Medicaid Renewal Basics - �Helping Families Stay Covered

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Linda Katz, Esq.

Consultant, Protect Our Healthcare

January 23, 2024

Medicaid Renewals: “Return to Normal”

• Usually Medicaid recipients need to renew coverage once/year.
• During the pandemic, renewals were suspended so that people didn’t lose critical coverage.
• In April, as required by CMS, the state began Medicaid renewals again, starting with elderly/people with disabilities and people age 19 – 64. This has been called “Return to Normal Operations” (RTNO).
• Renewals for households with children started in December (to renew by end of January) and will continue through March (to renew by end of April). This includes children enrolled as Katie Beckett.
• People enrolled in SSI are not part of this RTNO. Their Medicaid is linked to their receipt of SSI.

Four cohorts for family renewals

Find the month in which the family is likely to receive the renewal packet

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• Check the anticipated renewal date in the online account: healthyrhode.ri.gov.
• Person needs to know their user name and password.
• Use the quick look-up tool: www.ri.gov/EOHHS/Medicaid_renewal.
• Person needs to know their Medicaid ID number – it’s on their white Anchor card under “MID” - and their date of birth.
• NOTE: The date is the date of their renewal month. The month in which they will receive the packet is the MONTH BEFORE.

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The good news – administrative renewal

Many families will be renewed “administratively” (sometimes called “passive renewal”). If the information in their renewal form is correct, they do not need to do anything and coverage will continue.

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Around 50% of renewals are administrative renewals.

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For children, the administrative renewal rate is estimated to be between 80 – 90%.

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If there is information that is not correct, the person writes in the correct info, signs the form (p. 9 or 10) and returns it.

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Note: If the renewal is for both Medicaid and SNAP, the form needs to be filled out and returned, even if Medicaid will be auto-renewed, because SNAP is not auto-renewed.

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Active Renewal

If the notice says: Action Required, the person needs to read through the form and write-in changes.

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Then sign the form (p. 9-10) and

return it within 30 days from the date on the top of the notice and at least by the 10^th of the next month.

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They may also receive a separate notice called “Additional Documents Required” telling them what verification they may need to submit.

Mixed Household Renewal �Child – administrative renewal�Parent – active renewal

Parent coverage scheduled to end

Child’s coverage will continue

Family of 2 with income of $4,000/month. Parent not eligible (assuming income that state used is correct). Child is eligible.

Income limit for parent: $2,317

Income limit for child: $4,317

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The Process in Pictures

Renewal notice arrives – in the beginning of the month, in our example,

January 3. If all in family = passive renewal – all set. If active renewal watch for ADR.

The Process in Pictures

This notice is sent in the beginning of the second month… In our example, (renewal sent in January) the person will receive this notice in February, if an active renewal and/or documents haven’t been received.

This notice is sent when DHS has received the renewal packet on time. Note: “until you hear from us, your coverage remains active”.

Submitting the Renewal Form and Documents

• Bring to a DHS Scan Center between 8:30 and 4:00
• 1 Reservoir Ave., Providence
• 249 Roosevelt Ave., Pawtucket
• 125 Holden St., Providence

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• Submit at a DHS Office. Ask for a receipt.

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• Mail to DHS. (For documents, make copies and mail with p.4 of the ADR). PO Box 8709, Cranston, RI 02920.

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• Documents requested in an ADR can also be uploaded to the customer portal or through the HealthyRhode Mobile App.

The Process in Pictures

Decision Notice – will arrive around the 15^th of the second month – February. This is a notice that benefits will continue

Even though the next page says: ”there has been a change”….

The Process in Pictures

Medicaid is being terminated…but the person is eligible for coverage through HSRI

There may be different outcomes for children and parents

Good News: Some People No Longer Eligible for Medicaid due to Income get help paying for Coverage through

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• People who do not have affordable coverage from their employer can enroll in a Qualified Health Plan (QHP) through HSRI and receive help paying their monthly premium.

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• If the person’s income is below 200% of the federal poverty level (FPL) they will be automatically enrolled in a QHP and their monthly premium will be paid by the state for 2 months. (They will be enrolled in an NHPRI plan, but can change if they wish.)

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• If income is between 200 and 250% FPL, they need to sign up on their own, and the state will pay their monthly premium for 2 months.

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Income Limits for Children, Parents and� Adults age 19 – 64 (income limits increase Jan. 2024)

1. Juanita and daughter Jen receive Medicaid. They enrolled in May, 2020 after Juanita lost her job. She went back to work in Jan. 2022, earning $4,000/mo. At renewal, Jen will stay in Medicaid and Juanita will be automatically enrolled in a QHP.
2. Reeva has two children, Tasha (14) and Kyla (19). At renewal, eligibility for Reeva and Tasha will be measured against the Medicaid limits for parent and child. Kyla’s eligibility will be measured against the MA Adult Income limit.
3. Tom and Terri are married and have a son, Micky. Micky turned 19 in November, 2022. At renewal, the Medicaid income limit for Tom and Terri is $2,268, and for Micky it is $1,677 since eligibility is measured against the MA Adult income limit for all. They will be eligible to enroll in a QHP and receive federal assistance to pay their premiums. Depending on their income, they may be eligible for state premium assistance and auto enrollment.
4. NOTE: If a person is pregnant at renewal, they should check the box on the renewal form and submit it since the income limit for a pregnant person is much higher than that for a parent or adult. In Juanita’s example – the income limit as a pregnant woman is $5,551 (family size of 3) instead of $2,317.

”Mixed status” families…

A brief summary of immigrant eligibility for Medicaid:

• All children in Rhode Island, regardless of immigration status, are eligible for Medicaid/RIte Care if they are otherwise eligible. This includes children who are undocumented and also lawfully present resident (LPR) children without a waiting period, refugees, granted asylum and a number of other categories.
• Parents/adults are eligible if they are an LPR in status for 5 years, refugees and persons granted asylum and other limited categories.
• Pregnant persons are eligible regardless of status.
• A parent can apply for coverage for their eligible child need to provide their income but do not need to provide any other information about themselves.
• During the Trump administration, anti-immigrant rhetoric and restrictions on eligibility for some public benefits made many immigrants – lawfully here and otherwise – fearful of applying for benefits to which they (and/or their children) were entitled. “The chilling effect”.
• Let’s make sure that when these families come up for renewal, they do not hesitate to renew coverage for their eligible children.

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A little more Good News

• After this RTN renewal, families will be renewed one year after the month in which they are renewed now.
• Changes during that year can result in changes to eligibility. For example, if the parent starts to earn more money.
• BUT:
• Beginning January, 2024 all children (under age 19) enrolled in Medicaid have continuous coverage for a year.
• Changes that happen during the year will not affect the children. So, even if the family income changes, the child will not lose coverage.
• Kids Count and partners are seeking to pass legislation that would provide continuous coverage for young children up to their 6^th birthday.

How Can I Help Families Keep Coverage?

• Check that the family’s address and contact information is up-to-date. If not, help them update by:
• Calling HSRI. 1-855-840-4774
• Calling their managed care plan (number on back of card)

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• Check the family’s renewal date through the ‘look up portal’ www.ri.gov/EOHHS/Medicaid_renewal. Remember – the date the renewal packet will come is the month before this date.

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• Keep track of the date the renewal packet will come and remind the family to be on the lookout for the envelope with the yellow form showing in the window. (Put a note on the family’s fridge – other ways you can help the family keep track of when to look for the renewal packet…)

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How Can I Help Families Keep Coverage?

• Check in with the family in the renewal month. Help them understand the renewal notice – whether “Happy Path” of administrative renewal or the need to take action. For some families, the children will be auto renewed, but parents need to submit information.
• Help them complete renewal or refer to a community assister who can help:
• Certified Application Counselors
• Navigators
• https://staycovered.ri.gov/get-help-your-medicaid-renewal/get-help-person
• The MCO may also be able to help. Call the number on the back of the MCO card

Watch for: families in which child has turned 19; child was in foster care; lost SSI coverage, mixed-status families. Contact RIPIN if notices or coverage are unclear. 270-0101

THE HSRI CALL CENTER (AND NOT THE DHS CALL CENTER) IS THE ENTITY TO CONTACT FOR QUESTIONS AND ASSISTANCE. 855-840-4774

What if a family loses coverage because they didn’t complete renewal?

• If the family receives a notice that their Medicaid will end because they didn’t complete renewal:

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• If they submit the renewal form and documents by the end of the renewal month, the family should be reinstated pending DHS ‘working the case’ and should be reinstated to their managed care organization (MCO).

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• If it’s after the renewal month, the person has 90 days from the date coverage ended to submit the renewal form and documents. DHS will review the case and if eligible will reinstate the coverage back to the date it ended. The person receives their white Anchor Card that they can use until they are reinstated to their MCO. This will give access to prescriptions and to any doctors that accept fee-for-service Medicaid. MCO enrollment should be fairly quick for families.

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• Sometimes people don’t realize their coverage has stopped until they go to get medication or see a doctor. If within 90 days of closure, they can submit the renewal documents or they can reapply. If they complete renewal, coverage goes back to the date of closure. If they reapply during the 90 day period or after, coverage goes back to the first of the month of application.

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What if the person thinks the decision to stop coverage is wrong?

• The person can file an appeal and request a hearing. If the appeal is filed within 35 days of the date on the Benefit Decision Notice, the termination does not take place (or coverage is restored) until the hearing is held.

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• There is an appeal form in the pages of the Benefit Determination Notice

• The person does not need to repay benefits they received while the request for hearing was pending if they lose the hearing.

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• RIPIN (270-0101) or RI Legal Services (274-2652) can help decide whether the person should file an appeal and may also provide representation at the hearing.

Whew… this is a lot. Where can I get more information?

• Protect Our Healthcare Coalition. Protecthealthri.org
• Helper Handbook and Appeals Fact Sheet (English and Spanish)
• Sign up for updates on coverage and more

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• State website: Staycovered.ri.gov
• Fact sheets in many languages
• Examples of notices
• List of community helpers

and more

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