R.I. releases updated Medicaid enrollment figures after completing renewal process

Outreach efforts for Medicaid renewals during the unwinding process attempted to reach multilingual audiences. Seen here is a Spanish language billboard at the intersection of Page and Pine streets in downtown Providence in May 2024. It reads 'Do you have Medicaid coverage?' (Alexander Castro/Rhode Island Current)

Nearly 75,000 people were removed from Rhode Island Medicaid after the state completed its annual redetermination process for the low-cost public health insurance program in May. That number represented about 20% of the people who were up for renewal for the first time since the COVID-19 pandemic.

But a quarter of people terminated from Medicaid during what is known as the “unwinding” process were able to continue their coverage with a qualified health plan from HealthSource RI, the state’s health insurance marketplace. Half of the people eligible for advance premium tax credits, which lower plan prices, enrolled during the transition.

“This is a testament to the collaborative approach we took in Rhode Island and our shared goal of keeping Rhode Islanders connected to health coverage,” said HealthSource RI Director Lindsay Lang in a statement Thursday when the Rhode Island Executive Office of Health and Human Services (EOHHS) announced the results of the year-long unwinding process.

“We are now at a record-high of 43,000 enrollments, a milestone that speaks to the vital resource we provide to those who need coverage and don’t have it through their employer.”

People who are on Medicaid typically need to renew their coverage annually. The federal government paused the need for renewals in March 2020 at the start of the COVID pandemic, requiring states to provide continuous coverage even if enrollees could no longer meet the personal income eligibility requirements. The continuous enrollment clause ended in April 2023, and states were given a year to resume normal Medicaid enrollments via the unwinding process. That meant people could lose their Medicaid coverage for the first time since 2020.

Medicaid enrollees account for about a third of the state’s population. Of the 80% of enrollees who kept their coverage, most didn’t have to submit anything at all. An average of 59% of renewals from May 2023 through April 2024 were completed automatically, with existing state information used to maintain coverage if the person was still eligible. Rhode Island ranked second in automatic renewals, in one nationwide data analysis from KFF , after North Carolina.

“All Rhode Islanders deserve access to health insurance and necessary covered services that help keep them and their families healthy and economically secure,” said Kristin Sousa, Rhode Island’s Medicaid director, in a statement. “I’m particularly proud that Rhode Island consistently led the nation in our passive renewal rate, which means that more than half of our members had their coverage renewed automatically based on information we had on file for them.”

The Medicaid Renewals Data Dashboard was updated at the beginning of July and supplies recent numbers on the state of Rhode Island Medicaid. In April 2023, 370,606 Rhode Islanders had Medicaid coverage. By June 2024, the number of people enrolled was 314,815.

People were slated for renewals at different times, but the last month of unwinding, April 2024, saw 55,903 renewals, the most of any month since May 2023, as well as the month with the most “active” renewals overall (which require that people send in updated information.)

Critical to this effort was a piece of mail that Medicaid enrollees were asked to return if they had outdated eligibility information on file. When enrollees need additional information to verify eligibility, the state’s Medicaid agency will mail out a packet requesting information. Failure to return the packet can result in loss of coverage, called a procedural termination.

According to the KFF data breakdown , procedural terminations accounted for 75% of Rhode Island’s disenrollments over the course of unwinding, a little higher than a national average of 69%. Eleven states and the District of Columbia had rates above 80%. Nevada and Utah had the highest rates of procedural termination among disenrollments, comprising 93% and 92%, respectively.

“Initially, I had concerns that when the State resumed processing renewals, systemic issues might arise. However, this was not the case,” said Rep. Tina Spears, a Charlestown Democrat who is the executive director of the Community Provider Network of Rhode Island, which advocates for providers who support people with disabilities, in a statement.

“The state did an excellent job preparing for the…unwinding and handling renewals promptly. I am proud to live in a state that makes every effort to ensure residents remain covered by health insurance.”

Unlike states where Medicaid largely serves children and the elderly, Rhode Island’s expanded Medicaid provides coverage to people without children who make below 138% of the Federal Poverty Level . People ages 18 to 64 accounted for the largest demographic of Rhode Island Medicaid recipients in June 2024, according to the state’s renewal dashboard .

In May 2024, Providence alone accounted for nearly 31% of enrollees, with 98,580 Medicaid recipients in the capital city. Pawtucket had 32,706 enrollees and over 20,000 Medicaid enrollees in Cranston and Woonsocket. Twenty-one of the state’s 39 municipalities were home to 1,000 to 5,000 Medicaid recipients.

‘All-hands-on-deck’ helped state Medicaid unwind

“The public health emergency unwinding represented a massive undertaking for States and their Medicaid Programs, including here in Rhode Island,” said EOHHS Secretary Richard Charest in a statement. “This was an ‘all-hands-on-deck’ effort.”

To promote public awareness of the unwinding process, the state invested in billboards in downtown Providence among other outreach efforts urging Medicaid recipients to check the status of their coverage. The Stay Covered website, which contains more information on Medicaid renewals as well as the renewal data dashboard, saw 88,668 unique visitors as of May, said EOHHS spokesperson Kerri White. Rounds of mini grants earlier this year — $320,000 across 28 community organizations  — helped with outreach efforts about renewals to diverse communities.

The state’s managed care organizations — Neighborhood Health Plan of Rhode Island, Tufts Health RITogether Plan and UnitedHealthcare Community Plan — help to deliver Medicaid services and coverage and conducted outreach with 71,000 direct mailings, 322,000 outbound phone calls, 35,000 emails, 170,000 text messages and 767 events in outreach efforts during unwinding.

Rhode Island Medicaid’s mobile platform, the HealthyRhode app , was first uploaded in 2020 but played an increased role in the promotion efforts with a two-month-long campaign that encouraged self-service renewal options through the app. The app has 12,800 monthly users and, during unwinding, saw 18,000 documents uploaded. The app is highly rated on both Apple’s App Store and Google Play , with a 4.8 and 4.3 on each store, respectively.

That’s compared to 3.7 stars for Massachusetts’ human services app , which might serve as a source of pride given how often Rhode Island compares itself to its neighbor.

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