In 2015, Rhode Island pioneered the Health Equity Zone Initiative, a community-focused program meant to help fill gaps in health care. But now the initiative’s future is hazy as it’s facing a funding gap.
The initiative is facilitated by the R.I. Department of Health, with the support of the R.I. Executive Office of Health and Human Services, and has expanded to include 15 health equity zones throughout the state. Each zone represents a different geographic area and is anchored by a backbone organization that serves as an administrative hub. Health equity zones are tasked with identifying their community’s unique health care needs and bringing organizations together to create programs to address them.
Over the last five fiscal years, almost two-thirds of the initiative’s funds – around $26 million of the $39.6 million budgeted – came from COVID-19 relief grants and other federal funds, with another 2.5% coming from general revenue, according to a RIDOH issue brief presented to the R.I. Senate in November 2023. Along with federal money, the program also largely relied on restricted receipts in previous years.
But because COVID-19 relief funds are quickly running out and restricted receipts that were meant for the initiative had to be reallocated to construct the new health labs, RIDOH requested $2.7 million in general revenue from Gov. Daniel J. McKee’s fiscal year 2025 budget.
Ultimately, McKee did not include funding for health equity zones in his budget proposal. RIDOH and EOHHS say they have been able to find other funding streams, so the gap stands at around $700,000.
McKee spokesperson Olivia DaRocha said in a statement to Providence Business News that over the last five years no more than $200,000 per year in funding came from general revenue in the form of allocations from RIDOH’s Office of Minority Health. So, an additional $1 million in non-health-related general revenue from untapped sources for fiscal year 2025 would have been “unprecedented and unsustainable,” she said.
Joseph Wendelken, a spokesperson for RIDOH and EOHHS, said, “Narrowing health disparities and promoting health equity” are priorities for the state agencies and they are looking for other ways to fill the funding gap.
One of these is a request to U.S. Sens. Sheldon Whitehouse, D-R.I., and Jack Reed, D-R.I., for $700,000 of congressional funds. Representatives for Whitehouse and Reed did not respond to PBN’s request for comment.
While it’s uncertain where the funds will come from, leaders of the state’s health equity zones are concerned about the initiative’s viability.
“We are alarmed,” said Rita Capotosto, vice president of the East Bay Community Action Program, which is the backbone organization of the Bristol, East Providence and Warren health equity zones.
Beginning on July 1, Capotosto said infrastructure funding, which goes toward staff and overhead expenses for the zones she oversees, will be reduced by 27.5%. While Capotosto says she’s still figuring out the budget for the next fiscal year, this drop in funds could mean cuts to staff and reducing the kinds of programs offered to community members.
“We’re going to have to take a hard look at all the work that we’re doing,” said Capotosto, who has lost staff members concerned about job security.
Health equity zone leaders agree that these losses would be detrimental to community members who have come to rely on the initiative.
The initiative’s community health workers have served almost 254,000 Rhode Islanders by providing resources such as meal deliveries, assistance with the Supplemental Nutrition Assistance Program, rent relief and other benefit applications, and training to use digital equipment.
“Without them [HEZs], there’s going to be a lot of individuals not being served,” said Melissa Sigua, health equity zone program manager for Wood River Health, which is the backbone agency of the Washington County Health Equity Zone. “It’s quite unfortunate.”
Sigua said that a key component of the health equity zone’s success is connecting organizations throughout the region that don’t usually work together to pool their resources. But this level of collaboration is in jeopardy if funds run out.
As health equity zone leaders are working to fill the immediate funding gap, they’re also concerned about sustaining the initiative long term.
DaRocha said that after fiscal year 2025, the initiative will “need to identify a sustainability plan beyond its existing funding sources if it plans to maintain its current level of service.”
Health equity zones have and will continue to fundraise, but sustained state support is valuable because funds are more equally distributed to communities and it allows for a more coordinated approach, said Anusha Venkataraman, managing director of ONE Central Providence, which operates under ONE Neighborhood Builders and convenes the Central Providence Health Equity Zone.
“That is how systemic transformative change happens, that is how the state government has improved and has [added value] partnering with communities,” Venkataraman said. “It would be a disservice to the work for it to be a piecemeal approach. … That’s where you’re going to see the same inequities that continue to drive gaps and outcomes arise.”
(Correction: An earlier version of this story gave an incorrect in the 11th paragraph on how much infrastructure funding will be reduced on July 1. It will be reduced at 27.5%, according to Riat Capotosto, East Bay Community Action Program vice president.)
