Section 210-RICR-30-05-3.21 - Disenrollment from RIte Share-Approved PlanA. RIte Share beneficiaries who are voluntarily or involuntarily disenrolled from an approved ESI plan must report the change in enrollment status to EOHHS in no more than ten (10) days from the date the disenrollment action occurs. The type of disenrollment determines EOHHS's response as follows: 1. Voluntary disenrollment - Medicaid-eligible RIte Share beneficiaries age nineteen (19) or older who voluntarily disenroll from an approved ESI will be terminated for coverage based on the failure to meet the non-financial cooperation requirements set forth in this Part. Voluntary disenrollment includes, but is not limited to, instances in which a RIte Share beneficiary: a. Requests that the employer drop coverage or cease enrollment for the entire family or a Medicaid-eligible individual in the family;b. Fails to meet the requirements established by the employer to maintain enrollment in the approved plan such as, submit required documentation or forms.c. Engages in unlawful or fraudulent acts, such as submitting false claims that violate the terms for continuing enrollment in the ESI plan. Please refer to § 3.5 of this Part.2. Involuntary disenrollment - Involuntary disenrollment includes the loss of access to ESI as a result of change in employment, termination of coverage by the employer for an entire class of workers, death, separation, divorce, disability of the policy holder, or any other factors that could be reasonably construed as involuntary disenrollment as defined in this Part.3. RIte Share Unit responsibilities - Upon receiving a report from the employer, the ESI plan insurance provider, or Medicaid beneficiary indicating that disenrollment has occurred, the RIte Share Unit verifies the accuracy of the report and assesses whether it is voluntary or involuntary in nature.a. Voluntary Disenrollment - Notice of Discontinuation. Once the report has been verified and it is determined to be voluntary disenrollment, EOHHS sends a "Notice of Discontinuance" noting termination of the Medicaid eligibility of the policy holder, parent(s) or caretaker relative in the applicant's household until the individual demonstrates compliance with enrollment procedures established by EOHHS. The "Notice of Discontinuance" must also include any remedies for shortening the period of ineligibility as well as the right to request a hearing and appeal the decision:(1) Medicaid-ineligible individuals are provided with a notice from EOHHS stating they are disqualified from RIte Share.(2) All Medicaid-eligible pregnant women and children must be automatically enrolled in a Medicaid managed care plan.(3) This period of Medicaid ineligibility may be shortened and Medicaid eligibility established if such individual becomes exempt from RIte Share enrollment or no longer has access to ESI for reasons such as a change in employment. (See § 3.21 of this Part).b. Involuntary disenrollment - There is no adverse action taken against Medicaid beneficiaries required to participate in RIte Share if disenrollment from an approved ESI plan is involuntary.210 R.I. Code R. 210-RICR-30-05-3.21
Amended effective 8/6/2019