The staff at Thundermist Health Center has been bracing for a flood of work this year, and that flood has now arrived.
The center, a community health care provider serving people in Woonsocket, West Warwick and southern Rhode Island communities, estimates most of its 50,000 patients will have to undergo a Medicaid renewal process that had been suspended during the height of the COVID-19 pandemic.
That means many will be declared ineligible for Medicaid assistance.
The nonprofit hired 20 additional “navigators” – people who work with patients to determine their Medicaid eligibility and find other insurance coverage – to help deal with the onslaught of calls for help, according to Elizabeth Lynch, Thundermist’s associate vice president of behavioral health and social services.
The average help session takes well over an hour, Lynch says.
“We are trying to keep this in the forefront of everyone’s mind over how significant this is,” Lynch said. “And we are bracing ourselves for this to get increasingly more difficult. It can be very complicated. These will be turbulent times over the next few months.”
Turbulent indeed. The federally mandated effort to restart Medicaid renewals began in April and is expected to take a year, affecting a Medicaid program that has expenditures comprising close to one-third of the state budget and reached $1.2 billion in state spending in 2022.
So far, about 7,000 Rhode Island residents have been removed from Medicaid. State officials estimate up to 40,000 – about 11% of Medicaid recipients – will be cut off and must find an alternative.
In a perfect world, Lynch says, information would flow freely between clients, state agencies and community providers to help with finding coverage. But this is not always the case.
“It is hard to do. Part of the reason these people are on the list of ‘redeterminations’ is because [organizations and agencies] haven’t been able to get through to them to tell them they are getting cut off,” she said. “We are dialing in to try and reach out to them. Or catch them at the point they are coming into the offices.”
According to the online database managed by the R.I. Executive Office of Health and Human Services, the number of people enrolled in Medicaid stood at 372,121 in July.
The state has struggled to stay within federal mandates on things such as call wait times, which are now approximately 54 minutes, according to agency spokesperson James Beardsworth.
In August, the U.S. Center for Medicaid and CHIP Services notified state Medicaid Director Kristin Sousa that it “has concerns [that long wait times are] impeding equitable access to assistance.”
In addition to wait times, Rhode Island 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%).
Beardsworth says 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 new round of $100,000 mini grants to support community groups engaged in renewal work.
About half of Medicaid recipients are expected to be automatically enrolled.
“We are pleased with the progress being made through the first five months but know there is still a lot of work that remains,” Beardsworth said.
The state has mailed more than 70,000 letters to Medicaid recipients through its first four waves of redeterminations. Neighborhood Health Plan of Rhode Island began an awareness campaign in October 2022 and still receives monthly eligibility data to identify customers who are at high risk medically. CEO and President Peter Marino says Neighborhood Health is reaching out to about 500 of those high-risk members monthly and has called about 11,000 customers overall who could now be ineligible for Medicaid coverage.
Marino acknowledges there has been some “frustration and confusion” among customers but says the automatic Medicaid renewal during the pandemic saved lives while preventing states from financially “being left holding the bag.”
“We always talk about people who are Monday morning quarterbacks. I think it was a good strategy to use Medicaid as a tool to help ensure people have coverage,” he said. “With all the bumps and bruises along the way, it’s done its job.”
Healthsource RI, the state health insurance exchange, has been a helpful backstop, some say. Six out of seven people who use the exchange receive financial assistance such as federal tax credits, according to the exchange. That assistance brings the average monthly cost of health insurance to $110; 31% of Healthsource RI users pay less than $20 a month.
But overall costs continue to climb. Partially subsidized plans can include thousands of dollars in deductibles and monthly premiums of up to $500.
The state commissioner approved an 8% rate increase for Neighborhood Health in 2023, and the insurer is again asking for another increase of 4.4% for individual plans and 9.5% for group plans.
Meanwhile, the Medicaid marathon at Thundermist continues. On a recent day, the nonprofit received from Neighborhood Health a list of 400 patients at risk of losing coverage.
“You worry most about the most vulnerable people,” Lynch said. “It’s your patient who is disenfranchised or moves around a lot. Those outside of the system. And often, these are the sickest patients.”
(Correction: An earlier version of this story misidentified the entity that has sent 70,000 letters to Medicaid recipients in Rhode Island to notify them of the renewal process. The state has sent the letters. There is also a clarification on the actions that Neighborhood Health has taken to assist its customers.)
