In R.I., approximately 700 enrolled in Medicaid may lose coverage due to error
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Beginning this month, Medicaid will begin using the correct income limit to determine eligibility for new applicants, White wrote. The corrected income limit will apply to current beneficiaries when their eligibility is reviewed 'either during the person's annual Medicaid redetermination (or Medicaid renewal) or during a quarterly post-eligibility verification (PEV) process.'
'Roughly 700 parents/caretakers currently enrolled in Medicaid fall between 138 percent and 141 percent FPL and are expected to be impacted by this update,' White wrote. 'These members will retain their Medicaid benefits until their cases are reviewed for eligibility.'
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During the 2023 state fiscal year, Rhode Island's Medicaid program provided full medical coverage to 389,000 people at some point during the year, and another 12,000 residents received limited benefits from Medicaid, according to the state's
The income limit error was discovered during a review of the Medicaid program to ensure it complies with federal and state regulations, according to White. The EOHHS 'believes the initial error predates the McKee Administration and likely occurred in 2014,' White wrote.
'Staff originally identified the issue as we prepared for the [state fiscal year] 2025 budget and took time over the proceeding months to fully understand and interpret the relevant documents, to conduct data analysis to understand the member impact, and to ensure that a clear transition pathway would be in place to mitigate harm to those losing coverage,' White wrote.
The income limit correction is necessary because state Medicaid programs must be administered according to federal rules and the agreements the state has made with the federal Centers for Medicare and Medicaid Services, according to White. The state is not allowed to spend Medicaid money 'for a certain group at a certain income level' without federal approval, White wrote.
'All Rhode Islanders deserve access to affordable health insurance,' Senate President Valarie Lawson said in a statement on Tuesday. 'My understanding is that EOHHS will allow coverage to continue for those enrolled in error until the expiration period. We hope and expect that they will review every circumstance and provide the assistance necessary to avoid disruptions in coverage.'
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House Speaker K. Joseph Shekarchi called the matter 'an example of why administrative departments need to do the fundamental things right the first time.'
'Errors like these have real consequences,' Shekarchi said
in a statement.
Rhode Island Attorney General Peter Neronha, who has been a
'These are working people that are struggling to make ends meet every single day,' Neronha said in a statement. 'Mind you, this is happening as the federal government is moving to make massive cuts to Medicaid, and our state government is scrambling to find solutions to a health care crisis that we've known about for quite some time.
'We must fix health care in Rhode Island now, and that obviously includes keeping Rhode Islanders insured,' Neronha added.
Those who are impacted by the income limit correction will receive a 'benefits decision notice' informing them they are no longer eligible and whether they are eligible for a Qualified Health Plan through HealthSource RI, the state's health care exchange, according to White. Some, White said, may qualify for auto-enrollment through HealthSource RI.
According to White, individuals at the corrected income level who are eligible for Advanced Premium Tax Credits can enroll in 'some' silver-level health plans 'with a small monthly premium cost,' thanks to federal subsidies.
White noted, however, that after this year it is 'very likely that federal subsidies will reduce, meaning that the monthly premium would increase.'
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Yet, 'plans available to this group also have reduced cost-sharing, making out-of-pocket costs much more affordable for medical services,' White wrote.
Christopher Gavin can be reached at
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