PROVIDERS (RI)- Medicaid and leadership challenges, as state takes over nursing home

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: Details on poor quality in the RI nursing home market. In this article, explained entirely by payment gaps (that have been in place for 11 years).


PROVIDERS (RI)- Medicaid and leadership challenges, as state takes over nursing home


Clipped from:



A Rhode Island nursing home with more than 30 citations for deficiencies and whose administrator’s license was suspended last month has been put into state receivership. 

While declining to comment about the situation at the facility itself, the sector’s leading advocates in the state told McKnight’s Long-Term Care News that the broader picture of nursing homes in distress has become acute due to surging labor costs and chronic underfunding. 

“Rhode Island Medicaid has been chronically underfunded for more than a decade,” said John Gage, president and CEO of the Rhode Island Health Care Association.

The state’s Medicaid rates are based on 2011 actual costs inflated by approximately 1% per year since 2012, Gage said. The estimated shortfall is $50 million to $60 million per year, and the pre-pandemic gap between reimbursement and the cost of care was approximately $30 per patient per day. Both Gage and his counterpart at LeadingAge Rhode Island, which represents nonprofit facilities, said the gap is likely much higher now.  

“We have a high rate of Medicare Advantage beneficiaries, and those plans don’t pay as well as 

traditional Medicare, so providers are squeezed on that end,” explained LeadingAge Rhode Island CEO James Nyberg. 

On top of that, the state’s skilled nursing facility workforce is down approximately 20% since the pandemic – registered nurses are down 16.5%, licensed practical nurses are down 18.3%, and certified nursing aides are down 25.4%, Gage said, adding that the usage of expensive staffing agency personnel has quadrupled.

What’s more, in 2021, the state approved a staffing minimum requiring 3.58 hours of direct care per patient per day that Gage said will cost approximately $60 million per year while funding was set at just $12 million per year. 

“Clearly, something has got to give,” he said. 

There are 80 nursing homes in Rhode Island, including the Charlesgate Nursing Center, which is in the process of closing due to staffing challenges and inadequate Medicaid reimbursements, Gage said.

Pattern of issues

The state Department of Health made a surprise inspection of the Pawtucket Falls Healthcare Center in October. What followed has been detailed in local media as a volatile situation in which a resident’s broken bone from a fall was not noticed for two days, staff medical errors, improperly administered COVID tests, and other problems. 

State investigators also said that former Administrator Sami Almadi “tried to deceive them” about discharge papers for a resident, who complained about an improper discharge. NBC10 reported that Almadi presented a discharge form on which at least one of two nurse’s signatures was forged. Almadi’s license was suspended last month, the station’s report said.

A court-appointed receiver has now been charged with overseeing the facility. A statement from the state’s interim health director said the department “tried to help the facility stabilize” but that a “pattern of health and safety issues” over the last seven months led to the receivership, NBC10 reported.