Post-Eligibility Verification (PEV)
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. That’s why we also use certain data sources to check income and employment information every three months (quarterly). These quarterly checks are called post-eligibility verifications (PEV).
If you are found during PEV to be above the income threshold for Medicaid, you will get a notice from the State of RI requesting more information about your income and employment. You will get those notices in the mail or through the HealthyRhode Customer Portal.
- If you provide documentation that shows you are income eligible, the State will keep you enrolled in Medicaid.
- If you provide documentation that shows you are not income eligible (or you do not reply to the notice), the State will send a second notice informing you that you are no longer eligible for Medicaid. The notice will also give you information about health coverage through HealthSource RI (HSRI) and how to appeal the decision.
More About Post-Eligibility Income Verification (PEV) for Medicaid Members
A: You should respond right away if you receive a letter, text, or email from the State about your Medicaid coverage. Make sure your contact information is up to date so you don’t miss any important communications.
A: The State requires Medicaid to verify income and employment information for 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 is checking this information again.
A: If you’re enrolled in Medicaid, you must tell the State right away about any changes to your 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.
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.
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.
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.
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.