Ensure the Viability of the Public-Private Human Services and Healthcare System through Comprehensive Rate Setting with State Agencies and for Public and Commercial Insurers

Strong state agencies in tandem with community-based social and health service provider organizations are critical to a responsive system. Community providers based in local communities respond nimbly to changing needs and most effectively coordinate with families, schools, healthcare, etc. To fulfill their missions, private agencies rely on a combination of private philanthropy, government contracts, insurance reimbursement. Contract rates and insurance payments don’t meet costs, diminishing both program viability and quality. State agency rate-setting methodologies are law in many states and should be implemented in Rhode Island. Equally, the state needs to address insurance reimbursement rates for both its Medicaid and commercial insurers to achieve parity and consistency in addressing health and behavioral health needs. Budget constraints and years of funding cuts or flat rates have brought the sector to the fiscal brink even while state agencies take on service delivery, creating competition with the sector and moving services away from the community.