How Rhode Island pays for disability services

Waiver inventory

Rhode Island operates its entire Medicaid program, including all IDD long-term services and supports, under a single Section 1115 demonstration. There is no freestanding 1915(c) DD waiver, no 1915(i) DD benefit and no 1915(k) Community First Choice election for this population. The demonstration was approved effective July 1, 2009 and now runs through December 31, 2030, with the most recent approval issued November 28, 2025 (CMS approval letter).

State-only funded programs

• Rhode Island Community Living and Supports (RICLAS): the state-operated group home system, staffed by state employees, budgeted within BHDDH's Hospital and Community Rehabilitative Services program. It carries a general revenue appropriation with a Medicaid offset. The FY2027 Governor's budget applies a RICLAS Medicaid adjustment of $133,273 to general revenue. A clean RICLAS-only annual appropriation is not broken out in the published budget analysis. Administering agency BHDDH. Senate Fiscal Office FY2027 Governor's Budget Analysis
• Consent Decree Transformation Fund: $928,200 general revenue plus $371,800 federal specified for integrated day activities and supported employment (FY2026 budget article). Partially state-only. Same source.
• Developmental Disabilities Residential Support (capital): $296,000 in FY2026 and $100,000 per year FY2027 through FY2031 from Rhode Island Capital Plan funds for capital equipment and furniture at state-owned DD facilities. All state dollars. Same source.
• Rhode Island State Psychiatric Hospital: funded entirely by general revenue, but it serves a psychiatric rather than DD population, so it is not counted here.

Checked: BHDDH DD services pages, the FY2026 and FY2027 Senate Fiscal Office budget analyses, the DD Billing Policy Manual and the FY26 rate table. Rhode Island's DD system is overwhelmingly Medicaid-financed under the 1115, so the state-only footprint is small and mostly consists of state-operated RICLAS staffing, capital and the consent decree funds.

County / regional / local funding

None identified. Rhode Island has no county government with taxing authority. All DD funding flows through BHDDH and the Executive Office of Health and Human Services. Checked the Senate Fiscal Office budget analysis, RIPEC's FY2026 budget review and BHDDH provider materials; no county levy, regional center allocation or municipal DD funding stream exists.

Funding scale

• Total SFY2024 Medicaid expenditures for Rhode Islanders receiving IDD services: $402,780,914. Breakdown: residential $183,611,696 (45.6 percent), community supports $145,664,259 (36.2 percent), shared living $21,011,223 (5.2 percent), employment $20,909,816 (5.2 percent), center-based $7,766,023 (1.9 percent), self-direction $5,405,335 (1.3 percent), other $17,004,143, professional services $1,408,419. OHIC IDD rate benchmark report, March 2025
• Services for the Developmentally Disabled program, general revenue: FY2026 enacted $218,735,702; FY2027 Governor $232,730,377. Senate Fiscal Office FY2027 analysis
• Services for the Developmentally Disabled, all funds FY2027 Governor: $541.3 million, of which $232.7 million general revenue. Same source.
• Whole BHDDH department FY2027 Governor: $755.7 million all funds, $334.1 million general revenue, $403.8 million federal. Same source.
• FMAP: 57.50 percent FY2026 (56.31 percent FY2025). MACPAC Exhibit 6
• Spending per participant: not published as such. Dividing $402.8 million SFY2024 IDD claims by roughly 4,300 people receiving direct services yields approximately $93,000 per person. This is a calculation, not a published figure.
• People served: 4,878 receiving state or community-based services as of October 2025; 4,300 receiving direct residential, employment and community-based services; approximately 4,300 served through state-run and community-based providers including case management. Same Senate Fiscal source.
• Waiting list: Rhode Island does not operate a capped waiting list for adult DD services. The program is budgeted as a caseload and medical entitlement item through the semi-annual Caseload Estimating Conference, which the consent decree action plan and RIGL 35-17-1 required beginning November 2021. The November 2025 Caseload Estimating Conference added $6.3 million general revenue to reflect continued growth in residential and community-based services. No waiting list count is published. Same source.

Residential funding detail

Rhode Island funds five distinct residential models, all as Medicaid per diems under the 1115 demonstration, all acuity-tiered A through E, all billed against a 344-day billing year rather than 365:

• Community Residence Supports (T2033), the traditional agency-operated group home. Tier A $293.79 per day to Tier E $529.78 per day.
• Noncongregate Residential Services (T2016), same tier range, $293.79 to $529.78 per day. The DD Billing Policy Manual notes this service is being phased out.
• Supported Living (awake) (H0043), $266.03 (Tier A) to $466.71 (Tier E) per day.
• Shared Living Arrangement, standard (T2033:U1), $147.26 (Tier A) to $227.71 (Tier E) per day. The host family or home provider receives a separate stipend of $75.00 (Tier A) to $135.00 (Tier E) per day out of that rate.
• Whole Life Shared Living Arrangement (H2016), $178.21 (Tier A) to $339.12 (Tier E) per day, with a home provider stipend of $101.25 to $229.50 per day. Emergency SLA is a flat $406.08 per day.

Payment structure is per diem with acuity tiers set through the Supports Intensity Scale based tiering built into Project Sustainability, plus an "Additional Funds" or supplemental funding modifier (L9) that lets BHDDH authorize variable amounts above the tier for individually justified need. Community Supports and respite are 15-minute units layered on top for people living in their family home or their own home.

Room and board is not in the rate and is not state-funded. The DD Billing Policy Manual states that room and board for a Shared Living Arrangement, and equally for Whole Life SLA, is set at two-thirds of the monthly standard Rhode Island SSI payment, paid by the person out of SSI. Residential and supportive living rates exclude room and board, facility maintenance, upkeep and improvement.

Rhode Island has no state ICF/IID for people with intellectual disabilities. The Ladd School closed in 1994. The state-operated residential system is RICLAS, a network of state-staffed group homes budgeted within BHDDH's Hospital and Community Rehabilitative Services program rather than the DD program.

Rate structure link: DD Services Rate Table FY26, revised 09/30/2025

Comparable service rates

Official rate schedule links

• DD Services Rate Table FY26, revised 09/30/2025
• FY25 Rate Table, revised 08/23/2024
• DD Billing Policy Manual, revised 12/27/2024
• OHIC Social and Human Service Programs Review: IDD Medicaid Rate Benchmarks, March 2025
• Project Sustainability successor: DD Rate and Payment Options Study, Final Rate Models
• EOHHS Enhanced HCBS Rate Increase program guidance

Notable features and flags

• May 11, 2026: the federal court entered an order recognizing Rhode Island's substantial compliance with the 2014 DOJ consent decree and extended the monitoring period. An easy-read version of the substantial compliance order was released in June 2026. Quarterly state reports run through December 2025 and a Court Monitor's report covers November to December 2025. BHDDH consent decree page
• October 2023: an addendum extended the consent decree through a two-year oversight period with federal judge and court monitor involvement through June 30, 2026, after the state could not reach full compliance by the original July 1, 2024 date. The action plan required raising average direct support professional wages to $20 per hour by FY2024 and later to an average of $22 per hour following the December 2022 rate review. Senate Fiscal Office FY2027 analysis
• FY2027 Governor's budget: adds $18.3 million all funds, including $7.7 million general revenue, for a DD provider rate increase driven by the OHIC biennial rate review. OHIC's recommended IDD rate model moves baseline expenditures from $212 million to $233.5 million, a $21.3 million change with a $42.7 million estimated fiscal impact across fee-for-service and managed care. The Governor funded only half the OHIC amount, phasing the balance over two years. Same source.
• November 2025 Caseload Estimating Conference: added $6.3 million general revenue for FY2027, reflecting continued growth in residential and community-based services, plus a $364,446 FMAP correction shifting federal cost to general revenue. Same source.
• January 1, 2026: Rhode Island's minimum wage rose to $16.00 per hour, with $17.00 scheduled January 1, 2027. This compresses direct support professional wage differentials and drives provider capacity pressure. BHDDH DD News and Updates newsletter
• November 28, 2025: CMS issued the most recent approval for the Rhode Island Comprehensive Demonstration, which now runs through December 31, 2030, giving the DD benefit package a long runway. A CMS letter to the state followed on August 17, 2026. medicaid.gov demonstration 83101
• Self-direction is an established option with its own rate lines (Discovery Self-Directed, Job Development Self-Direct, Job Coaching Self-Direct, Job Retention Self-Directed, Transportation Self-Direct) and accounted for $5.4 million or 1.3 percent of SFY2024 IDD claims.

Confidence

Solid: the FY26 rate table (all residential per diems, community supports, respite, employment) taken verbatim from the BHDDH PDF; SFY2024 total IDD Medicaid spending of $402.78 million and its service-category breakdown from OHIC; FY2026 enacted and FY2027 recommended general revenue for the Services for the Developmentally Disabled program; the 4,878 and 4,300 people-served counts as of October 2025; the FMAP; the 1115 authority and its December 31, 2030 expiration; the consent decree chronology through the May 2026 substantial compliance order; the room and board rule set at two-thirds of the monthly standard SSI payment. Estimated: the per-participant figure, which I computed rather than sourced. Could not find: a published RICLAS-only annual appropriation; a published case management or service coordination rate, since conflict-free case management does not appear on the FY26 rate table; a published waiting list figure, which I believe reflects that Rhode Island runs an entitlement-style caseload rather than a slot-capped waiver, but I could not locate an explicit BHDDH statement to that effect; a full-funds FY2025 actual or FY2026 enacted total for the DD program, since the Senate Fiscal Office analysis gives all-funds only for FY2027.

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