Rhode Island, along with the rest of the nation, will begin its Medicaid renewal process for the first time since 2020, when the U.S. declared a public health emergency for the COVID-19 pandemic that allowed states to keep people continuously enrolled in the program. On April 1, continuous enrollment ended; now, the state has a year to complete the renewal process for the more than 350,000 Rhode Islanders enrolled in Medicaid.
About half of the renewals are expected to be passive, or require no action on the part of the Medicaid enrollee because the state has enough information to verify continued eligibility, according to a press release from Gov. Dan McKee. The other half of enrollees will have to submit documentation to confirm their continued eligibility.
The renewal process will be led by the Executive Office of Health and Human Services, the Department of Human Services and HealthSource RI, the state’s official health insurance marketplace.
To ease the process, renewal reviews will be staggered throughout the coming year. Still, individuals familiar with the program in Rhode Island said some concerns remain about the re-enrollment process.
Factors that can contribute to losing eligibility
Issues with Medicaid renewal processes throughout the country have historically led to many eligible individuals losing coverage and only realizing during a medical emergency, according to Ira Wilson, professor of medicine and health services, policy and practice.
While there are legitimate reasons for losing eligibility, such as getting a new job, Wilson said that “you can also lose coverage … because you didn’t know you needed to re-enroll.”
Rhode Island Medicaid enrollees should have already received a letter and email from the state outlining the steps of the renewal process. But Wilson said there is always the possibility that enrollees changed their contact information or address within the past year, causing them to be missed in the renewal process.
The end of continuous enrollment poses additional problems for Medicaid renewal this year. DHS is unprepared to handle the coming “tsunami” of Medicaid renewals, said Stacy Smith, president of Council 94 AFSCME/AFL-CIO Local 2882, a union of workers who make eligibility determinations for programs including Medicaid. Medicaid grew by nearly 21 million enrollees between February 2020 and December 2022, a nearly one-third increase.
Smith said that beyond the “crushing” number of cases the state will face and a high number of unfilled DHS positions, state employees who determine Medicaid eligibility are held to strict time limits to resolve cases — 35 minutes maximum, and only 20 minutes for call center cases. She also alleged that Rhode Islanders have experienced wait times of nearly an hour when using DHS call centers, prompting the DHS phone number to not be included on a letter sent to Rhode Islanders facing renewal.
When asked for comment, a DHS spokesperson referred The Herald to testimony from DHS Acting Director Kimberly Merolla-Brito.
Speaking to Uprise RI, Merolla-Brito said that short-staffing is “definitely an area of concern.”
“I do feel that our workforce projections … allocate the staff that we need to manage (the) work ahead,” she said. “(That) doesn’t mean it will be easy and it does mean we will need additional support in terms of our interagency work and community providers.”
Medicaid renewals in Rhode Island
Wilson said that Rhode Island is “Medicaid-friendly” overall and that the state is taking steps to “reduce the pain” of the end of continuous enrollment.
In particular, Wilson highlighted that Rhode Island is relying upon existing state data to automate the process of checking individuals’ eligibility rather than “making somebody show up and sign something and validate some criterion to be eligible.”
A DHS spokesperson also referred The Herald to a presentation that emphasized that the renewal process was designed to ensure that even individuals deemed no longer eligible for Medicaid coverage would still have access to affordable healthcare. Many Rhode Islanders who are unenrolled from Medicaid will be matched with alternative coverage provided by HealthSource RI, the state’s health insurance marketplace, and most Rhode Islanders are eligible for federal financial assistance to reduce insurance premiums.
According to the presentation, six out of seven Rhode Islanders qualify for federal financial assistance that reduces insurance premium costs, with over 30% of HSRI customers paying less than $20 per month for their plans.
Wilson emphasized that it will ultimately be up to individual states to decide how they approach the Medicaid renewal process.
“There are going to be (Medicaid-friendly states) who are going to look at this as, ‘How do we maintain access that people deserve?’” Wilson said. “Then there are going to be other states that say to themselves, ‘How are we going to use this to reduce our state financial commitment to the Medicaid program?’”
For Rhode Island’s part, Wilson says the state appears to belong to the first category.
“I have asked a couple of knowledgeable people about what’s going on in Rhode Island, and all they’ve said is everybody’s terribly worried about it and working really hard,” Wilson said. “There’s this risk of 25,000 to (30,000) people losing their insurance, and nobody wants that.”
Yael is a senior staff writer covering city and state politics. She is junior, and hails from the Bay Area.
