Report: Wait times for R.I. Medicaid recipients longest in New England

PROVIDENCE – Wait times for Rhode Island Medicaid recipients to speak with state officials is the worst in New England, according to a WPRI-TV CBS 12 report.

WPRI reviewed the letters the U.S. Centers for Medicare and Medicaid Services sent to each state that provided a series of metrics tied to the ongoing recertification process which requires all Medicaid recipients to re-enroll in the federal health insurance program.

After reviewing the data, WPRI found Rhode Islanders waited an average of 39 minutes per call, the longest of the six New England states. Also, residents in neighboring states Connecticut and Massachusetts were shorter. Connecticut was one minute and Massachusetts was two minutes.

“CMS has concerns that your average call center wait times and abandonment rate are impeding equitable access to assistance for people who apply for Medicaid,” CMS officials wrote to Rhode Island leaders.

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Kim Merolla-Brito, director of the R.I. Department of Human Services who oversees the call center, defended the state’s effort to WPRI in trying to shorten times while admitting it has been a challenge.

“It is not acceptable,” she told Target 12. “It has been something that DHS has been working on for quite some time.”

Merolla-Brito told WPRI that staffing has been an issue. She said she needs 20 more people before she asks the General Assembly for another 20 full-time positions. She also added that the call center also handles calls from SNAP recipients, unlike other states that are solely dedicated to Medicaid.

“The data that we have I believe will support us asking for it,” she said. “It changes the model in the call center and brings a higher ratio of staff.”

In addition to wait times, Rhode Island has been notified it was one of only five states that didn’t meet federal targets in categories such as the percentage of callers who hung up while waiting (21%) and the percentage of cases that took more than 45 days to process (12%) and the percentage of people deemed ineligible for Medicaid for procedural reasons (11%).

According to the online database managed by the R.I. Executive Office of Health and Human Services, in July more than 3,000 Rhode Islanders were removed for procedural reasons, meaning they failed to update information or fill out a form; 702 were determined to be ineligible. About 35% were pre-enrolled in an exchange plan.

Office spokesperson James Beardsworth told PBN that the R.I. Department of Human Services has added the ability to automatically call back people who can’t wait on the phone to reduce call times and the state is providing a second round of $100,000 mini grants to support community groups engaged in outreach and renewal work.

The department also has closed the call center to the public on Wednesday so employees can catch up on processing paperwork to help mitigate wait times.

R.I. Medicaid Director Kristin Sousa, who oversees the program, acknowledged the concern but said in a letter to the CMS that Rhode Island was deferring the renewal process for families with children until January to make sure they worked out the problems in the system, according to WPRI.

“This additional time will provide the state an opportunity to maximize efficiency by identifying and addressing procedural, structure, or system issues while processing Medicaid redeterminations,” she wrote in a letter dated Aug. 22, obtained by WPRI.

As of Aug. 11, 7,000 Rhode Island residents have been removed from Medicaid since April 1, when the state began a renewal process that hadn’t taken place since the COVID-19 pandemic erupted in 2020.

An unprecedented nationwide review of the 84 million Medicaid enrollees began in the spring and requires states to remove people whose incomes are now too high for the federal-state program offered to the poorest Americans.

Rhode Island has 12 months to complete the renewal process for the more than 350,000 individuals enrolled in Medicaid. State officials estimate up to 40,000 – about 8% of Medicaid recipients – will be removed and must find alternative coverage.

With news reports from PBN.