The bill amends Section 40-8.9-9 of the General Laws in Chapter 40-8.9, titled "Medical Assistance — Long-Term Care Service and Finance Reform," to establish a long-term care rebalancing system reform goal. It mandates the executive office of health and human services to apply for necessary waivers and amendments to allocate at least 50% of Medicaid long-term care funding for individuals aged 65 and over, as well as adults with disabilities, towards home- and community-based care. The office is required to report annually on the distribution of funding between institutional and community care, as well as current and projected waiting lists for these services. The bill emphasizes a person-centered approach that promotes individual choice and access to a variety of supportive services in community settings, aiming to reduce reliance on institutional care. Additionally, it introduces provisions for shared living arrangements, allowing care from both related and unrelated family caregivers without imposing more restrictive eligibility criteria than those in place as of January 1, 2025.

The bill also aims to ensure continued funding for assisted-living services at facilities financed by the Rhode Island Housing and Mortgage Finance Corporation prior to January 1, 2006, as long as these services remain a covered Medicaid benefit. It proposes a one-time increase in base payment rates for home-care service providers to raise wages for personal care attendants and home health aides, with specific adjustments effective July 1, 2018, and mandates annual inflation increases starting July 1, 2019. Furthermore, it establishes a behavioral healthcare enhancement for providers with trained direct-care workers and requires compliance statements from employers to ensure wage increases are passed on to employees. The bill also emphasizes the establishment of a statewide network of qualified case management entities to promote choice and community integration, while introducing higher resource eligibility limits for individuals with long-term care needs, and outlines reforms to home- and community-based services to prevent institutionalization.