PROVIDENCE, R.I. (WPRI) — Thousands of Rhode Islanders have been kicked off Medicaid following a recent shift in federal policy, and state leaders expect the number will grow even as they have limited insight into where else recipients might be getting health coverage.
The state reports about 7,000 Rhode Islanders have been removed from the federal-state health insurance program since a recertification requirement started again in April.
R.I. Medicaid Director Kristin Sousa said about 1,100 of those people have shifted over to the state-based health exchange, HealthSource RI, where they’re receiving heavily subsidized private insurance called “qualified health plans.”
What’s more difficult to discern is where the remaining 5,900 people are going to get health insurance — if at all. State officials are hopeful many of them are getting coverage through employers or other private entities, but currently there’s no way to track what’s happening.
“We do not have the ability to know who went to private insurance outside of the qualified health plans,” Sousa told Target 12. About 5,000 of the people removed from the rolls so far qualify for the subsidized health insurance plans, but haven’t connected with HealthSource RI, she said.
And the number of people losing Medicaid coverage is only expected to rise, as each month the state goes through the recertification process with a new cohort of recipients.
Rhode Island’s Medicaid enrollment ballooned to more than 350,000 people — about a third of the state’s population — during the coronavirus pandemic, as the federal government offered states extra money if they kept people continuously covered.
Before the pandemic, Medicaid recipients had to provide information each year showing they still qualify for the program, and state leaders projected earlier this year roughly 25,000 Rhode Islanders could lose the insurance after 12 months of recertification. Sousa said so far the state is on track with that projection.
Sousa said the shift in policy so far has gone relatively smoothly, which is welcome news to state officials who were bracing for a massive influx of service calls, questions and confusion.
“For the first few months, it has gone fairly well,” Sousa said. “We have had a bump or two in the road.”
The bumps have mostly involved mistakenly including a Medicaid recipient in the wrong cohort, which Sousa said has happened when they’ve been erroneously identified as childless. The biggest chunk of people getting kicked off the roles will likely happen between December and March when households with children are slated to go through the process.
The health research organization KFF reports the Rhode Islanders removed from the rolls so far represents about 22% of the people who have gone through the process, which is tracking lower than national trends. Roughly 4.1 million Medicaid enrollees have been disenrolled across 42 states and Washington, D.C., representing 39% of the people who went through recertification in those states, according to KFF.
Arguably the best indicator of how many people are completely losing health insurance will show up in the state’s uninsured rate, which last year totaled 2.8% in Rhode Island compared to 8% nationally.
“Our overall goal in this is not to just do Medicaid redeterminations,” Sousa explained. “The goal is to keep our uninsured rate as low as possible.”
But state leaders won’t likely know the full effect of recertification on the uninsured rate until next fall, as it will take a full year for all 350,000 Medicaid recipients to go through the process. The state typically does a health survey showing a snapshot of statewide coverage rates once per year.
“I’m not sure we have a sense of where it will end up,” Sousa said.
One of the biggest challenges before and since the renewal process began has been call wait times. The R.I. Department of Human Services fields a large swath of service calls related to Medicaid coverage, and most recently the average wait time totaled 45 minutes.
“The wait times are still way too long,” Senate Finance Committee Chairman Lou DiPalma told Target 12.
DiPalma has been watching the recertification process closely — both in his current role and his previous positions in committees with ties to human services and oversight. The Middletown Democrat also expressed concern over staffing levels at the call centers, which continues to be an issue challenging the state.
Sousa agreed that a 45-minute wait time is too long for Rhode Islanders seeking services, and she said they have been trying to fill vacant full-time positions for several months. But hiring has been tough, she said, and the state has even resorted to transfers in workers from other parts of state government.
“We still have some hiring to do,” she said.
But overall, DiPalma said he hasn’t heard too many complaints from his constituents about the process so far, which he said is a good indication of how it’s been going. And Sousa said the positive aspects of the recertification effort so far are a testament to the state’s aggressive outreach both though community partner organizations and health insurance providers that manage Medicaid plans.
“Rhode Island is doing better than most states,” Sousa said. “What we are hearing nationally is that there are several states that are struggling with this process.”