes and challenges, including those related to funding, provider

contracts, provider staffing and turnover, and family enrollment and retention; and

     (10) An analysis of how other states have combined Medicaid and MIECHV home-visiting

grants to support and sustain home-visiting programs, including an analysis of how other states use

Medicaid’s Targeted Case Management option.

     (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 carried out by community nonprofit

organizations.

     (g) 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.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- THE RHODE ISLAND FAMILY HOME --

VISITING ACT

***

     This act would change the department of health’s annual reporting requirements regarding

the family home-visiting program. This act would also appropriate the minimum amount of general

revenue to access the maximum amount of federal MIECHV funds and the department to spend all

federally available funds.

     This act would take effect upon passage.

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