Transitioning from Medicaid to a Qualified Health Plan
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 https://staycovered.ri.gov.
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 https://healthsourceri.com/sep.
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.
Frequently Asked Questions:
Who is eligible for auto-enrollment?
Most individuals and families who fit the following criteria will be eligible for auto-enrollment and two months’ payment through the Medicaid to QHP Transition Program:
- Your Medicaid coverage is ending
- You don’t have access to other coverage from an employer or elsewhere
- Your household has an income below 200% of the federal poverty level. Make sure your income is up to date in your application.
200% of FPL for 2023 coverage
I was auto-enrolled. Do I need to do anything?
First, make sure your income and other application information is correct in your account. If it is out of date, your tax credits may not be accurate, and you might have to reconcile them later on your tax return. Second, you may want to browse other plans or add dental coverage. See the following questions for more information on coverage, changing plans, and adding dental.
I was auto-enrolled. Is dental coverage included in my plan?
No, you have not been automatically enrolled for a dental plan, BUT you can browse our plans and add one. The two months’ premium assistance applies to dental plans as well. Please note that tax credits do not apply to dental, so you will be responsible after the first two months for the full premium payment.
I was automatically enrolled in a plan, but I’d like to learn about different health plans. If I want to, how do I change plans?
HealthSource RI offers plans from multiple insurance companies, and you may choose to switch to a plan with another company within this program. Visit HealthSourceRI.com/Calculator to view your options.
To change your health plan, please call 1-855-840-4774 for assistance or click here to learn about other ways to get help. If you would like to enroll in a different plan or add dental coverage, you may do so no later than 60 days from the day your Medicaid coverage ended.
I was automatically enrolled in a plan but do not need this health coverage. How do I disenroll from this program?
To disenroll from health coverage through HSRI, visit HealthyRhode.RI.gov or call us at 1-855-840-4774.
- If you do not need or do not want this coverage, you must opt-out no later than 60 days from the day your Medicaid coverage ended. Failure to do so may result in tax liability or premiums owed to the carrier.
- Keep in mind that health insurance is required in Rhode Island. See our website for details.
I was auto-enrolled after the end of my Medicaid coverage. Does my HealthSource RI plan cover abortion services?
Those who were auto-enrolled were put into one of two versions of the Neighborhood Value plan. Depending on income, it might be the CSR 87 or CSR 94 version of that plan.
Neighborhood Value does not cover abortion except in very limited circumstances. However, there are plans available that include coverage for abortions. Keep in mind that copays, deductibles, and monthly premiums vary for each plan, so consider these when looking at all HSRI plans.
Those who were auto-enrolled have a 60-day opportunity to switch plans after their coverage start date, and that plan change can apply retroactively if desired. When viewing HSRI materials or picking a plan online, plans that exclude most abortion coverage have an asterisk (*) before the name. Plans without an asterisk include coverage for abortion services.
Am I eligible for my first two months with HSRI to be paid?
You may be eligible for medical and dental coverage through HealthSource RI with payments to cover the first two months if:
- You were recently disenrolled from no-cost coverage through RI Medicaid
- You don’t have access to other coverage from an employer or elsewhere.
- You are part of a household with an income below 250 percent of the Federal Poverty Level (FPL). Make sure your income is up to date in your application.
250% of FPL for 2023 coverage
I am eligible for the state payment program. Will the State pay for any plan I choose?
Yes, the State will pay for two months of any health and/or dental plan you choose. However, be sure to pick one that you can afford when you need to make payment after the first two months. To get the coverage activated quickly, you may make your own first payment. This will not reduce the payment the State will make. It will be applied as a credit toward your next month(s). The state payment might be a little less than two months of premium.
Why is the state payment a little less than two months of premium?
If you enroll in a plan yourself (other than an auto-enrolled plan) and are eligible for our payment program, there may be a small amount not covered by the state payment. Most medical plans in RI have some benefits that go above and beyond what’s defined in RI as the Essential Health Benefits (EHB). These extra non-EHB benefits generally are not subject to federal tax credits or eligible for payment under HSRI’s payment program. This may leave you with a small amount to pay, in the range of $0.10-$3.50 per person per month.
Does this premium assistance program apply to dental coverage as well?
Yes, the State of Rhode Island will also cover the premium payments for two months of dental coverage for individuals eligible for the Medicaid to QHP Transition program. You must choose dental coverage to have it. It is not part of auto-enrollment.
When does the State make payments for coverage?
The State will make payments once per month, shortly after the 18th of the month. The State will pay for both months of medical/dental (if selected) premium together. If you change plans or add a dental plan after payment was made, there might be a second payment to cover the difference.
What if I don’t need the coverage, or I choose less expensive coverage, but the State has already paid? Do I owe money back?
If you don’t need the coverage, please cancel it. You don’t need to do anything to pay back the money if a payment was already made. If the money is unused on your account, HSRI may recover it directly later.
What happens if I made a payment before the State could pay?
If you already made a payment before the State did, the State’s payment will be applied as a credit toward the next month.
What happens if the State makes a payment, but I don’t continue payments? Am I at risk of owing tax credits to the IRS?
Once you fall behind on payment, you have a grace period to catch up. If you don’t catch up, your coverage will be terminated. You may owe your insurance carrier for unpaid month(s) of coverage. When you file taxes, you may have to pay back tax credits paid on your behalf for month(s) where you didn’t make a payment. These tax credits can be significant. If you don’t need or can’t keep your coverage, please tell us as soon as possible to avoid owing money later.
What should I do if I would like to keep my coverage after the initial 2 months?
First, make sure your income and other application information is correct in your account. If it is out of date, your tax credits may not be accurate, and you might have to reconcile them later on your tax return. After the second month of coverage, enrolled customers should be aware that they must make premium payments billed in future months to stay covered. Premium payments are due on the 23rd of each month. Your invoices will tell you the amount you owe and when it is due.
Other Coverage Questions
I wasn’t auto-enrolled, but I need coverage. How do I enroll?
Depending on your income and access to other coverage, you may still be eligible for our payment program. Even if you do not qualify for the payment program, you may still be eligible to enroll in health coverage with financial assistance through HealthSource RI. To get a quick quote and see how much financial assistance you may be eligible for, visit HealthSourceRI.com/Calculator. (The calculator will show you your monthly premium, but it will not tell you if you are eligible for two months of premium payment). To enroll, visit HealthyRhode.RI.gov, call us at 1-855-840-4774, or click here to learn how you can get enrollment assistance.
Why is it important to update my income and other account information?
If your income or other information, particularly access to other coverage, is out of date, your tax credits may not be accurate, and you might have to pay some or all of them back later when you file taxes. Also, if your information is out of date, you may not be receiving all the financial assistance you could be. Please update your account to make sure you don’t get too much or too little assistance.
My Benefits Decision Notice said my Medicaid coverage is ending, and I qualify for no tax credits. I need coverage. Is that right? What can I do?
First, make sure your application information is complete and up to date. Certain application questions, such as whether you give consent for us to obtain and use information from other sources to verify your eligibility, can disqualify you from tax credit assistance. Once you update them, you may be eligible.
Once you’ve updated your application, there are still some reasons you may not qualify for tax credits. Income that is too high or access to other coverage are common reasons. Contact us if you still need assistance in determining why you do not qualify. If you are still ineligible for tax credits, you can still buy a plan through HSRI at full cost if you choose.