Section 210-RICR-30-05-3.5 - RIte Share Enrollment as a Condition of EligibilityA. Medicaid members over the age of nineteen (19), who have access to RIte Share-approved ESI must enroll in that ESI as a condition of continuing Medicaid eligibility. This requirement also applies to any individuals who have, or previously had the option to waive ESI coverage to receive financial compensation, including but not limited to, an increase in hourly wage, an increase in weekly salary, and/or a lump sum payment. (An increase in wages for waiving coverage is also known as "pay in lieu of benefits.") 1. Exemptions - In certain circumstances, Medicaid members with access to ESI are exempt from enrolling as condition of maintaining eligibility: a. Under age 19. Medicaid-eligible children and young adults up to age nineteen (19) are not required to enroll in a parent/caretaker relative's ESI as a condition of maintaining Medicaid eligibility.b. Enrolled in RI Works (TANF). There is a limited six (6) month exemption from the mandatory enrollment requirement for RI Works program participants. See § 3.6 of this Part below.c. Pregnant women. Although the State encourages enrollment, pregnant women will not be sanctioned if they do not comply.2. Mandatory ESI Enrollment - Once it has been determined by EOHHS that the ESI offered by a particular employer is RIte Share-approved, all eligible Medicaid members with access to that ESI are required to participate in RIte Share.3. Non-compliance - Failure to meet the mandatory enrollment requirement results in the termination of the Medicaid eligibility of the policy holder and other Medicaid members nineteen (19) or older in the household that would have been covered under the ESI until the policy holder complies with the RIte Share participation and enrollment procedures established by EOHHS in this rule. (See § 3.20 of this Part).4. Reinstatement - The period of ineligibility may be shortened and Medicaid eligibility reinstated if a. the policy holder complies with RIte Share's request to enroll in ESI,b. if the employer's plan is no longer RIte Share-approved,c. if the policy holder no longer has access to that ESI (e.g., decrease in work hours).210 R.I. Code R. 210-RICR-30-05-3.5
Amended effective 8/6/2019