A joint initiative of The Economic Progress Institute and Rhode Island KIDS COUNT
Latest RI Health Coverage Project News
Medicaid Open Plan Enrollment
Medicaid beneficiaries who are enrolled in a managed care plan are allowed to change plans once a year, during an open enrollment period.* As of July, 2017 there are three plans participating in Medicaid managed care: Neighborhood Health Plan of RI, Tufts Health Plan and UnitedHealthcare Community Plan.
This year’s open plan enrollment period will run from September 1 – October 31. Current managed care enrollees will receive a notice from OHHS telling them about open enrollment and the opportunity to change plans. If the person wants to stay with their current plan, they do not need to do anything. If they want to change, they can mail back the form or call HealthSource RI.
OHHS will stagger the notices by zip code so not everyone will receive a notice about open enrollment at the same time. You can see the timeline for the notices here.
OHHS will soon be posting information for members, a sample open enrollment letter and the health plan selection form. Check the Open Enrollment web page for more information.
*Continued eligibility for Medicaid coverage is separate from plan enrollment. Medicaid recipients are notified about renewing their Medicaid eligibility one a year based on when they applied or last renewed.
Help Make Sure that Thousands of Medicaid Recipients Don’t Lose Health Insurance Coverage
Since late May, the Executive Office of Health and Human Services (EOHHS) has been running Post Eligibility Verification (PEV) checks of income for thousands of families and individuals who receive Medicaid/RIte Care. (This does not affect seniors and people with disabilities). OHHS matches the income in the customer’s account with income posted in the state’s wage and unemployment databases.
If the data match indicates that current income is above the Medicaid limit, EOHHS sends a notice asking the recipient to submit current income information or risk losing their Medicaid coverage. This notice includes a note with directions on how to submit the information and the date by which the information needs to be submitted. So far around 19,000 households received this notice.
Households that fail to submit updated information showing that they are still eligible for Medicaid are sent another notice informing them that they are ineligible for Medicaid and benefits will stop at the end of the month. So far at least 4,700 individuals have been notified they are ineligible for Medicaid either because they never responded to the first notice to update their income or their current income is above the Medicaid limit. Most individuals who are no longer eligible for Medicaid because their income is too high are eligible to purchase a low-cost health plan through HealthSource RI.
EOHHS is also sending notices and requests for information to other Medicaid recipients (including people with disabilities and seniors) to ensure that only eligible individuals continue to get benefits. This includes people who have been asked to confirm citizenship or immigration status and people who do not have a current RI address.
Health Insurance for People Who Are Uninsured
- You recently lost health insurance coverage:
- from a job
- from college coverage
- from parent’s coverage at age 26
- no longer covered by another government health plan like Medicaid/RIte Care
- You recently moved to Rhode Island
- Your household size has changed due to marriage, divorce, a new child
- Your immigration status has changed–you gained lawful status or became a U.S. citizen.
For more information about these “Special Enrollment Periods” go to the SEP Health Source RI page.
For enrollment assistance you can visit the HealthSource RI contact center at 401 Wampanoag Trail, East Providence, Monday – Friday, 8am – 7 pm or you can call 855-840-4774.
HealthSource RI is hosting community enrollment sessions for currently uninsured Rhode Islanders who want to enroll in coverage:
- Wednesday, September 6 – Neighborhood Guild, 325 Columbia Street in Wakefield (11am – 5pm)
DHS Office Hours
DHS continues to have extended afternoon hours at 2 of its offices. Below are the offices and hours. Note: Customers can go to any DHS office to enroll in SNAP, CCAP, Medicaid, or other public benefits.
|M – F||Tues & Weds|
|Pawtucket||8:30am – 4:00pm||N/A|
|Providence||8:30am – 4:00pm||4:00pm – 6:30pm|
|Woonsocket||8:30am – 4:00pm||4:00pm – 6:30pm|
|Warwick||8:30am – 4:00pm||N/A|
|Newport||8:30am – 4:00pm||N/A|
|South County||8:30am – 4:00pm||N/A|
For addresses and phone numbers check out the DHS regional offices page.
Health Insurance for People who are Uninsured
The type of health insurance available to you and your family depends on your income. Adults with income below 138% of the Federal Poverty Level (FPL) may be eligible for RIte Care/Medicaid. The RIte Care/Medicaid income limits for children and pregnant women are higher.
Individuals and families with income above the RIte Care/Medicaid limits can buy coverage through Health Source RI (HSRI). Tax credits are available to help pay for coverage if income is below 400% FPL and if income is less than 250% FPL you can also get help paying for out-of-pocket costs (cost-sharing reduction).
HOW TO ENROLL
• Apply on-line at www.HealthSourceRI.com.
• Call 1-855-840-4774 to enroll over the phone.
• Enroll in-person at the HSRI contact center at 401 Wampanoag Trail, East Providence
• Enroll in-person with a community-based Navigator. (Call 2-1-1 to find a navigator in your community or check this brochure.).
WHEN TO ENROLL
• Individuals and families who are eligible for Medicaid/RIte Care coverage can enroll at any time.
• The Open Enrollment period for HealthSource RI plans closed on January 31, 2016, and reopens in November, 2016. Until open enrollment in November, people who are uninsured because of life changes such as losing health insurance at a job, giving birth or adopting a child, marriage/divorce, a death in the family, or moving to Rhode Island can enroll in a HealthSource RI plan. It’s important to apply for coverage soon after the life-changing event. For more information click here for a factsheet about the special circumstances for enrolling in coverage through HSRI. You can also download a poster explaining eligibility for HSRI coverage here.
HealthSource RI also hosts enrollment sessions for currently uninsured Rhode islanders who want to enroll in coverage:
Webinar: Recording of our webinar for Community Helpers that explains how to help families renew their insurance and more about the rolling renewal option.
Business Process Plan: Help make sure families who come to your agency know about RIte Care renewal. See our Business Process Plan to help your organization think about how to make sure everyone you work with stays covered.
Notices: The Executive Office of Health and Human Services has sent a series of notices to families who need to renew their RIte Care Coverage.
Press and alerts: Read our recent press releases and newsletters about the RIte Care renewal process.
- First Notice of Coverage Termination to Effected RIteCare Parents – November 15, 2013 – Parents with income between 138-175% FPL currently receiving health coverage through RIte Care received an initial notice that their eligibility would be redetermined.
- Parents Losing RIte Care and RIte Share Eligibility December 31, 2013, Process Chart by EOHHS – outlines upcoming dates important for service providers and parents regarding upcoming transitions for effected populations.
- 2014 Health Insurance Options for Uninsured Rhode Islanders – October 2013 – Learn more about what affordable health coverage options are available to individuals and families in Rhode Island.
- What’s Next for RIte Care? – October 2013 – Learn more about the changes happening in Medicaid in Rhode Island over the next three months and post January 1, 2014.
- Countdown to Coverage 2014: Rhode Island’s Options for Affordable Health Coverage – September 2013 – See examples of how Rhode Islanders will benefit from new health coverage options beginning January 1, 2014 as well as information about Medicaid, HealthSource RI, tax credits, enrollment information and more. Available in Spanish.
- Essential Health Benefits: Rhode Island’s Choice Under the Affordable Care Act – December 2012 – Read about the Essential Health Benefits (EHBs) that Rhode Island chose to include in its “benchmark” plan required under the Affordable Care Act.
- Principles for Consumer-Focused Navigators and Navigator Entities – October 2012 – The RI Health Coverage Project and it’s leadership team recommend the following guiding principles to ensure a program with consumer-focused navigators and navigator entities.
- Consumer Support System and the Health Insurance Exchange – May 2012 – This fact sheet provides an overview of the consumer support system and how the “Navigator” program will provide one-on-one assistance to consumers.
- Rhode Island Health Coverage Project Overview – April 2012 – Rhode Island is working hard to create new health insurance choices. The Rhode Island Health Coverage Project ensures that consumers have a voice in the process. Available in Spanish
- What are the Pathways to Health Insurance Coverage in 2014? – May 7, 2012 – The Affordable Care Act (ACA) is designed to improve health care by reducing the number of uninsured Americans. Beginning in 2014, most Rhode Islanders will have health insurance coverage through one of the following ways: 1) Coverage through their employer 2) through the Exchange 3) through Medicaid or 4) through the Basic Health Program. Also available in Spanish and Portuguese.
- Who is the Affordable Health Care Act Helping in Rhode Island? – February 07, 2012 – Health care reform legislation, called the Affordable Care Act (ACA), was passed by Congress in 2010. Many Rhode Islanders and Americans are already benefiting from parts of the law that have already gone into effect. Who is the Affordable Care Act helping in Rhode Island? Read the issue brief to find out. Available in Spanish and Portuguese.
- The Basic Health Program: Providing Affordable Coverage for Rhode Islanders – February 10, 2012 – A key goal of the Patient Protection and Affordable Care Act (ACA) is to allow more Americans to have health coverage by providing affordable health insurance. Under the new law, Rhode Islanders will be covered through several ways, including the Basic Health Program. This issue brief will explain the Basic Health Program, and how this option will help Rhode Island families.
- Flyer to Help 2,000 Uninsured Parents Get Coverage (February 21, 2014) Flyer in Spanish
- Updated Password Letter and Updated Username Letter (January 16, 2014)
- Parents Who Lost RIte Care Coverage: Deadline for February Coverage Approaches (January 21st alert)
- Application for State Premium Assistance Program for Parents Who Lost Coverage
- Letter on Next Steps, and Follow-up Letter with Password received by RIte Care and RIte Share Parents around January 2, 2014
- Letter, Fact Sheet, and Opt-out Form mailed to RIte Care and RIte Share Parents December 6, 2013
- Update for RIte Care Parents Who Lost Coverage (Jan 7, 2014)
- First Notice of Coverage Termination to Effected RIteCare Parents
- Policy Memo: More Time is Needed to Transition Parents from RIte Care to HealthSource RI
Preparing for 2016: Renewals, Open Enrollment and Consumer Assistance Workshop Materials
September 22, 2015
On September 22, 2014, the Health Coverage Project hosted a workshop attended by over 150 community helpers. The workshop included presentations by staff from the Department of Human Services, HealthSource RI, RI Health Center Association, RIREACH, RI Parent Information Network, RI Legal Services, and our Project Staff. Topics included the basics of coverage and Medicaid renewal, HealthSource RI open enrollment and renewal, and Community Assistance.Link to Workshop Materials
Getting Covered / Staying Covered Workshop
December 9, 2014
On December 9, 2014, the Health Coverage Project hosted a workshop of approximately 150 community helpers. The workshop included presentations by staff from the Executive Office of Health and Human Services, HealthSource RI and our Project Staff. Topics included the basics of coverage, Medicaid renewal, HealthSource RI enrollment and renewal, and Consumer Assistance.Link to Workshop Materials
Health Coverage: How Did RI Do? What Now?
May 20, 2014
September 26, 2013
Countdown to Coverage: Ready for Lift Off! PowerPoint Presentation– an overview of the Affordable Care Act, how Medicaid is evolving inRhode Island, and how Rhode Islanders will access affordable coveragethrough HealthSource RI.
Countdown to Coverage 2014 – a fact sheet about Rhode Island’s options for affordable health coverage.
What’s Next for RIte Care?-a chart addressing the changes that will be happening in RIte Care inthe next 3 months and after January 1, 2014. There is also a federalpoverty level chart.
Health Care for People who are Uninsured– a contact list for those who are uninsured now and may continue to bebecause of certain circumstances (i.e. immigrant status).
Health Coverage Project Overview – a description of the Project and its goals.
HEALTHSOURCE RI MATERIALS
HealthSource RI Application Presentation– shows screen shots of the online application process and wherecommunity helpers will be able to direct applicants who need additionalassistance.
May 22, 2013
Countdown to Coverage: Health Care Reform in Rhode Island – A presentation about changes in access to RIte Care and Medicaid coverage and new opportunities for affordable private insurance through the Exchange as well as how people can access health care now.
Rhode Island Health Benefits Exchange: Communications Discussion – A presentation from Megan Hall of the Exchange giving an update on the Exchange’s progress and the outreach and education plan.
Letter to the Community – a letter from the Exchange requesting those agencies interested in helping with outreach and enrollment to fill out the contact form and return it to the Exchange.
Exchange Fact Sheet – for individuals and small businesses.
Contact Form – for those who would like to receive e-mails from specific organizations.
Family Resource Counselors List – contact information for family resource counselors in Rhode Island.
RIte Care order form – for those who would like more of the RIte Care materials provided at the workshop.
- More About Medicaid PowerPoint Presentation – November 2013 – For those currently enrolled in Medicaid, this presentation is an overview of what coverage changes you and your family may encounter under the Affordable Care Act.
- A Celebration of Children’s Health PowerPoint Presentation – November 2013 – This presentation explores how RIte Care works for children & families in Rhode Island and what they can expect under ACA in 2014.
- 2013 Workshop: Countdown to Coverage: Health Reform in Rhode Island – May 2013- This presentation covers the changes to accessing RIte Care and Medicaid and new opportunities for affordable private insurance through the Exchange as well as ways people can access health care now.
- Health Reform in Rhode Island: Countdown to Coverage – December 2012 – View a presentation from recent forums that describes how the Affordable Care Act is helping Rhode Islanders and the changes that will go into effect in January 2014 .
- Countdown to Coverage Presentation – May 2012 – This presentation provides basic information about the Affordable Care Act, assistance available to consumers, and how people can access health care and health coverage now.
- Health Reform: Seven Things You Need to Know to be Ready: This publication from Consumer Reports provides an overview of the changes and new options that consumers and those shopping for coverage can expect in 2014.
- Health Reform: Seven Things You Need to Know Now: This Consumer Reports publication is your guide to understanding the law (Affordable Care Act). They cannot cover every possible situation or detail, but highlight the major changes that consumers need to know about to take advantage of the full benefits of health reform come January 1, 2014. (This publication is also available in Spanish.)
- Designing the essential health benefits for your state: An advocates guide: Consumer advocates have a great opportunity to involve themselves as their states choose their benchmark plans and define their essential health benefits packages. This resource includes an overview of the requirements that a state’s essential health benefits package will need to meet and outlines the process for defining these benefits using a benchmark plan. It also provides steps advocates can take to engage in the benchmark plan selection process and to advocate for a comprehensive essential health benefits package in their state.
- Health Reform Hits Main Street: Confused about how the new health reform law really works? This short, animated movie explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014. (video from Kaiser Family Foundation, also available in Spanish.)
- Implementation Timeline: The implementation timeline is an interactive tool designed to explain how and when the provisions of the health reform law will be implemented over the next several years. (from the Kaiser Family Foundation)
- What Will Health Care Do for You?: An interactive grid that lets you choose your health insurance status to find out what health care will do for you. (from Health Care for America Now)
Health Care Reform Background
Congress passed The Affordable Care Act (ACA) in 2010 and the U.S. Supreme Court upheld most of the law in 2012. The ACA was created so that nearly all Americans would have access to affordable health insurance through commercial or public coverage, health care costs would be controlled, and the health care delivery system would be improved.The U.S. Department of Health and Human Services has primary responsibility for guiding implementation of the ACA and providing information to consumers and others. On January 13, 2011, Governor Lincoln Chafee signed an Executive Order creating the RI Health Care Reform Commission, chaired by Lieutenant Governor Elizabeth Roberts, to oversee all aspects of ACA implementation. On September 19, 2011, the Governor signed another Executive Order creating the RI Health Benefits Exchange, responsible for developing the Exchange website where people will be able to compare health insurance plans, purchase insurance and apply for Medicaid or subsidies to help pay for private coverage. Small business will also be able to purchase coverage through the Exchange.
Frequently Asked Questions about Health Reform – An extensive list of FAQs and educated answers provided by the Kaiser Family Foundation.
Zooming in on Health Reform– understanding the potential impact of the ACA on Medicaid and the uninsured at the local level
HealthRIght -has a mission to enact health care reform that ensures high-quality, accessible, sustainable and affordable health care and healthier lives for all Rhode Islanders.
Community Catalyst – works with advocates across the country to make sure consumers have a role in transforming health care in their communities.
Kaiser Family Foundation – provides in-depth information on key health policy issues.
Families USA – nonprofit advocacy organization that offers resources on finding, choosing, and using health coverage.
Georgetown University Center for Children and Families – an independent, nonpartisan policy and research center with a mission to expand and improve health coverage for America’s children and families.
- Center for Southeast Asians
- City of Providence, Health Communities Office
- Community Action Partnership of Providence
- The Economic Progress Institute (Project Lead)
- East Bay Community Action
- The Genesis Center
- Parent Support Network
- Rhode Island Free Clinic
- Rhode Island Health Center Association
- Rhode Island KIDS COUNT (Project Lead)
- Rhode Island Parent Information Network
- Rhode Island State Council of Churches