As pandemic protections end, R.I. must do more to protect Medicaid enrollees’ access to care

Health care advocates call on the state to improve communication, increase capacity at DHS, and build the network of assisters able to help the state’s most vulnerable residents obtain health care coverage

Workers at a , in Jefferson City, Mo., Medicaid call center review information regarding eligibility determinations on Aug. 16, 2023. Federal Medicaid officials have raised concerns that call center wait times are too long in 16 states, including Missouri and Rhode Island. States are handling an influx of questions after a pandemic-era moratorium on removing people from Medicaid ended this spring.David A. Lieb/Associated Press

For decades, Medicaid has been indispensable to improving the health of hundreds of thousands of low- and medium-income Rhode Islanders, including more than half of Rhode Island’s children. It also provides essential health coverage to pregnant people, people with disabilities, and seniors and reduces racial inequities in coverage and care.

Medicaid helps drive better access to health care; enrollees are more than one and a half times as likely to receive an annual checkup, and less than one-third as likely to skip care due to cost, as are people who are uninsured. Medicaid is also deeply popular – an overwhelming majority of people across the United States support the program.

Fortunately — thanks to years of committed work by non-profit, community, advocacy, and patient organizations in Rhode Island’s Protect our Healthcare Coalition — Rhode Island is among the nation’s leaders in the quality of our Medicaid program. And we continue to make Medicaid more robust and more accessible to those who need it: over the last 18 months we extended coverage to include all financially eligible children regardless of immigration status, and to pregnant people for 12 months after pregnancy – and we recently incorporated coverage for Doula care and abortion care into Medicaid.

During the Covid-19 pandemic, many lost their employment-related health insurance coverage. To protect Americans’ access to health care, the federal government established new – but temporary – rules, ensuring that anyone who gained access to Medicaid kept that coverage throughout the pandemic.

As the pandemic rules end, every state must now recertify the eligibility of every current Medicaid enrollee. As states do so, an alarming number of individuals nationwide are losing the health care they need despite remaining eligible due to overly complex administrative rules and bureaucratic red tape.

Fortunately, Rhode Island is doing many things well. Improved data sharing means the state can automatically renew Medicaid coverage for many enrollees. The state is automatically enrolling Rhode Islanders whose income is slightly too high for Medicaid into a low- or no-cost health plan via the state’s ACA marketplace, HealthSourceRI.

However, more needs to be done. In August, the state reported that as many as 7,000 people have been removed from Medicaid since the recertification requirement started again in April. And many struggle to find help due to wait times at the Department of Human Services (DHS) call center and limited staffing at DHS offices.

We are not alone in our concerns; the federal Centers for Medicare and Medicaid Services (CMS) have expressed their concern with DHS call center wait times and their impact on Rhode Islanders’ access to health care. We encourage the State to find ways to increase DHS capacity, especially as the pace of renewals accelerates into the fall and winter.

Consumers also report being confused or misled by the official renewal notices they receive from DHS. We encourage DHS to work with local advocates to ensure these notices are written clearly and available in multiple languages.

Rhode Island must also continue to build the network of assisters able to help enrollees renew their Medicaid coverage (or obtain other forms of coverage) – particularly for elderly and disabled Rhode Islanders, who face especially challenging coverage transitions while frequently having significant health care needs.

While this period of transition will be difficult, Rhode Island has done much to lessen its negative impact on Medicaid enrollees with significant needs – and by building DHS capacity, working with partners to improve notices, and investing in the network of community assisters, Rhode Island can build on its commitment to a robust, inclusive, and accessible Medicaid system that works for all.

Shamus Durac is the Interim Chair of the Protect Our Healthcare Coalition and Senior Attorney and Health Policy Analyst with RIPIN, a community non-profit that operates Rhode Island’s health insurance consumer assistance program in partnership with the Rhode Island Office of the Health Insurance Commissioner. Nina Harrison is the Policy Director at the Economic Progress Institute, a nonpartisan research and policy organization dedicated to improving the economic well-being of low- and modest-income Rhode Islanders.

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