Rhode Island's aid and health programs are projected to cost $178.1 million more in fiscal 2028

Rhode Island's budget writers now expect cash assistance, services for people with developmental disabilities and medical assistance, which includes Medicaid, to cost $4.90 billion in fiscal 2028. That is $178.1 million, or 3.8 percent, more than the $4.72 billion adopted for the current year. State general revenue would pay $111.2 million of the increase, or 62 percent, although it covers 37.5 percent of the total.

The figures come from the caseload estimating conference, a meeting held twice a year at which the State Budget Officer and the House and Senate fiscal advisors must agree on what these programs will cost. The result is an estimate, not an appropriation; the General Assembly and the State Budget Office use it to prepare the budget. The Legislature's schedule set the conference for Nov. 4, and the General Assembly posted the adopted estimates on Nov. 5.

Medical assistance is most of the bill

Medical assistance is $4.26 billion of the total, or 87 percent. The other two categories rose a combined $19 million, so about $159 million of the $178.1 million increase is in medical assistance. Its general-revenue share is $1.58 billion, up $104.0 million from $1.48 billion in fiscal 2027. That is $104.0 million of the $111.2 million rise in state money.

Managed care is the largest single increase, up $75.4 million or 6.7 percent, to $1.21 billion from $1.13 billion. Two long-term care lines also rise. Nursing and hospice care goes to $524.5 million from $492.7 million, up $31.8 million or 6.5 percent. Home and community care goes to $401.2 million from $374.8 million, up $26.4 million or 7.0 percent.

A drop the tables do not explain

Medicaid expansion moves the other way, falling to $667.3 million from $715.9 million, a $48.6 million or 6.8 percent decline. The adopted tables give no reason. They do not say whether the conference expects fewer people on the line or a lower cost for each person. The conference's current-year estimate for Medicaid expansion is also $18.7 million below the enacted budget.

Across all three programs, the conference lowered this year's total by $38.3 million, to $4.72 billion from the $4.76 billion the enacted fiscal 2027 budget assumed. General revenue is $5.5 million lower.

Rhode Island Works, the state's cash-assistance program for families, is now estimated at 5,671 people this year, 929 or 14 percent fewer than the 6,600 the budget assumed. The conference set fiscal 2028 enrollment at 5,248. Total cash-assistance costs, which also include child care, SSI and general public assistance, still rise to $115.2 million in fiscal 2028 from $112.5 million in fiscal 2027. Private community developmental-disability services rise 3.2 percent, to $522.9 million from $506.7 million, with $224.0 million from general revenue.

Why Nov. 10 matters

The revenue estimating conference meets at 9 a.m. Tuesday, Nov. 10, according to the Legislature's media advisory. The same three officials must agree on how much general revenue the state will take in this year and next. The meeting will be televised on Capitol Television and streamed at capitoltvri.cablecast.tv.