2025 -- H 6190

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LC002582

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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J O I N T   R E S O L U T I O N

MAKING AN APPROPRIATION OF $118,422 FOR RHODE ISLAND PARENT

INFORMATION NETWORK, INC. (RIPIN)

     Introduced By: Representatives Spears, Donovan, Boylan, Speakman, Carson, Fogarty,
McEntee, Morales, Azzinaro, and O'Brien

     Date Introduced: April 04, 2025

     Referred To: House Finance

     WHEREAS, The approximately 40,000 Rhode Islanders with coverage through both

Medicare and Medicaid, known as “dual-eligible enrollees” or “duals,” are some of the most

medically fragile Rhode Islanders; and

     WHEREAS, Medicare and Medicaid are poorly coordinated programs, coverage options

for duals are complex, and transitions in forms of coverage can have serious adverse impacts on

duals if significant outside assistance is not available to ensure needed medical services continue;

and

     WHEREAS, Approximately 11,500 duals are currently enrolled in the Rhode Island

Medicare-Medicaid Plan, operated by Neighborhood Health Plan of Rhode Island as

“Neighborhood Integrity,” and a further approximately 13,000 duals are enrolled in other dual-

specific Medicare plans (called “dual special needs plans” or “D-SNPs”); and

     WHEREAS, The Medicare-Medicaid Plan model is no longer supported by the federal

government and all existing Medicare-Medicaid Plans, including Neighborhood Integrity, will

sunset as of no later than December 31, 2025; and

     WHEREAS, The Executive Office of Health and Human Services (“EOHHS”) had

planned a new managed care duals delivery system model to launch January 1, 2026, and issued a

procurement whereby awarded vendors would operate new dual-specific Medicare plans that

integrated Medicare and Medicaid benefits within a single plan, but has recently canceled that

procurement, leaving the future of the managed care duals delivery system in Rhode Island in a

state of confusion and flux; and

     WHEREAS, RIPIN has operated, since 2016, Rhode Island’s Medicare-Medicaid Dual

Ombudsman Program (the “RIPIN Dual Ombudsman”), which helps duals navigate complicated

Medicare and Medicaid enrollment rules, Medicaid redeterminations, obstacles to health plan

enrollment, claim and prior authorization denials, access to care challenges, provider disputes,

and applications for other federally-funded benefit programs; and

     WHEREAS, The RIPIN Dual Ombudsman is funded through Medicaid administrative

matching with half federal Medicaid funding and half state funding, at the amount of $236,844

all-funds ($118,422 general revenue) per calendar year, serving 437 clients annually, with 4,456

individual client interactions, and saving clients $343,189 in health care costs during FY2024, a

better than 1-to-1 return on investment, with a 92% client satisfaction rate; and

     WHEREAS, The Governor’s proposed fiscal year 2026 budget proposes to terminate

funding for the RIPIN Dual Ombudsman as of December 31, 2025, so it only includes funding for

operations for half of FY2026 ($118,422 all-funds, $59,211 general revenue); and

     WHEREAS, With an additional $59,211 in general revenue above the Governor’s

FY2026 proposal, the RIPIN Dual Ombudsman program could operate at current capacity for the

whole fiscal year; and

     WHEREAS, Without the RIPIN Dual Ombudsman, there will be no dedicated resource to

assist duals, and the sunset of that program would coincide with the largest system transition in

the history of Rhode Island’s managed care duals delivery system; and

     WHEREAS, Continued funding for the RIPIN Dual Ombudsman is in keeping with the

EOHHS Mission Statement “to foster and strengthen a community-driven, equitable,

comprehensive, responsive, and high-quality health and human services system in Rhode Island”;

now therefore be it

     RESOLVED, That there is hereby appropriated, out of any money in the treasury not

otherwise appropriated for the fiscal year 2025-2026, the total sum of $118,422 in general

revenue to RIPIN to continue the operation of the RIPIN Dual Ombudsman, with the expectation

that such funds will be matched by federal Medicaid funds; and the state controller is hereby

authorized and directed to draw their orders upon the general treasurer for the payment of said

sum, upon receipt of properly authenticated vouchers.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

J O I N T   R E S O L U T I O N

MAKING AN APPROPRIATION OF $118,422 FOR RHODE ISLAND PARENT

INFORMATION NETWORK, INC. (RIPIN)

***

     This resolution authorizes the appropriation of the sum of $118,422 for RIPIN to

continue the operation of the RIPIN Dual Ombudsman.

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