Rhode Island’s health care system is in crisis, and it cannot be ignored any longer.

As many Rhode Islanders can attest, booking a doctor’s appointment has never been more difficult. A recent poll conducted by SocialSphere found that more than half of Rhode Island respondents reported facing at least one health care access challenge in the past year. As leaders of our state’s largest health care systems, we, along with our talented clinicians, experience this every day.  The shortage of primary and specialty care providers forces patients to seek routine care in the emergency departments, where they face overcrowded waiting rooms and long waits. Chronic workforce shortages and clinician burnout add to the difficulty for patients to get the care they need.

The root cause of this crisis lies largely with Medicaid in Rhode Island. As the public health insurer for low-income individuals and families, Medicaid in Rhode Island reimburses hospitals and physician groups far less than the cost of care. The State of Rhode Island allocates significantly less funding toward Medicaid than our neighboring states. Rhode Island has among the highest percentage of Medicaid enrollment in New England, and our provider reimbursement rates are the lowest in the region. For example, a hip replacement in Massachusetts is reimbursed up to $7,670 by Medicaid. In Rhode Island, our state’s Medicaid program reimburses us $1,800 for the same procedure.  That doesn’t even cover the hip implant itself, which costs about $4,700.

Severe underpayment by the State of Rhode Island translated to a combined FY2023 and FY2024 loss of $138 million at Brown University Health and a $84.2 million loss at Care New England for patients on Medicaid. This is a health equity issue: we’re reimbursed the least to care for patients who often need care the most.

The impact of these funding shortfalls is far-reaching. Low reimbursements severely hinder our ability to recruit, retain and compensate talented physicians, nurses and the entire health care team, while we also manage rising costs of technology, supplies and infrastructure. Patients lose access to care when there are too few doctors to see them and too few nurses to staff hospital beds. Financially distressed health organizations in Rhode Island will continue to have to lay off staff.  Essential programs and the ability to provide a social safety net to the most vulnerable are at risk of reductions or closure of patient programs, as we have seen other health systems do.  

Fortunately, our state legislators and government officials have the power to fix our health care crisis by maximizing the federal funding for Medicaid. Most of Rhode Island’s Medicaid budget comes from the federal government, which matches $2 for every dollar the state puts in. In other words, a $90-million state investment brings an additional $180 million in federal Medicaid funds to Rhode Island, injecting $270 million into our health care system. If we fail to act, this potential funding will go to other states, leaving Rhode Island to fall even further behind. 

Investing in Medicaid will ensure all Rhode Islanders receive the care they need. It will help retain our compassionate and talented doctors and nurses and ensure our facilities are equipped to meet the needs of our patients. It will keep care and jobs in Rhode Island. The time for action is now. Our state leaders must act to save health care in Rhode Island.

Michael Wagner, MD, FACP, is president and CEO of Care New England. John Fernandez is president and CEO of Brown University Health.