Medicaid eligibility and enrollment in Rhode Island

Many Medicare beneficiaries receive Medicaid’s help with paying for Medicare premiums, affording prescription drug costs, and covering expenses not reimbursed by Medicare – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Rhode Island includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

During the pandemic, federal rules prevented states from disenrolling anyone from Medicaid, even if they were no longer eligible or didn’t respond to an updated eligibility determination information request. But that rule ends March 31, 2023, and states were allowed to start disenrolling people from Medicaid as soon as April 1, 2023. This process, which lasted about a year, was known as “unwinding,” as it referred to an unwinding of the pandemic-era continuous coverage rule.

Rhode Island created a new protocol to automatically enroll people in a plan through HealthSource RI if they lost Medicaid and their household income was no more than 200% of the poverty level. And for people up to 250% of the poverty level who transitioned to a plan through HealthSource RI (including those with income above 200% of FPL who manually selected a plan), the state paid their after-subsidy premiums for the first two months.⁶

By 2025, the program was only paying the after-subsidy premium for one month, and that ends at the end of 2025.⁷ But the auto-enrollment and premium assistance played an important rule in helping people maintain coverage in Rhode Island after the pandemic.

During the unwinding period, 5,923 people in Rhode Island transitioned from Medicaid to a Marketplace plan. Nearly 2,500 of those people were automatically enrolled in a Marketplace plan (most states do not have a process for automatically enrolling a person in Marketplace coverage when they’re disenrolled from Medicaid).⁸

As of November 2015, Rhode Island joined eight other states and the District of Columbia in adding transgender healthcare to the covered services under the state’s Medicaid program.⁹ Rhode Island Medicaid now covers gender reassignment surgery and hormone therapy for transgender individuals.

Several other states have since added similar provisions to their Medicaid programs, ensuring access to transgender healthcare.¹⁰

Sovaldi and Harvoni have been heralded as miracle drugs for their ability to cure a significant percentage of Hepatitis C cases. But they’re breathtakingly expensive.¹¹ As a result, many state Medicaid programs — including Rhode Island’s — required patients to meet a pre-determined set of criteria before the Hep C drugs could be prescribed. There were concerns, however, that states were too restrictive in setting their requirements, and the benefits of paying for Hep C treatment sooner and for more patients may outweigh the additional cost of the medication.

In 2015, Rhode Island was denying the majority of claims for Hepatitis C drugs. But in the spring of 2016, Medicaid director Anna Rader Wallack said that the issue was being revisited to determine whether Medicaid should take a larger role in covering the drugs that can cure Hepatitis C. And in early 2018, the state announced a new policy with regards to Hepatitis C treatment: Patients with Hepatitis C no longer need to have severe liver damage or cirrhosis to qualify for Hepatitis C drug coverage. That was welcome news for patient advocates, but the increased Medicaid spending for Hepatitis C temporarily pushed Medicaid costs over budget.

This website has details on how each state’s Medicaid program handles coverage for the drugs that treat Hepatitis C. Rhode Island is one of the states that gets an A+ grade.

As of September 2025, total Rhode Island Medicaid and CHIP enrollment was 303,351,¹² which was 60% higher than enrollment had been in 2013.¹³

Although the federal government is paying nearly all of the cost of covering the newly-eligible population, the state pays nearly half of the cost of covering the traditional Medicaid population (pregnant women, elderly people, etc. who aren’t part of the Medicaid expansion population).¹⁴

Learn more about how Medicaid funding works.

Enrollment for Medicaid and CHIP are year-round, but tend to spike during the general open enrollment due to outreach from the exchanges.

The first states to implement Medicaid did so in January 1966, and Rhode Island wasn’t far behind them. Medicaid became available in the state in July 1966. Rhode Island uses a Medicaid managed care model to provide coverage.  RIte Care and Rhody Health Partners (UnitedHealthcare) are the managed care programs in the state. RIte Care is for pregnant women and children, and utilizes UnitedHealthcare Community Plan of New England, Tufts, or Neighborhood Health Plan of RI to provide coverage.

RIte Share is a premium assistance program that pays all or a portion of an eligible employee’s share of employer-sponsored health insurance premiums.

Rhode Island was among the states that immediately moved forward with Medicaid expansion as called for in the ACA. Former Governor Lincoln Chafee made it clear immediately after the Supreme Court ruling (which made Medicaid expansion optional for states) that Rhode Island would be implementing Medicaid expansion and fully embracing the ACA (the state also set up its own state-run exchange).

Governor Chafee signed the fiscal year 2014 budget in July 2013, and it included a provision to expand Medicaid starting January 1, 2014. Eligible residents were able to begin enrolling on October 1, 2013, when the state’s health insurance exchange opened for business.