Transitions from Medicaid to QHP: Financial Help Available through HealthSource RI


Return of Medicaid Renewals

Before the COVID-19 pandemic, people enrolled in Medicaid had their eligibility reviewed every 12 months. This is called “Renewal” or “Redetermination.” During the pandemic, the federal government paused these eligibility redeterminations for Medicaid recipients. However, yearly Medicaid renewals will resume starting in April 2023. People who received Medicaid before the pandemic are familiar with the yearly renewal process. However, people who enrolled in Medicaid for the first time after March 2020 will experience the renewal process for the first time.

HealthSource RI has a Medicaid to QHP Transition Program to help people stay covered if their Medicaid coverage is ending. This program has a few components, including auto-enrollment for certain customers, and two months of premium payment for those and other customers. Even if you don’t qualify for these special programs, federal tax credits can help you afford coverage through HealthSource RI if you aren’t offered affordable coverage elsewhere.


If you have questions about the return of Medicaid Renewals, please visit



60-Day Special Enrollment Period Available for Medicaid Terminations

As Rhode Island’s state-based marketplace, HealthSource RI (HSRI) offers Special Enrollment Periods (SEP) for residents who have experienced a Qualifying Life Event (QLE). Residents whose Medicaid coverage ends are eligible for a 60-day Special Enrollment Period to apply for coverage through HealthSource RI. This is available prior to loss of coverage and for 60 days after loss of coverage. Additionally, if someone in this group does not apply through HealthSource RI in that initial period, they may open another 60-day SEP by updating and resubmitting their application at any time between March 31, 2023 and June 30, 2024.

Outside of termination from Medicaid, any other QLE still applies for eligibility to enroll in a plan. For more information about HSRI’s Special Enrollment Period or other ways you could be eligible to enroll, visit



Coverage through HealthSource RI is Now More Affordable than Ever!

HealthSource RI is Rhode Island’s official health coverage marketplace, which means we are your only source for getting financial assistance to help lower your monthly coverage costs. We connect Rhode Islanders to health plans that meet their needs and their budgets. Currently, 6 out of 7 of our customers receive financial assistance, in the form of Advanced Premium Tax Credits (APTCs) to help lower their monthly coverage costs. In 2022, over 30% of our customers were paying less than $20 per month for their coverage. And thanks to federal action, health coverage through HSRI is now more affordable than ever! Historically high tax credits will remain in effect until 2025.



HealthSource RI’s Auto-Enrollment Program and Premium Assistance

It’s essential that Rhode Islanders retain health coverage as Medicaid renewals start again. In support of that goal, HealthSource RI, in collaboration with Governor McKee, has instituted the Auto-Enrollment Program. The goal of this program is to help residents avoid unnecessary gaps in health coverage that could occur when Medicaid renewals commence for the first time in over three years.

The Auto-Enrollment Program connects Rhode Islanders who are terminated from Medicaid with health coverage through HealthSource RI. Those eligible for auto-enrollment will be enrolled in a silver health plan. Silver health plans have very low premium payments and allow individuals to access the reduced out-of-pocket costs of a Cost-Sharing Reduction plan. Eligible individuals will be able to enroll in a Qualified Health Plan (QHP) with financial support to cover the first two months’ premiums. This support is provided by the State of Rhode Island’s federal American Rescue Plan Act (ARPA) resources. These federal resources, combined with the already available and historically high level of tax credits made possible by ARPA, helps keep health coverage accessible.

  • Those at less than 250% of the federal poverty level (FPL) (for instance, $33,975 for an individual or $69,375 for a family of four) are eligible for federal premium tax credits and Rhode Island’s two months’ premium assistance, ensuring a zero-cost transition to coverage through HSRI. They will have to pick a plan and enroll through HSRI.
  • Those at less than 200% FPL ($27,180 for an individual or $55,500 for a family of four) are eligible for the federal premium tax credit and two months’ premium assistance. They will be automatically enrolled into a designated plan through HSRI.

Individuals will have 60 days to change their plan or disenroll from their plan in the program.

Individuals who are automatically enrolled in a qualified health plan (QHP) will also be eligible for the 60-day Special Enrollment Period. They will have sixty days from the end of their Medicaid coverage to select a different health plan from the one they were automatically enrolled in or retroactively disenroll. During this Special Enrollment Period, individuals may also select and enroll in a dental plan, if needed, and may be eligible for additional premium payments through this program for their dental coverage.

This initiative is critical to ensure Rhode Island’s families continue to have access to quality health coverage and do not experience gaps in health coverage when Medicaid recertification begins. Having quality health coverage will also help ensure that people enrolled in this initiative can avoid high medical billing costs they might otherwise face if they were uninsured.