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Frontline workers warn conflict-free case management rollout has created unsustainable caseloads
Summary
Frontline case managers and union representatives told the House subcommittee that the phased rollout of conflict-free case management at BHDDH and long-term support programs has increased workloads and turnover. Workers urged limits on caseload sizes, regionalization of assignments and more staffing to preserve person-centered casework.
Frontline case managers, supervisors and union representatives told the House Finance subcommittee that the state's implementation of conflict-free case management has increased worker caseloads and contributed to turnover, leaving some vulnerable clients with less consistent support.
Why it matters: Conflict-free case management is a federally driven model intended to separate assessment and support from service provision to avoid conflicts of interest. Workers said the rollout in Rhode Island has outpaced available provider capacity and staffing, producing unsustainable workloads for case managers responsible for person-centered planning.
Workers'accounts Speakers from the Developmental Disabilities Council, BHDDH-contracted case managers and state casework supervisors described similar problems: - High caseload counts: Case managers said realistic person-centered work requires significant time per individual; at stated caseload levels (examples cited up to 40'48 individuals per case manager), staff said they were reduced to surface-level contacts rather than a person-centered approach. - Regionalization: Several speakers asked for regional assignment models so workers'travel times fall and appointment scheduling becomes more efficient (for example, grouping meetings geographically rather than statewide travel back and forth). - Turnover and training: Frontline staff described rising turnover that increases reassignments and leads to a bottleneck in intake and service transitions.
Union and provider perspectives Union and provider representatives who testified urged the committee to consider workload caps, better staffing ratios and predictable case-assignment rules. They said the conflict-free model requires sufficient provider capacity, clearer role definitions, and transition training so existing state and contract staff can perform the new functions without service interruptions.
Agency response and next steps EOHHS and BHDDH staff acknowledged the rollout challenges and said they have been meeting with providers and stakeholders. Agency officials said they are working to refine the model and to provide technical assistance; to date, they reported continued outreach but did not announce a specific statewide caseload cap. Members asked for concrete staffing and workload data and asked the agencies to provide a regionalization and staffing plan in follow-up materials.
Sources: Testimony from Lina Souza (BHDDH frontline worker), Alex Blue (BHDDH case manager), Matthew Guttup (SEIU Local 580), and the Rhode Island Developmental Disabilities Council.
