Section 210-RICR-30-05-3.7 - RIte Share Premium AssistanceA. Under the RIte Share Premium Assistance Program, the State pays the employee's premium. Medicaid members also receive wrap-around services. 1. Premium payments - EOHHS pays for ESI premiums as follows: a. EOHHS pays the employee directly for their share of the ESI, orb. EOHHS pays the employer directly for the employee's share of the ESI.2. Cost-sharing - Medicaid beneficiaries enrolled in ESI are not obligated to pay any cost-sharing that is not otherwise applicable to Medicaid. For RIte Share enrollees, EOHHS pays for any ESI co-insurance and deductibles. Co-pays are not covered by EOHHS, but as long as the RIte Share enrollee seeks services from a participating Medicaid provider, the RIte Share enrollee cannot be billed for copayments by that provider.) RIte Share Enrollees are notified of the cost sharing policy through their initial enrollment notice.3. Wrap-around coverage - Services and benefits that are covered by Medicaid, but are not offered through the ESI plan, are made available through the Medicaid program. Wrap-around services/coverage ensures that RIte Share enrollees receive health coverage comparable in scope, amount and duration to Medicaid members enrolled in Medicaid managed care. Medicaid covers these services for Medicaid members participating in RIte Share when using Medicaid providers.4. Repayment and recoupment - EOHHS has the authority to recover Medicaid benefit overpayment claims and cost-share arrearages through offset of the individual State income tax refund in accordance with R.I. Gen. Laws §§ 44-30.1-1, 44-30.1-3, 44-30.1-4 and 44-30.1-8 in R.I. Gen. Laws Chapter 44-30.1 entitled 'Setoff of Refund of Personal Income Tax.'210 R.I. Code R. 210-RICR-30-05-3.7
Amended effective 8/6/2019