| Group |
Income Eligibility |
| Children |
250% FPL |
| Pregnant Women |
250% FPL |
| Parents |
185% FPL |
| SSI Disabled |
74% FPL |
Medicaid, SCHIP, and Federal Authority2
Section 1115 Waiver - After receiving approval from CMS in 1993, the state implemented the Rhode Island RIte Care demonstration, which provides families on the Family Independence Program and eligible uninsured pregnant women, parents, and children up to age 19 with comprehensive health coverage. The demonstration expanded coverage to parents up to 185 percent FPL and to children and pregnant women up to 250 percent FPL.
SCHIP 1115 Demonstration - In 2001, the state received approval to implement a demonstration that would allow the state to claim Title XXI funding for parents of Medicaid or SCHIP-eligible children with incomes between 100 percent and 185 percent FPL and pregnant women with incomes between 185 percent and 250 percent FPL.
RIteShare - The state operates a premium assistance program available to those who qualify for Medicaid coverage. For more information on premium assistance programs, visit the SCI-funded Premium Assistance Toolbox. RIteShare, the state's premium assistance program for those eligible for Medicaid helps families get health insurance coverage through their employer (or spouse's employer). If a family qualifies, RIte Share will pay for all or part of the employee's share of the health insurance premium. RIte Share also pays for co-payments in the employer's health insurance plan.
Dependent Coverage
Insurance carriers must cover unmarried dependent children up until the age of 19 or until 25 if the young adult is financially dependent and is at least a part-time student. Rhode Island has special dependent provisions for disabled children. (Public Law 2006-377).
Other
In 2006, Governor Donald Carcieri (R) signed into law a number of new health initiatives including several coverage expansions focused on providing premium relief for small businesses. First, the Health Insurance Commissioner is empowered to work with business, insurance, and other stakeholders to develop a new, affordable health plan, called The Wellness Health Benefit Plan. The legislation sets a target premium of 10 percent of wages, while at the same time providing benefits that meet certain affordability principles.
Meeting this legislatively-defined price point is expected to reduce premiums for all small businesses to approximately 25 percent below market rate through a combination of enhanced negotiating leverage via premium rate controls, administrative cost reductions, and innovative plan design elements. In addition, eligible low-wage small businesses (those with average wages in the bottom quartile) will save an additional 10 percent of premium through a state-sponsored reinsurance program. This reinsurance program passed into law during the 2006 legislative session; however, it is contingent upon the identification of a new funding source during the coming year.
Information presented in the profile was summarized in December 2006 from a review of state Web sites and reports, and through contacts with state officials. In most cases the profiles were reviewed by state officials; however, it is possible that states have implemented strategies that are not reflected in this profile. |
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| 1 This overview provides a general description of state coverage levels under their Medicaid and SCHIP programs, including coverage through waivers, as of October 2006. Health Management Associates researched eligibility information from state web sites, data from state reports, and verified through contacts with state officials during the fall of 2006. This does not reflect the specific eligibility categories or requirements. This is not intended to be a substitute for eligibility information provided by each state. Individuals interested in applying for these programs should contact the state directly for specific eligibility requirements. |
2 The profile only includes Medicaid and SCHIP waivers intended to make comprehensive expansions to the uninsured. At this time, the profiles do not include Family Planning, Pharmacy Plus waivers, or long-term care waivers. |
3 Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2005 and 2006 Current Population Survey. |
| 4 Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends. 2004 Medical Expenditure Panel Survey-Insurance Component. |
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