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Medicaid eligibility and enrollment in Rhode Island

Thousands of people who have lost Medicaid after the pandemic have been automatically enrolled in a HealthSource RI plan


Who is eligible for Medicaid in Rhode Island?

The following residents are eligible for Rhode Island Medicaid based on income (MAGI)1 (note that these limits include a built-in 5% income disregard, as required by the ACA for MAGI-based eligibility):

  • Adults under 65 with incomes up to 138% of the poverty level.
  • Children with household incomes up to 266% of the poverty level.
  • Pregnant women with household incomes up to 258% of the poverty level; eligibility is for Medicaid or CHIP, depending on where the person is in that income range. Doula services are covered. Medicaid coverage for the mother continues for 12 months after the baby is born2)
  • People who are disabled, blind, or 65+ who have low incomes and low asset/resource levels can also qualify for Medicaid (non-MAGI, meaning that there are asset limits as well as income limits)

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 Rhode Island Medicaid?

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.


Federal poverty level calculator



Has Rhode Island expanded Medicaid under the ACA?

Yes, Rhode Island implemented the ACA’s expansion of Medicaid in 2014. Thie means adults under age 65 are eligible for Rhode Island Medicaid with household income up to 138% of the poverty level. In 2024, that amounts to about $20,782 in annual income for a single adult.3

Rhode Island’s Medicaid/CHIP population grew by more than 171,000 people — a 90% increase — from the fall of 2013 through late 2023.4 Nationwide, the average enrollment growth stood at 52% as of late 2023. The increase in Medicaid enrollment stems mostly from Medicaid expansion under the ACA, and the COVID-related ban on Medicaid disenrollments between March 2020 and March 2023.

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, including Rhode Island, receive $9 in federal money for every $1 they spend to provide care for the Medicaid expansion population.

Rhode Island has accepted federal Medicaid expansion

  • 362,020 – Number of Rhode Islanders covered by Medicaid/CHIP as of October 20235
  • 171,187 – Increase in the number of Rhode Islanders covered by Medicaid/CHIP from late 2013 to October 20236
  • 43,027 – Number of RI residents disenrolled from Medicaid as of December 20237
  • 90% – Increase in total Medicaid/CHIP enrollment in Rhode Island since late 20138


How is Rhode Island handling Medicaid renewals after the pandemic?

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 ended March 31, 2023, and states resumed the process of disenrolling people from Medicaid after that.

By December 2023, more than 43,000 people had been disenrolled from Rhode Island Medicaid, while coverage had been renewed for more than 75,000 enrollees.7

Rhode Island created a new protocol that automatically enrolls people in a plan through HealthSource RI if they lose Medicaid and their household income is no more than 200% of the poverty level. And for people up to 250% of the poverty level who transition to a plan through HealthSource RI (including those with income above 200% of FPL who manually select a plan), the state will pay their after-subsidy premiums for the first two months.

By the end of 2023, Rhode Island reported that 8,213 people had transitioned from Medicaid to a private plan through HealthSource RI, including 2,940 who were automatically enrolled (and received the two months of state premium assistance) plus another 2,324 who actively enrolled but qualified for the two months of state premium assistance (the remaining 2,949 actively enrolled and were not eligible for the state premium assistance).7

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 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 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 (Rhode Island also established a state-run exchange/Marketplace).

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.


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 healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

Footnotes

  1. Medicaid, Children’s Health Insurance Program, & Basic Health Program Eligibility Levels” Centers for Medicare and Medicaid Services. December 2023. 
  2. CMS Roundup (Apr. 21, 2023)” Centers for Medicare and Medicaid Services. April 21, 2023. 
  3. 2024 Poverty Guidelines: 48 Contiguous States (all states except Alaska and Hawaii)” U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation. Published January 2024. 
  4. Total Monthly Medicaid & CHIP Enrollment and Pre-ACA Enrollment” KFF. MONTH. Accessed MONTH. 
  5. July 2023 Medicaid & CHIP Enrollment Data Highlights”, Medicaid.gov, Accessed November 2023 
  6. Total Monthly Medicaid & CHIP Enrollment and Pre-ACA Enrollment”, KFF.org, Accessed February 2024. 
  7. Medicaid Renewals Data Dashboard“, State of Rhode Island, Accessed February 2024.   
  8. Total Monthly Medicaid & CHIP Enrollment and Pre-ACA Enrollment”, KFF.org, Accessed February 2024 

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Apply for Medicaid in Rhode Island

Online at HealthSourceRI or HealthyRhode.ri.gov, 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.

Rhode Island section

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