Changes are coming to Medicaid that could put some Rhode Islanders’ health coverage at risk. Nine Brown University School of Public Health students are preparing to help local Medicaid recipients navigate those changes.
The People, Place and Health Collective at Brown will be launching a Medicaid Student Fellows program to provide outreach to educate the public ahead of the changes to Medicaid in President Trump’s “One Big Beautiful Bill Act,” passed by Congress and signed into law in July 2025.
More than 30,000 Rhode Islanders could be affected. The team will focus on unhoused people, those with substance use disorder or in recovery, immigrants and refugees, and students, according to Abdullah Shihipar, a research associate associate and narrative projects lead at the collective.
Shihipar said the team is planning to canvas businesses, houses of worship, and community centers, make presentations, and host tables at clinics and drop-in sites to share information about Medicaid.
He was interviewed by the Globe about the program.
Can you describe the work that the Stay Covered R.I. Medicaid Fellows Outreach program will be doing?
Shihipar: We have nine student fellows who will be going out into the community and working with community members to ensure that they can either stay covered through Medicaid, or that they can find alternative options for care when that is not possible. This project involves both education and direct assistance. Our fellows will be letting people know about the changes that are happening or have happened already.
In the case of non-citizens who have lost Medicaid, that change happened on Oct. 1. For the Medicaid expansion population, that population will be subject to work requirements starting January 1.
How will these changes impact individuals and organizations?
People might get a notice in the mail that tells them, “We weren’t able to renew your Medicaid. You you need to show X-Y-Z,” and so our students can help people understand that, and help walk them through a notice that they may not understand, and other sorts of changes that they may not understand.
These changes are going to create more paperwork for both individuals and organizations, and so our students have become certified application counselors in the state of Rhode Island, and therefore they’re able to directly help people with their applications and their renewals.
It’s telling people about changes and listening to their own personal circumstances and communicating about how the changes might affect them personally.
How is the outreach program funded?
It’s a project through the Executive Office of Health and Human Services for the State of Rhode Island. It’s a joint initiative, so some funding comes from the School Public Health and some from EOHHS.
Where will students be offering help?
They’ll be at Dorcas International, they’ll be at Refugee Dream Center, they’ll be at a number of Brown University Health locations, they’re going to be at Amos House, which is a provider of services for unhoused people. Project Weber/RENEW, CODAC Behavioral Healthcare, which is the treatment center. They will also be at initiatives called Shower to Empower, which is run by House of Hope CDC, where they go and provide mobile showers for folks. We will have students in Woonsocket, as well as Clínica Esperanza in Providence.
What was the selection criteria for the student fellows providing outreach?
We got a lot of interest, with 45 applicants for nine positions. There were many students who had some sort of outreach experience working with people, and that’s a key component of this project.
One student had helped uninsured patients navigate care, another student did outreach on HIV and COVID-related issues. We had a number of students who worked with unhoused people in particular, especially because that group is one that is going to be most affected by these changes. We had some students who did street medicine to unhoused individuals on the street. We have students who can speak Spanish and Portuguese on health care issues.
Public health is fundamentally about people: Are you good with people? Do you have experience working with them? Across our cohort, we have students who have stepped up to the challenge and been successful in reaching people.
What is changing for Medicaid recipients in Rhode Island?
There were changes to non-citizen eligibility on Oct. 1, and what that means is for most non-citizens and green card holders — or people who don’t have have a green card, or are not US citizens — most of them are now ineligible for Medicaid, and not receiving Medicaid anymore.
For instance, people who have been granted asylum, people who have been granted refugee status, special immigrant visa holders from Afghanistan, Syria, and Iraq, victims of domestic violence, people have special visas, where they may be particularly marginalized, they are no longer eligible for Medicaid. So it’s basically most visa holders who were previously eligible, are no longer eligible, and that has created issues.
Are those federal- or state-mandated changes?
Medicaid is federally funded but implemented by the states. And to get the funding, Rhode Island Medicaid has to comply with changes that were in H.R. 1 (One Big Beautiful Bill Act). So that was a federally mandated change that the state has to implement.
Are there individuals this bill may not impact?
People who are under 19, regardless of immigration status, can still get care since they get Medicaid, and pregnant women throughout the duration of their pregnancy, as well as 12 months in the postpartum period.
The other bucket is work requirements. Work requirements applies to childless adults age 19 to 64. So above 65, work requirements don’t apply to you. If you have kids, work requirements don’t apply to you.
There’s also going to be change in how often they renew their Medicaid. It’s going to be twice a year, instead of once a year. What they’re requiring for work requirements is that you either make more than $580 a month, or you have to meet 80 hours of a combination of qualifying activities. Those can be employment or they can be certain forms of unpaid work, like if you are in an apartment and help the superintendent with certain tasks in exchange for reduced rent, that would count. Volunteering for a certified nonprofit would count. If you are recognized as a part-time student by an accredited institution, that also counts.
Why should these changes to Medicaid concern Rhode Islanders who may not be directly affected?
These sorts of changes can be disruptive to the health care system as a whole, because when someone loses Medicaid, that is lost dollars for the health care system and that becomes uncompensated care, that becomes bad debt, which then is a burden for hospital systems and creates broader ramifications for health care as a whole.
It’s easy to see this as “Oh, that only affects people on Medicaid.” ... But the implications can have huge, pretty disruptive implications on the health care system, and that’s why I think it’s important for people to know just in general that this thing is going on.
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Carlos Muñoz can be reached at carlos.munoz@globe.com. Follow him @ReadCarlos and on Instagram @Carlosbrknews.