Rhode Island Medicaid, SCHIP, and Federal Authority

Section 1115 Waiver – After receiving approval from the Centers for Medicare and Medicaid Services (CMS) in 1993, the state originally implemented the Rhode Island RIte Care demonstration [1], providing families on the Family Independence Program and eligible uninsured pregnant women, parents, and children up to age 19 with comprehensive health coverage. RIte Care currently provides coverage to parents with incomes up to 185 percent of the federal poverty level (FPL) and to children and pregnant women up to 250 percent of the FPL using title XIX and XXI funds.

Under the demonstration, the state also operates a premium assistance program, RIte Share, which is available to those who qualify for Medicaid coverage. RIte Share [2] 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.

As of April 2008, approximately 7,428 people were enrolled in RIte Share.  For every 1,000 people enrolled in RIte Share, the State of Rhode Island saves over $1 million in avoided costs.  RIte Share has been an effective tool to address concerns about “crowd out” (substituting public coverage for employer-sponsored insurance).