Initial Medicaid Implementation: Rhode Island began their Medicaid program in July of 1966, within the first year that the state could implement Medicaid.
When the program was initially started, it was estimated that 8% of the population would be eligible for coverage. Following the change that limited Medicaid federal reimbursement to spending for people that earned less than 150% of AFDC rates, Rhode Island reduced Medicaid eligibility to meet those rates and continue to receive federal reimbursement. At one point early in the Medicaid implementation, a dispute arose between the optometrists and ophthalmoligists. The Boston regional office held resolve the dispute which was a rare intervention of the office in state matters. The dispute rested in differences in payment rates and coverage of services between the two professions.
Key Medicaid Political Issues: Rhode Island has had a focus on treating mental health conditions and children’s health care for a number of years. The state has focused this priority in the development on their medical home model. Rhode Island has been an early adopter to several health care benefits including transgender health care services, Hepatitis C treatment and expanded treatment for opioid addiction. Since 2009 the state has occupied under a single global waiver. The waiver has allowed the state flexibility in how it provides benefits, especially for long-term care services. The waiver has a high limit on the budget neutrality limits meaning that the state can provide enhanced benefits without having to significantly reduce services for other beneficiaries or in other parts of the Medicaid program.
Medicaid Expansion Implementation: Rhode Island expanded Medicaid with sign ups beginning in October of 2013 with coverage beginning in January of 2014. The state was under the control of a Democratic governor and legislature and is solidly Democratic in presidential voting so the choice to expand saw little debate in the legislature or governor’s office. The Rhode Island Public Expenditure Council, a non profit group that reviews economic proposals by the state, looked into the state’s decision to expand and determined that the state could save money on existing programs and increased coverage and economic activity, but the extent of the implementation of the proposal was unclear and what the expenditures would be in out years when the state had to pay could be significant depending on the enrollment effort.
General facts about Rhode Island Medicaid:
Medicaid program name: Medicaid
CHIP Program name: Rite Care
Separate or combined CHIP: Separate
Medicaid Enrollment: 308,000 (2018 estimate)
Total Medicaid Spending: $2.6 billion (FY 2017 Estimate)
Share of total population covered by Medicaid: 20% (estimate)
Share of Children covered by Medicaid: 37.5% (estimate)
Share of Medicaid that is Children and Adults: 80%
Share of Spending on Elderly and people with disabilities: 59%
Share of Nursing Facility Residents covered by Medicaid: 60% (estimate)
Expansion state: Yes
Number of people in expansion: 62,000
Work Requirement: No