AN ACT RELATING TO STATE AFFAIRS AND GOVERNMENT -- HEALTH CARE FOR CHILDREN AND PREGNANT WOMEN (Requires the EOHHS 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.)

H7693

2026 -- H 7693
========
LC005128
========

STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
____________
A N A C T
RELATING TO STATE AFFAIRS AND GOVERNMENT -- HEALTH CARE FOR
CHILDREN AND PREGNANT WOMEN

Introduced By:
Representatives Tanzi, Ajello, Spears, Boylan, Donovan, Carson, Cotter,
Shanley, McGaw, and Bennett

Date Introduced:
February 11, 2026

Referred To:
House Finance
It is enacted by the General Assembly as follows:
1
SECTION 1. Legislative findings. The general assembly finds and declares:
2
(1) Rhode Island pediatricians are facing a major workforce crisis which is causing
3
decreased healthcare access for children. Without significant intervention, the situation is expected
4
to worsen and negatively impact not only the health or our children, but the long-term health of the
5
adults in our state.
6
(2) According to a 2024 survey of Rhode Island pediatricians, less than fifty percent (50%)
7
of pediatric primary care offices were accepting new or transfer patients other than newborns or
8
siblings of current patients. Families that move to Rhode Island to work, or those whose pediatric
9
providers retire, cannot find a doctor to care for their child.
10
(3) The same survey showed that forty-two (42) of one hundred fifty-six (156), twenty-six
11
and nine-tenths percent (26.9%) of respondents, stated that they plan to retire within the next six
12
(6) years. This correlates to a potential loss of seventy-one (71) providers when applied to the two
13
hundred sixty-two (262) pediatricians who are currently practicing primary care in Rhode Island,
14
and a projected net loss of forty (40) to forty-five (45) providers by 2030. Current providers do not
15
have the capacity to increase panel size to accommodate more patients as most are working with
16
full patient loads.
17
(4) Rhode Island also suffers from shortages in pediatric subspecialists and child
18
psychiatrists, causing unnecessary delays in care for children. The American Academy of Pediatrics

1
has predicted that despite increasing medical complexity of American children, the supply of
2
specialists will continue to decline without significant investments in the workforce. In Rhode
3
Island, current Medicaid payment rates for pediatric specialists is lower than that for general
4
pediatricians, as they were not included in the last rate increase in the governor’s budget.
5
(5) On average, Medicaid payment rates in Rhode Island are approximately twenty-five
6
percent (25%) lower than those in Massachusetts and Connecticut, which causes significant
7
difficulty in recruiting new pediatric providers to our state.
8
(6) Medicaid rates have a significant impact on the availability of pediatric health care to
9
children statewide, regardless of income. Nationally and in Rhode Island, pediatric health care
10
providers are more dependent on Medicaid than adult health care providers to keep their practices
11
open and operating because Medicaid covers a large portion of children’s health care. In Rhode
12
Island in 2022, fifty-eight percent (58%) of children under age seven (7), and fifty-four percent
13
(54%) of children ages zero to eighteen (18) were covered by Medicaid insurance. Only eight
14
percent (8%) of Rhode Islanders over age nineteen (19) were covered by Medicaid. In 2019,
15
children represented about twenty-five percent (25%) of the U.S. population, yet received less than
16
ten percent (10%) of total health care spending.
17
(7) Spending on health care during childhood has been documented to improve health into
18
adulthood, thereby reducing future costs. Investments in children’s health care can produce
19
improved outcomes in subsequent generations.
20
SECTION 2. Chapter 42-12.3 of the General Laws entitled "Health Care for Children and
21
Pregnant Women" is hereby amended by adding thereto the following section:
22

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

23

The executive office of health and human services shall pursue a Medicaid state plan
24
amendment and allocate sufficient state general revenue to increase Medicaid payment rates to
25
equal one hundred thirty percent (130%) of Medicare rates for all payment codes for outpatient
26
clinical services rendered to patients under nineteen (19) years old on or before October 1, 2026 to
27
ensure rates allow pediatric providers to provide adequate services for their current patient panels.
28
Increased rates will allow practices to recruit and retain pediatric providers to include, but not be
29
limited to, pediatricians, pediatric specialists, child psychiatrists, family medicine physicians, nurse
30
practitioners, and physician’s assistants to improve the current workforce shortage, and offset the
31
projected shortfall in replacing physicians who plan to retire.
32
SECTION 3. This act shall take effect upon passage.
========
LC005128
========

LC005128 - Page 2 of 3
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO STATE AFFAIRS AND GOVERNMENT -- HEALTH CARE FOR
CHILDREN AND PREGNANT WOMEN
***
1
This act would require the executive office of health and human services to amend the state
2
Medicaid plan and secure sufficient state general revenue to increase Medicaid payment rates to an
3
amount equal to one hundred thirty percent (130%) of Medicare rates for outpatient clinical
4
pediatric services.
5
This act would take effect upon passage.
========
LC005128
========

LC005128 - Page 3 of 3