Rhode Island’s Primary Care crisis – Governor’s short/long term plan – AG responds

Governor Dan McKee, joined by members of his Health Care System Planning Cabinet, announced a series of short- and long-term strategic actions to strengthen Rhode Island’s primary care system.

“In the changing landscape of health care, we need to take proactive steps to ensure our residents have continued access to primary care,” said Governor Dan McKee. “My Health Care System Planning Cabinet will continue to identify strategies to strengthen the health care workforce, create stronger fiscal oversight and support practices in expanding their patient base.”

Accelerating a primary care Medicaid rate review

Given the critical need for further investments in primary care, Governor McKee will be filing a budget amendment to accelerate a proposed review of primary care provider rates, recommending that the Office of the Health Insurance Commissioner (OHIC) complete the primary care rate review one year earlier. This is an important step in determining how Rhode Island may need to adjust its rates to create a more competitive primary care job market in the state.

The Governor first proposed the primary care provider rate review in his FY 2025 budget, but it was not included in the General Assembly’s final budget.

Requiring commercial health insurers to increase funding for primary care reimbursements

Last month, through the Office of the Health Insurance Commissioner, the McKee Administration implemented new regulations requiring commercial health insurers to incrementally increase funding for primary care reimbursements over a four-year period, with the goal of doubling per-member primary care spending by 2029.

Reducing red tape by easing prior authorization requirements

The regulations also require a 20% reduction in prior authorization requirements—where providers are required to get approval from insurance companies or other entities before giving a treatment, test, or medication to a patient. This change will reduce time-consuming administrative burdens on primary care providers, allowing them to deliver care to patients more effectively.

These measures are designed to enhance financial support for primary care practices, improve access to necessary treatments, and allow providers to focus more on patient care, ultimately contributing to a more efficient and effective health care system.

Providing grants to help primary care practices serve additional patients and hire new providers

The Governor is announcing $5M in grants for primary care practices to support the recruitment and retention of PCPs and increase access and capacity to serve Rhode Islanders in primary care settings.

Interested primary care practices can be awarded a maximum grant of $375,000 per practice:

• Up to $75,000 for providers that expand their patient panels (i.e. serve more patients)

• Up to $300,000 for providers that recruit new primary care physicians or mid-level providers, such as Nurse Practitioners or Physicians Assistants, to the Rhode Island primary care workforce. “New” includes providers from recently closed practices, recent graduates, providers from other states, or providers from other specialties.

• Up to $5,000 for providers that agree to serve Medicaid patients – for the first time

Funds may be used for compensation of newly recruited providers, recruitment efforts and for administrative needs that may be incurred because of expanding patient panels.

Applications are open from April 29 to May 16 and can be found here.

Strengthening fiscal oversight of Rhode Island’s health care system

Governor McKee recently filed a budget amendment to strengthen fiscal oversight of Rhode Island’s health care system. The proposed amendment would require hospitals, nursing facilities, Federally Qualified Health Centers, Certified Community Behavioral Health Clinics (CCBHCs), large physician practices, and other providers to submit quarterly financial reports to the State.

The goal of this new requirement is to improve transparency and to support early identification of financial risks that may threaten the continuity of care. Recent health care provider closures and layoffs have underscored the need for additional proactive measures that enable the State to monitor financial solvency and engage in timely problem-solving.

This new reporting requirement is designed to be an early-warning mechanism–not a punitive measure. By collecting financials on a quarterly basis, the State can engage providers earlier to preserve stability, promote solvency, and avoid disruptions in care.

This budget amendment is one of the early recommendations of the Governor’s Health Care System Planning Cabinet.

Expanding the primary care student loan forgiveness program

In his FY 2026 budget, Governor McKee also proposed new investments in the Health Professional Loan Repayment Program—specifically for primary care providers and pediatricians. Under this program, participating health professionals commit to working for at least two years in Rhode Island. If passed by the General Assembly, this would mark the first time since FY08 that general revenue would support this important initiative.

Data from 2013 to 2023 show that 91 percent of Loan Repayment Program recipients continue to practice in Rhode Island after their service obligation is complete. More than 100,000 Rhode Islanders receive health care from a former or current program participant.

“From investments in provider rates and primary care training sites to the launch of our Certified Community Behavioral Health Clinics, the Governor and his administration continue to take deliberate, strategic action to strengthen the foundation of Rhode Island’s health care system,” said Richard Charest, Secretary of the Rhode Island Executive Office of Health and Human Services. “These challenges didn’t emerge overnight, and they won’t be solved overnight – but by making targeted investments and improving system accountability, we can better serve Rhode Islanders and build a more resilient health care system for the future.”

To advance the McKee Administration’s efforts in this critical area, the Governor’s Health Care System Planning Cabinet has convened a health care crisis sub-group that focuses on strengthening the primary care system and addressing potential impacts from federal budget and program changes.

“Primary care is the backbone of the healthcare system in Rhode Island,” said Director of Health Dr. Jerry Larkin. “These measures being announced today will help strengthen our primary care workforce, which is key to improving health outcomes throughout the state. Primary care provides a foundation for preventive care, early disease detection, management of chronic conditions, and so much more.”

“The new incentive grants represent Medicaid’s continued commitment to supporting primary care access, especially for patients who have historically faced the greatest barriers to care,” said Kristin Pono Sousa, Rhode Island Medicaid Director. “By helping providers grow their practices and serve more Medicaid members, we’re not just expanding access – we’re investing in a stronger system of care for Rhode Islanders.”

“A strong primary care system is the key to better health and lower costs,” said Cory King, Rhode Island Health Insurance Commissioner. “At a time when the future vitality of the primary care workforce is uncertain, the McKee Administration’s actions will better resource primary care while advancing initiatives that hold the health care system accountable for increasing costs and premiums.”

Jeffrey Borkan, MD, PhD, Assistant Dean for Primary Care-Population Medicine, The Warren Alpert Medical School of Brown University: “It is thrilling to see the Governor and the State step in to assure that Rhode Islanders will be able to access primary care now and in the future. Primary care is an essential part of the healthcare system and both saves money and saves lives. Efforts such as these can help move us out of the current crisis that all recognize is deleterious to the health of our population and ensure that there will be providers of primary care for decades to come.”

Christopher Klaus, MD, Rhode Island Academy of Family Physicians, Executive Board President: “Anyone who has tried to find a new primary care provider in recent years knows firsthand the growing shortage across the state. Factors such as provider retirements, relocations to competing states, and reduced working hours due to burnout have all contributed to this challenge. The RIAFP strongly supports initiatives to enhance compensation, reduce administrative burdens, and promote primary care as the foundation of a strong and sustainable healthcare system for all Rhode Islanders. This is essential for the health of the people of our state.”

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AG Peter Neronha responds

Within minutes of the release being sent by Gov. McKee, RI Attorney General Peter Neronha released his response statement. Neronha is widely thought to challenge Gov. McKee in the next election:

“The Governor’s health care announcement today is a slapdash response to political and public pressure because of the dissolution of Anchor Medical, and unfortunately, I expected nothing more. Last week, he floated the idea of monitoring quarterly financials of physician groups, which is (1) not enough and (2) something the Governor could have, and should have, been doing all along.

Today’s press conference offered more of the same, with the Governor hanging his hat on promises of future studies and reviews, demonstrating a deep misunderstanding of the issues at hand. He began by calling Rhode Island’s health care system one of the best in the nation, once again showing how out of touch this Governor is with the reality of the situation.  

Additionally, an incremental and vaguely defined grant program targeted at paying administrative costs rather than increasing reimbursement to primary care physicians will not be enough to provide the sustained investment needed. Our PCPs are overworked and overburdened by a state health care system that doesn’t support them. Our residents are scrambling to find primary care physicians to care for them through illnesses and fill prescriptions for life-preserving medications. We are in crisis. And some of us have been sounding the alarm for years.

“We will never fix this crisis through talking points and half-baked proposals, like a woefully underfunded loan forgiveness program which would forgive loans for less than two physicians.

And we don’t need more posturing and subgroups. We need significant, state-funded investments, including increasing Medicaid reimbursement rates for primary care now to reach parity with our neighboring states. We need to require health insurance companies to significantly reduce or eliminate prior authorization requirements, as my Office has pressured Blue Cross Blue Shield to do and are working with the legislature to mandate.

We need improved data collection systems and analysis to consistently understand the problems our health care system faces, and solutions born out of that analysis. So far, we have none of this. Because when you ignore a problem, or pretend that it doesn’t exist, like this Governor has done here and elsewhere, the problem doesn’t go away, but it does get much, much worse.

“In the coming weeks, my Office will be releasing information obtained through several completed health care studies, both that we commissioned and that we conducted in-house, to help us more fully understand the issues at hand. We will also be announcing a partnership initiative that will offer potential solutions for this crisis.

“Our residents don’t want bureaucratic nonsense and Tuesday-morning lip-service; they want and need quality health care. We need a consistent data-driven, multi-pronged, and innovative approach now that will help us achieve long-term structural reform and will immediately help us avoid the worst of this crisis before it’s too late. Because it almost is.”

This is a developing story