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Rhode Island and the ACA’s Medicaid expansion

75% increase in RI Medicaid population; uninsured rate at 4.1%, among the lowest in the nation

ACA’s Medicaid eligibility expansion in Rhode Island

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Rhode Island embraced the provision to expand Medicaid in 2014 under the Affordable Care Act (ACA). Federal funding covered the cost of expansion through 2016, after which the state began to pay part of the cost. The federal/state split is now 90/10, so states that have expanded Medicaid receive $9 in federal money for every $1 they spend to provide care for the Medicaid expansion population. And the Build Back Better Act would temporarily increase federal Medicaid expansion funding to 93%.

Rhode Island’s Medicaid/CHIP population grew by more than 143,000 people (a 75% increase) from the fall of 2013 through mid-2021. That was the 11th-highest percentage increase in the country; nationwide, the average enrollment growth stood at 44% as of mid-2021.

According to U.S. Census data, the uninsured rate in Rhode Island dropped from 11.6% in 2013 to 4.3% in 2016, although it inched back up in 2017, to 4.6% (this was typical in many states; the national average uninsured rate was slightly higher in 2017 than it had been in 2016). By 2018 it had dropped back down to 4.1%, and remained at that level in 2019. Vermont had the nation’s third-lowest uninsured rate in 2019, trailing only Massachusetts and DC.

Nationally, uninsured rates jumped in 2020 due to the coronavirus outbreak and associated losses of employer-provided health insurance. While the national average uninsured rate was 9.2% in 2020, Rhode Island’s uninsured rate was still just 4.1%.

Medicaid has served as a crucial safety net during the COVID pandemic, in Rhode Island and across the country. Under the Families First Coronavirus Response Act, the federal government has increased federal Medicaid funding for states’ traditional (non-expansion) Medicaid populations. The additional funding has helped to reduce Rhode Island’s costs and generate a budget surplus in 2021.

Rhode Island has accepted federal Medicaid expansion

  • 334,556 – Number of Rhode Islanders covered by Medicaid/CHIP as of May 2021
  • 143,723 – Increase in the number of Rhode Islanders covered by Medicaid/CHIP fall 2013 to May 2021
  • 66% – Reduction in the uninsured rate from 2010 to 2019
  • 75% – Increase in total Medicaid/CHIP enrollment in Rhode Island since Medicaid expansion took effect

Who is eligible for Medicaid in Rhode Island?

In addition to the aged, blind, and disabled, the following residents are eligible for Medicaid coverage in New Hampshire:

  • Non-disabled adults under 65 with incomes up to 138% of poverty level.
  • Pregnant women with household incomes up to 253% of poverty level.
  • Children with household incomes up to 261% of poverty level.
  • Women with household incomes up to 250% of poverty  level who lose coverage under RIte Care (Medicaid managed care) 60 days postpartum are eligible for two years of Extended Family Planning coverage that provides gynecological check-ups and contraceptives.

How does Medicaid provide financial assistance to Medicare beneficiaries 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.

How do I enroll in Medicaid in Rhode Island?

The state Medicaid office has worked together with HealthSourceRI (the ACA-created state-run exchange) to streamline the application process for Medicaid.  You can apply online via these websites:

Alternately, you can print a paper application and mail the completed form to HealthSourceRI, HZD Mailroom, 74 West Road, Suite 900, Cranston, RI, 02920-8413.

You can also call 855-609-3304 for phone assistance, or visit 70 Royal Little Drive in Providence for in-person assistance.  HealthSourceRI can help you find local in-person assistance as well.

Rhode Island Medicaid covers transgender healthcare

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. Rhode Island Medicaid now covers gender reassignment surgery and hormone therapy for transgender individuals.

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

Hepatitis C drug coverage expanded

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. 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 in order 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 Medicaid enrollment numbers

As of May 2021, total Rhode Island Medicaid and CHIP enrollment was 334,556, which was 75% higher than enrollment had been in 2013.

Looking historically, when Medicaid was expanded in Rhode Island, 64,590 people enrolled in Medicaid through HealthSourceRI between October 2013 and March 2014. Of that group, 34% were already eligible for Medicaid before the program was expanded, but may not have been aware of their eligibility.

Although the federal government is paying nearly all of the cost of covering the newly-eligible population, the existing nearly 50/50 state/federal split in Rhode Island applies to any enrollees who were eligible based on the previous guidelines (note that federal funding for this population has temporarily increased under the Families First Coronavirus Response Act).

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

Rhode Island Medicaid history

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 Medicaid expansion history

Rhode Island was among the states that moved forward with Medicaid expansion as called for in the ACA. Former Governor Lincoln Chafee made it clear immediately after the Supreme Court ruling 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.

In 2013, Rhode Island estimated that about 40,000 new enrollees would gain coverage under the state’s Medicaid program by 2022, most of whom would be newly-eligible due to Medicaid expansion. But the COVID pandemic has driven Medicaid enrollment considerably higher, nationwide. By the end of 2020, CMS reported that 82,223 people were enrolled in expanded Medicaid in Rhode Island. And enrollment has continued to climb since then.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Apply for Medicaid in Rhode Island

Online at HealthSourceRI or, or you can use a paper applicationHealthSourceRI can also help you find local in-person assistance.

Eligibility: The aged, blind, and disabled.  Also, adults with income up to 138% of poverty, pregnant women with income up to 253% of poverty, and children with incomes up to 261% of poverty.

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