A September 1 state rate review found Rhode Island's Medicaid fee-for-service primary-care rates now exceed those in four other New England states, with Vermont still higher. The state's most recent access data, collected before the increase, show 44% of practices with new-patient waitlists.
Uprise RI · Adriana Vossari · September 3, 2026
A September 1 state rate review found Rhode Island's Medicaid fee-for-service primary-care rates now exceed those in four other New England states, with Vermont still higher. The state's most recent access data, collected before the increase, show 44% of practices with new-patient waitlists.
Medicaid reimbursement shapes whether Rhode Island primary-care practices take Medicaid patients, and the state's latest survey found average new-patient waits of at least 71 days. A further increase proposed by the governor would not begin until October 2027.
Rhode Island's published Medicaid fee-for-service rates for primary care are now higher than those in Massachusetts, Connecticut, Maine and New Hampshire, according to a rate review the Office of the Health Insurance Commissioner submitted on September 1. Vermont's enhanced primary-care rate remains higher than Rhode Island's, at roughly 110% of it.
The day after the report landed, Gov. Dan McKee said he would propose about $16.5 million in state and federal funds for a further Medicaid primary-care increase. Under the administration's own assumptions, that money would not start flowing until October 1, 2027.
For patients, the practical question is narrower: does a higher published rate mean it is easier to get an appointment? The state's own data do not yet answer that.
The General Assembly's fiscal 2026 budget, enacted in June 2025, authorized Rhode Island Medicaid to pay 100% of the Medicare Physician Fee Schedule for defined primary-care services, with annual updates to keep pace with Medicare. The change took effect October 1, 2025, and the state updated its schedule again on July 1 of this year using the 2026 Medicare rates. The statutory authority is in Public Law 25-278 .
Those are real dollars on a fee schedule. As of July 1, Rhode Island Medicaid pays $97.30 for CPT code 99213 — a routine 20-minute visit with an established patient — and $138.53 for code 99214, the 30-minute version.
The legislature's budget analysis put $26.4 million behind the increase in fiscal 2026, including $8.3 million in state general revenues, against an estimated full-year impact of $35.3 million. A separate $10.5 million went to a full-year rate increase for Federally Qualified Health Centers, the community health centers that carry a large share of Medicaid patients and are paid under a different methodology entirely. FQHCs were excluded from the rate review.
The comparison making headlines measures one thing: the published fee-for-service schedule, meaning the price the state pays directly, per visit, when it is not routing the payment through an insurer. Roughly 90% of Rhode Island Medicaid enrollees are in managed care, where a private plan administers benefits and negotiates its own rates with practices.
Rhode Island requires those managed-care organizations to treat the fee-for-service rates as a floor. Plans may pay more. Whether they do, and by how much, is not public — and neither are other states' managed-care rates, which is why the commissioner's office could not extend the comparison to them.
The report also notes a timing wrinkle. Because data from other states arrive on a lag, the regional comparison used Rhode Island's October 2025 rates rather than the July 2026 schedule now in force. Across the four categories of office visits examined, other New England Medicaid schedules ranged from about 50% to 110% of Rhode Island's rate, with Connecticut's base rate and New Hampshire's fee schedule near the bottom.
A fee schedule is also not a practice's total revenue. Value-based payments, care-management fees, add-on codes and practice incentives sit outside the comparison, and the report says those arrangements are not measured consistently from state to state.
The most recent statewide look at appointment availability comes from the Department of Health's primary care landscape analysis , published in June. Of 144 responding practices, which collectively serve about 750,000 Rhode Islanders, 44% reported a waitlist for new patients. Among the 61 practices that reported appointment data, the average wait for a new patient was at least 71 days. One practice reported a maximum wait of more than 365 days.
Those figures describe conditions before the rate change. The survey went out in February 2025 and asked about 2023 and the then-current period; the Medicaid increase took effect eight months later. The rate review, for its part, states plainly that workforce and patient access were outside its scope.
So the honest summary is this. Rhode Island has strengthened its published Medicaid position relative to most of its neighbors, and no state agency has yet published a measurement showing whether more practices are accepting Medicaid patients or whether waits have shortened.
The rate review did more than benchmark. It built an independent model of what primary care costs to deliver, using staff wages, benefits, overhead and administrative expenses, and concluded that current reimbursement does not cover those costs.
To close the gap under a traditional physician-led practice model, the report estimates rates would need to rise roughly 48% on average for established-patient office visits and roughly 66% for new-patient visits. Its composite adult physician-led figure shows a current rate of $120.96 against a modeled $190.55 — and $235.14 for a practice with an expanded care team including nurses, social workers, clinical pharmacists and behavioral-health staff.
The recommendation is an average of about 150% of Medicare for physician-led primary care and 110% of Medicare for care led by advanced-practice providers. Those are recommendations, not rates. They would require action by the General Assembly and approval from the federal Centers for Medicare and Medicaid Services.
The arithmetic between the report and the governor's office does not line up neatly. Health Insurance Commissioner Cory B. King's report estimates its traditional-care-team recommendation would cost about $22 million a year across fee-for-service and managed care. McKee's proposed figure is about $16.5 million in state and federal funds. Neither the report nor the governor's September 2 announcement explains the difference.
McKee announced a primary-care package in April 2025 that included $5 million in grants, changes to commercial-insurance requirements and an accelerated Medicaid rate review. The state ultimately awarded $6.695 million to 85 primary-care practices for recruitment, retention and added capacity. A training-sites program filled about 65% of its trainee slots in its first reporting period — a pipeline number, not an appointment-availability number.
Attorney General Peter Neronha, who has described primary-care access as a statewide crisis, reached an agreement with Brown University Health on September 30, 2025 as a condition of a physician-group merger. The system committed to taking on 40,000 new primary-care patients by December 31, 2029 and hiring at least 15 additional primary-care providers by December 2027. Those are obligations with reporting requirements attached, not results.
McKee has framed the additional investment as positioning Rhode Island as a national leader in primary-care spending. The rate review is more restrained: it cautions that comparing reimbursement across states says nothing about whether rates cover practice costs, aid recruitment, or improve access.
The commissioner's office scheduled a public forum for September 16 to take comments and questions on the rate review . Any further rate increase would have to survive the fiscal 2028 budget process at the State House and clear federal review before reaching a single exam room.
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This bill mandates that Medicaid and private insurers pay independent primary care doctors higher rates to match neighboring states.
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Requires the Health Insurance Commissioner to review primary care reimbursement rates and analyze the cost impact of insurance mandates every five years.
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