Rhode Island and the ACA’s Medicaid expansion

49% increase in RI Medicaid population; uninsured down to 5.7%

rhode-island Medicaid guide

Medicaid expansion in Rhode Island

Rhode Island embraced the provision to expand Medicaid under the Affordable Care Act (ACA). Federal funding is covering the cost of expansion through 2016, after which the state will begin to pay 5 percent of the expense starting in 2017. The state’s portion of the cost will never exceed 10 percent though.

The state’s total Medicaid population grew by 93,000 people (a 49 percent increase) from the fall of 2013 through July 2016. According to U.S. Census data, the uninsured rate in Rhode Island dropped from 11.6 percent in 2013 to 5.7 percent in 2015. Only six states and the District of Columbia had lower uninsured rates in 2015.

Kaiser Family Foundation estimated that only 55,000 people who were still uninsured in Rhode Island as of late 2015. And nearly half – 49 percent – were eligible for Medicaid.

Medicaid expansion

The ACA called for the expansion of Medicaid to cover all legally-present residents in the US with household incomes up to 133 percent of poverty level (138 percent with the built-in income disregard). But in the summer of 2012, the Supreme Court ruled that states could not be penalized for opting out of the expansion.

Rhode Island is among them. 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). At the time, Rhode Island estimated that there were about 40,610 low-income childless adults in the state who would be newly eligible for Medicaid starting in 2014.

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.

Am I eligible?

In addition to the aged, blind, and disabled, the following Rhode Island residents are eligible for coverage under the expanded Medicaid program:

  • adults with incomes up to 138 percent of poverty.
  • Pregnant women with household incomes up to 253 percent of poverty.
  • children with household incomes up to 261 percent of poverty.
  • Women with household incomes up to 250 percent of poverty 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.

Prior to 2014, non-disabled adults without children were ineligible for Medicaid regardless of their income.  The expansion of Medicaid has been particularly beneficial for this group.

How do I apply?

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:

Or 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.

RI 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.

But may be too restrictive on Hep C drugs

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 – require patients to meet a pre-determined set of criteria before the Hep C drugs can be prescribed. There’s concern however, that states may be 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.

Changing leadership

Rader Wallack served as director of HealthSourceRI (the state’s ACA exchange) for most of 2015. But in October 2015, she was appointed to lead the state’s Medicaid program instead. Rader Wallack began her new role at Medicaid in November 2015.

But less than a year later, in September 2016, she left RI Medicaid for a job at Brown University School of Public Health. Elizabeth Roberts, Rhode Island’s Secretary of Health and Human Services, appointed Deputy Medicaid Directors Deb Florio and Darren McDonald to run the state’s Medicaid program while the state conducts a search for a permanent director.

Eligibility determination system overhaul

Medicaid eligibility in Rhode Island has long been determined by the Office of Health and Human Service’s 25-year-old InRhodes system. In addition to verifying eligibility for Medicaid, InRhodes also determined eligibility for premium subsidies through HealthSourceRI, along with other public assistance programs.

The state began overhauling the InRhodes system in 2013, and had intended to finish the upgrade by 2015. But in October 2015, Rhode Island officials announced that the state received an additional $112.8 million in federal funds to continue upgrading the system, and the project was expected to extend into 2016.

The new system launched in September 2016, at healthyrhode.ro.gov. For the full upgrade, Rhode Island spent a total of $80 million and the federal government will spend a total of about $285 million. But state officials estimate that by 2018, the new computer system will have paid for itself via more efficient operations and effective ways to curb fraud and misuse.

Enrollment progress

64,590 people enrolled in Medicaid through HealthSourceRI between October 2013 and March 2014.  Of that group, 34 percent 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 the full cost of covering the newly-eligible population through 2016, the existing nearly 50/50 state/federal split in Rhode Island applies to any enrollees who were eligible based on the previous guidelines.

This has caused some budget woes in RI, as it has in many other states. The enrollment of a significant number of already-eligible residents is known as the “woodworker” effect (people coming out of the woodwork) and is driven by the publicity and outreach surrounding the ACA’s exchanges and open enrollment.

Enrollment for Medicaid and CHIP are year-round, but tend to spike during the general open enrollment due to outreach from the exchanges. During the second open enrollment period, 65,396 HealthSourceRI enrollees were eligible for Medicaid or CHIP.

Prior to the first open enrollment, the prediction was that 51,000 newly-eligible Rhode Island residents would enroll in Medicaid by July 2015. But by March 2014, 42,320 newly-eligible residents had enrolled – about 83 percent of the total anticipated, more than a year ahead of schedule. By July 2016, total Medicaid/CHIP enrollment in Rhode Island was 49 percent higher than it had been in late 2013. Net enrollment had climbed by 93,000 people, including both the “woodworker” and newly-eligible populations.


In early 2015, Governor Gina Raimondo established the Working Group to Reinvent Medicaid, tasked with presenting innovative recommendations to modernize the state’s Medicaid program and increase efficiency. Their recommendations were unveiled in April, and included $85.5 million in state savings. Most of the group’s recommendations (amounting to $70.5 million) were included when Raimondo created the state’s health and human services budget for the 2016 fiscal year.

Medicaid spending is a significant portion of Rhode Island’s state budget. $1.9 billion of the state’s $8.5 billion budget was allocated for Medicaid in 2014, and the state announced in April 2014 that the cost of providing Medicaid coverage in the 2015 fiscal year would be $52 million more than originally anticipated.

When the budget was released for the 2016 fiscal year that began in mid-2015, it included $2.3 billion for Medicaid. Officials announced in October 2015 that they expected a relatively small Medicaid budget deficit for the 2016 fiscal year: $5.7 million, which is only a quarter of one percent of the state’s current $2.3 billion Medicaid budget. And although the FY 2016 budget included more than $70 million in cuts to the Medicaid program, officials noted that the state wasn’t quite on target to meet all of the spending cut goals, and would possibly miss the savings mark by up to almost $11 million in the 2016 fiscal year.

But in good news, the federal government is currently fully covering the cost of providing care to all of the newly-eligible enrollees, and will continue to do so through the end of 2016. That is pumping hundreds of millions of dollars into the state’s economy, and the federal government’s share for this population will always be at least 90 percent.

Medicaid history in Rhode Island

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 providers in the state. RIte Care is for pregnant women and children, and utilizes UnitedHealthcare Community Plan of New England 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.

How to apply in RI

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

General overview



Medicaid Expansion

Short Term Availability