Section 210-RICR-30-05-3.12 - Enrollment ProcessA. Medicaid beneficiaries who are required to participate in RIte Share must enroll in the ESI plan as directed by EOHHS. Enrollment into RIte Share may occur upon initial determination or at the time of Medicaid annual renewal, or as deemed appropriate by EOHHS. Enrollment in RIte Share is deemed to be a "qualifying event" and may occur at any time, including outside the open enrollment period. 1. Eligibility determination and RIte Share referral - The referral for RIte Share participation is based on information provided by the Medicaid beneficiary in conjunction with an initial Medicaid application or annual Medicaid renewal; and documented in the EOHHS database as to whether an employer offers RIte Share-approved coverage.2. Notice RIte Share participation required - A notice must be sent by EOHHS indicating that participation in RIte Share is a condition of retaining Medicaid eligibility as follows: a. Fourteen days' notice. Upon determining that a Medicaid member is qualified for coverage through RIte Share, EOHHS provides a written "Notification of Eligibility for Enrollment" stating the employee must select a RIte Share-approved ESI plan through their employer's personnel or human resources office within fourteen (14) calendar days.b. Thirty days' notice. Written notice will be sent to the Medicaid beneficiary approximately thirty (30) days prior to the date that enrollment in RIte Share is required, but only in instances when approval of the ESI plan is the impetus for the requirement to enroll rather than a determination/renewal of Medicaid eligibility3. Prior agreement - In certain circumstances, EOHHS may have a prior agreement with the employer which permits the RIte Share Unit to enroll an eligible individual/family in the ESI plan upon receipt of an acknowledgment or written consent from the policy holder. The notification of enrollment sent from the RIte Share Unit to the Medicaid-ineligible policy holder as well as to any Medicaid recipients in such cases shall explain any such prior arrangements and any additional appeal and hearing rights that follow therefrom.210 R.I. Code R. 210-RICR-30-05-3.12
Amended effective 8/6/2019