Medicaid eligibility and enrollment in Rhode Island

Many Medicare beneficiaries receive Medicaid’s help with paying for Medicare premiums, affording prescription drug costs, and covering expenses not reimbursed by Medicare – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Rhode Island includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

During the pandemic, federal rules have prevented states from disenrolling anyone from Medicaid, even if they were no longer eligible or didn’t respond to an updated eligibility determination information request. But that rule ends March 31, 2023, and states can once again disenroll people from Medicaid as soon as April 1, 2023. Leading up to that, the Rhode Island Office of Health and Human Services is asking all Medicaid enrollees to ensure that their contact information is up-to-date, so that they can receive renewal packets in a timely manner.

Rhode Island has created a new protocol that will automatically enroll people in a plan through HealthSource RI if they lose Medicaid and their household income is no more than 200% of the poverty level. And for people up to 250% of the poverty level who transition to a plan through HealthSource RI (including those with income above 200% of FPL who manually select a plan), the state will pay their after-subsidy premiums for the first two months.

Rhode Island lawmakers are also considering legislation (H.5254) that would push Medicaid eligibility for current enrollees out through January 1, 2024, even if they no longer meet the eligibility guidelines. So instead of disenrollments resuming in the spring of 2023, this legislation would have them start in early 2024.

As of November 2015, Rhode Island joined eight other states and the District of Columbia in adding transgender healthcare to the covered services under the state’s Medicaid program. Rhode Island Medicaid now covers gender reassignment surgery and hormone therapy for transgender individuals.

Several others states have since added similar provisions to their Medicaid programs, ensuring access to transgender healthcare.

Sovaldi and Harvoni have been heralded as miracle drugs for their ability to cure a significant percentage of Hepatitis C cases. But they’re breathtakingly expensive. As a result, many state Medicaid programs — including Rhode Island’s — required patients to meet a pre-determined set of criteria before the Hep C drugs could be prescribed. There were concerns, however, that states were too restrictive in setting their requirements, and the benefits of paying for Hep C treatment sooner and for more patients may outweigh the additional cost of the medication.

In 2015, Rhode Island was denying the majority of claims for Hepatitis C drugs. But in the spring of 2016, Medicaid director Anna Rader Wallack said that the issue was being revisited to determine whether Medicaid should take a larger role in covering the drugs that can cure Hepatitis C. And in early 2018, the state announced a new policy with regards to Hepatitis C treatment: Patients with Hepatitis C no longer need to have severe liver damage or cirrhosis in order to qualify for Hepatitis C drug coverage. That was welcome news for patient advocates, but the increased Medicaid spending for Hepatitis C temporarily pushed Medicaid costs over budget.

This website has details on how each state’s Medicaid program handles coverage for the drugs that treat Hepatitis C.

As of October 2022, total Rhode Island Medicaid and CHIP enrollment was 357,950, which was 88% higher than enrollment had been in 2013.

Although the federal government is paying nearly all of the cost of covering the newly-eligible population, the existing nearly 50/50 state/federal split in Rhode Island applies to any enrollees who were eligible based on the previous guidelines (note that federal funding for this population was temporarily increased under the Families First Coronavirus Response Act, starting in 2020; that additional funding will be phased out by the end of 2023).

Enrollment for Medicaid and CHIP are year-round, but tend to spike during the general open enrollment due to outreach from the exchanges.

The first states to implement Medicaid did so in January 1966, and Rhode Island wasn’t far behind them. Medicaid became available in the state in July 1966. Rhode Island uses a Medicaid managed care model to provide coverage.  RIte Care and Rhody Health Partners (UnitedHealthcare) are the managed care programs in the state. RIte Care is for pregnant women and children, and utilizes UnitedHealthcare Community Plan of New England, Tufts, or Neighborhood Health Plan of RI to provide coverage.

RIte Share is a premium assistance program that pays all or a portion of an eligible employee’s share of employer-sponsored health insurance premiums.

Rhode Island was among the states that immediately moved forward with Medicaid expansion as called for in the ACA. Former Governor Lincoln Chafee made it clear immediately after the Supreme Court ruling (which made Medicaid expansion optional for states) that Rhode Island would be implementing Medicaid expansion and fully embracing the ACA (the state also set up its own state-run exchange).

Governor Chafee signed the fiscal year 2014 budget in July 2013, and it included a provision to expand Medicaid starting January 1, 2014. Eligible residents were able to begin enrolling on October 1, 2013, when the state’s health insurance exchange opened for business.