Health Insurance for Families and Pregnant Women (RIte Care/RIte Share and Affordable Coverage Through Health Source RI)
Beginning January 1, 2014, families and pregnant women can enroll in health insurance coverage using an on-line application through HealthSource RI. For families with low income, all family members may be eligible for RIte Care/Rite Share (Medicaid). For families with moderate income, children will be eligible for Rite Care and the parent(s) may be able to enroll in coverage through HealthSource RI and receive federal and state assistance to help buy a commercial health insurance plan. Similarly, pregnant women may be eligible for Rite Care/RIte Share if income is within the limits or for help purchasing commercial coverage.
Pregnant women, children and young adults (under age 19) and parents/caretaker relatives are eligible for comprehensive medical and dental coverage through the Medicaid program. For medical coverage, families/individuals are enrolled in either RIte Care or RIte Share depending on whether there is access to employer sponsored health insurance coverage. For dental coverage, children born after May 1, 2000 are enrolled in RIte Smiles, a managed care program. Older children and adults use their Medicaid card to access dental care.
RIte Care: Recipients enroll in one of 2 managed care plans: Neighborhood Health Plan of Rhode Island or United Health Care of New England. There is no cost for enrollment. (Effective January 1, 2014.)
RIte Share: Pregnant women and families in which an individual can enroll in health insurance at their job are required to enroll in that coverage if the state determines that the insurance meets certain standards. The state pays the employee’s share of the cost (minus a required co-payment if income is above 150% FPL). Recipients also receive a Medicaid card to cover costs and services not provided through the employer’s plan (e.g., transportation, interpreter services).
Children/young adults under age 19 with income less than 266% FPL. Child/young adult must be a citizen or eligible immigrant. Eligible immigrants include refugees, granted asylum, lawful permanent residents (LPR) and other lawfully present statuses (e.g., applicant for asylum).
Parents (or caretaker relatives) living with a child(ren) under age 18 (or 18 and will complete high school before turning 19) with income less than 138% FPL. Parent/caretaker relative must be a citizen or eligible immigrant. Eligible immigrant includes refugee, granted asylum and lawful permanent resident. An adult LPR must be in status for 5 years before he/she is eligible for Rite Care/RIte Share. Lawfully present immigrants who are not eligible for Rite Care/Rite Share can purchase coverage through HealthSource RI.
Pregnant women with income less than 258% FPL. All pregnant women are eligible for Rite Care/RIte Share regardless of status (including women who are “undocumented”).
There is no resource test for Rite Care/Rite Share. Income (tax-based modified adjusted gross income) must be within the applicable limit for a child, parent or pregnant women. For families with income below 138% FPL, parents and children may all be for Rite Care/RIte Share eligible. If income is above 138% FPL and below 266% FPL, children may be eligible for RIte Care and parents may be eligible for federal and state payments to help them purchase coverage through HealthSource RI.
How to Apply
Complete an application on-line through HealthSource RI or download an application here (also available in Spanish and Portuguese). The online system will check income, citizenship, immigration status and other required information by accessing other government data bases. The website is secure and all information is maintained confidentially. If the information cannot be checked this way, applicants will be asked to provide paper documentation.
HealthSource RI will determine eligibility for each family member applying for health insurance coverage. If all members are eligible for Rite Care they will choose a Rite Care plan. If children are eligible and parents are not (family income is between 138% and 266% FPL), the parent will enroll the children in a Rite Care plan and select a commercial plan to purchase through HealthSource RI.
*Families and pregnant women can enroll in Rite Care/Rite Share at any time. There is a limited period to enroll in a commercial plan through HSRI. For 2014, the open-enrollment period ends on March 31, 2014. People can enroll outside of the open-enrollment period under certain circumstances including: loss of job-based health insurance, significant change in income, moving to a new state.
People needing help with the application process can call the HSRI Contact Center at 1-855-840-4774. The contact center is open Monday-Saturday, 8 am – 9 pm and Sunday 12 pm – 6 pm. Staff can answer questions while the person is completing the on-line application or can take an application over the phone. Some staff speak languages other than English and can access a language line People who want to meet with a helper to complete the application can meet with a Navigator in their community. There are bilingual navigators and navigators also have access to a language line for translation. Click here to find a Navigator.
A decision on a RIte Care/RIte Share application should be made within 30 days.
Families need to recertify for RIte Care/RIte Share on a yearly basis.
Families and pregnant women denied RIte Care/RIte Share can request a hearing within 30 days of the date of the notice.
RI Legal Services (1-800-662-5034) may provide assistance to families who are denied benefits, receive notice of termination or have other problems with RIte Care/RIte Share.
Annual Income Guidelines RIte Care/RIte Share (April 2015)
*Family size for pregnant women = 2 minimum. Increase if carrying twins, triplets, etc.