MCO Contract Update RI EOHHS and Medicaid are in the process of establishing a new managed care contract. If you or a loved one currently have health coverage through RI Medicaid, it’s important to know that you don’t need to take any action at this time. When a new contract is in place, the State will send information about any next steps.
Post-Eligibility Verification (PEV) Medicaid members are asked to self-report all income and employment information about their household to the State, including any changes that may occur throughout the year. Each quarter, as required by federal regulation, the State uses State Wage Information Collection Agency (SWICA) data from the RI Department of Labor and Training to verify that any self-reported employment and income information is accurate and complete. This process is called “Post-Eligibility Verification” or PEV, and it helps the State ensure that anyone who is enrolled in Medicaid continues to be eligible. In addition, HealthSource RI uses PEV to check that enrolled individuals are not deceased, incarcerated, or enrolled in Medicare. PEV was paused during COVID-19, as mandated by the federal Public Health Emergency (PHE). Since the PHE has ended, Rhode Island is scheduled to resume PEV at the end of August 2024. Following standard procedure, beneficiaries who are found during PEV to be above the income threshold for Medicaid will get a notice from the State of RI requesting additional documentation on their income and employment. Members will get those notices in the mail or via their customer portal in late August or early September. If the beneficiary responds to provide documentation that shows they are income eligible, the State will keep them enrolled in Medicaid. If the beneficiary provides documentation that shows they are not income eligible (or if they do not reply to the notice), the State will send a second notice informing them they are no longer eligible for Medicaid. Many Rhode Islanders may be eligible for coverage and/or affordability assistance through HSRI, and some will be automatically enrolled in a Qualified Health Plan (QHP) with HSRI and will have their first month’s premium paid by the state. Customers who are eligible for coverage through HSRI will receive information about their options in the notice informing them of their Medicaid termination. The notice will also give them information about HSRI and how to appeal the decision. About Post-Eligibility Income Verification (PEV) for Medicaid Members Q: What is the most important thing I should know about PEV? A: You should respond right away if you receive a letter, text, or email from the State. Make sure your contact information is up to date so you won’t miss any important communications. Send any requested documents to the State right away. Q: What is post-eligibility income verification for Medicaid members? A: The State uses information about your income and your job to confirm you’re eligible for Medicaid. We check this information once a year during your annual Medicaid renewal. Sometimes, things change during the year – you might get a new job, get a raise, or leave Rhode Island. We use certain data sources to check income and employment information every three months (quarterly). These quarterly checks are post-eligibility verifications (PEV). Q: Why is the State doing PEV checks now? A: The federal government requires states to verify income and employment information for Medicaid members throughout the year. States were allowed to stop doing this for a while so more people could stay covered during the COVID-19 public health emergency (PHE). Now, Rhode Island must check this information again. Q: How does the State verify income and employment information? A: All Medicaid members must tell the State right away about any changes to their income or employment. Rhode Island uses State Wage Information Collection Agency (SWICA) data from the Rhode Island Department of Labor and Training to make sure the information you give us is accurate and complete. We do this to make sure you remain eligible for Medicaid. The State will contact you if we need more information. Q: What happens if the PEV check says I am making too much money at my job? A: The State will tell you if our review of the data shows you are above the income threshold for Medicaid. We will send you a notice and ask for documents to learn more about your income and employment. This notice will come in the mail or through your account at HealthyRhode.ri.gov. Make sure you open any notices from the State right away. Q: What happens after the State reviews my documents? A: You’ll stay covered if your documents show that your income keeps you eligible for Medicaid. We will notify you that you’re no longer eligible for Medicaid if your documents show that you make too much money. You will lose Medicaid benefits if you don’t send the State the documents requested to verify your income. Q: What happens if I’m no longer eligible for Medicaid? A: You may be eligible to enroll in a qualified health plan (QHP) through HealthSource RI (HSRI). Many Rhode Islanders who aren’t eligible for Medicaid can get financial help through HSRI. You may be automatically enrolled in a QHP with HSRI and have your first month’s premium paid by the State if you meet certain eligibility guidelines. Q: What if the State says I’m not eligible for Medicaid and I don’t agree? A: You have the right to appeal if the State determines you’re not eligible for Medicaid and you disagree with that decision. Learn more about how to appeal a Medicaid eligibility decision.