Latest RI Health Coverage Project News
Medicaid co-payments would cost seniors, parents, and most adults nearly $11 million
The co-payment proposal (Budget Article 13) of the Governor’s FY2019 budget proposal would require adults (except for some adults with disabilities) to pay co-payments for vital health care services including:
- $4.00 for brand name prescription drugs and $2.50 for generics
- $3.00 for non-preventive doctor visits for physical health care
- $8.00 for non-emergency use of the emergency room
- $3.00 per inpatient hospital stay
Who is impacted: Co-payments will cause financial hardship and likely adverse health outcomes for over 150,000 adults, including parents, single adults and seniors who will be subject to these payments.
Across these populations, more than seven out of ten live below the poverty level. Several thousand parents enrolled in the RI Works program — overwhelmingly single mothers — struggle to get by on income that is 70% below the poverty level. (Poverty level for a family of 3 is $25,520.) The fact is, adult Medicaid members simply do not have the resources to pay for new out-of-pocket expenses.
What is at stake: A recently released Kaiser Family Foundation brief reviewed research from 65 papers published between 2000 and 2017 on the effects of premiums and cost sharing. The brief outlines numerous studies that found that cost sharing has negative effects on an individuals’ ability to access needed care and on health outcomes. For example, studies found that increases in cost sharing are associated with increased rates of uncontrolled hypertension and hypercholesterolemia.
While the state expects to save around $3.2 million by implementing co-payments, it will forfeit an additional $7.7 million in federal funds, a significant burden on our lowest-income households and on our state’s health care system. This potential loss of federal funds is higher than the usual 50% federal Medicaid match because a significant number of people impacted by the co-payment proposal are “expansion” adults for whom the state receives a 95% federal share.
900 Seniors and People with Disabilities incorrectly dropped from Medicare Premium Payment Program-coverage will soon be restored
Seniors and people with disabilities who have Medicare may be eligible to have Medicaid pay their Medicare monthly premiums (around $134/month) instead of having the cost of premiums deducted from their Social Security check.
In February, the state mailed 900 seniors and people with disabilities a notice telling them that they had incorrectly been dropped from this Medicaid Premium Payment Program (MPP) – and their Social Security checks had been incorrectly reduced to pay the Medicare Premium. While eligibility for MPP has been restored, it may take some time before the person sees their Social Security check increase.
Please read and distribute the fact sheet about this to help ensure that people get the benefits to which they are entitled.
Medicaid enrollees can switch plans through May 31
The nearly 300,000 Rhode Islanders enrolled in the state’s Medicaid program are eligible to change their health plans through the Annual Plan Change Opportunity, which runs from February through May. Neighborhood Health Plan of Rhode Island, Tufts Health Plan, and UnitedHealthcare Community Plan are the three participating plans.
OHHS is mailing Medicaid members notice about the plan change opportunity. The first notices were mailed at the end of February and the last notices will be mailed at the end of March. Members can call Health-Source RI at 1-855-840-4774 or mail in a plan change request form.
Before switching health plans, members should check to make sure their doctors and other providers are in the health plan in which they wish to enroll. Members are also encouraged to check the health plan’s drug list to ensure their medications are covered.
More information is available at http://www.eohhs.ri.gov/Home/PlanChange.aspx.
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.