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In Rhode Island today, more than 1 in 4 children are enrolled in RIte Care or another Medicaid program. And of the more than 18,000 who are uninsured, almost three-quarters are eligible for RIte Care. Thousands of uninsured, low-income parents are eligible as well.
Under health care reform, childless adults up to 133 percent of the federal poverty line will be newly eligible for Medicaid. If Rhode Island wanted to – a state official said it’s “highly unlikely” given the budget crisis – it could enroll them tomorrow, three years ahead of when it will be mandatory.
Depending on your perspective, health care reform’s Medicaid provisions are a godsend or a nightmare. By requiring states to cover more people, and ensure that everyone who is eligible is actually enrolled, reform dramatically strengthens the Medicaid safety net.
It also pumps hundreds of billions of dollars into the states, covering 100 percent of new Medicaid enrollees’ costs for three years, then gradually dropping to 90 percent for 2020 and beyond. For Rhode Island, one study estimates that will yield $1 billion in the first five years.
For providers, it means far fewer patients who can’t pay for care, even though for hospitals especially, Medicaid rates still fall far short of cost.
But the expansion of the Medicaid rolls will pose significant challenges. Along with about 25,000 adults who will be newly eligible, there are 30,000 to 50,000 adults and children who already qualify for Medicaid but are not enrolled, said David J. Burnett, associate director of the R.I. Executive Office of Health and Human Services, although some may have insurance and not need Medicaid. For most of those who do need the government program, however, the state could only get its standard federal matching rate (52 percent before the stimulus bill).
So when you ask officials how health care reform will affect the state budget, they can only guess at the answer, although they do tend to sound anxious. And as if the cost issue weren’t enough of a challenge, there are the logistics: How do you find all these people, enroll them and keep them enrolled?
The latter is a longstanding challenge for RIte Care. So-called “churn” is endemic, especially among people who are required to pay a monthly premium. It’s common for enrollees to forget to get recertified for the program, as they must do periodically.