RIte Care provides health insurance for low-income, uninsured Rhode Island children, pregnant women, and some low-income parents. It is funded with both Federal and State dollars through the Medicaid program. RIte Care provides insurance by offering enrollees a choice of three different RIte Care managed care plans through private insurers: Neighborhood Health Plan of Rhode Island and United Healthcare of New England. Eligibility is determined based upon family income. Generally, children and pregnant women are eligible up to 250% of the Federal Poverty Level (FPL) while parents are eligible in families up to only 185% of the FPL. (The FPL is different based on family size.) Some families must pay a premium for RIte Care coverage while others receive coverage without cost-sharing depending on their income level and family size. For example, a family of three that makes $31,746 annually pays $732 per year. A family of three that makes $25,755 or less is covered without cost-sharing.
RIte Share works in conjunction with the RIte Care program. It ensures that low-income children and families who already have insurance through an employer do not voluntarily drop coverage and move to the public RIte Care program. In the academic literature, this problem is known as “crowd-out.” If a family is income eligible for RIte Care but already has access to employer sponsored insurance (ESI), the RIte Share program will pay that family’s part of their health insurance premium and provide “wrap-around” benefits that RIte Care offers but that an employer’s plan does not. For example, RIte Care benefits may include certain prescriptions for children that an employer’s plan does not cover. RIte Share makes these benefits available to its enrollees and helps to make sure that as many Rhode Islanders as possible are insured through their workplace and creates a partnership between the State and employers.
RIte Care insures a little over 112,000 Rhode Islanders. Approximately another 7,000 Rhode Islanders are insured through RIte Share. Without this assistance, most of this population would likely be uninsured, go without needed care, and receive uncompensated care in emergency rooms.1
Forcing children and pregnant women to go without insurance also allows health conditions to worsen to critical levels when they might have been treated effectively at an earlier stage. This also means all Rhode Island families will interact with more sick people than is necessary. In addition, letting necessary medical care in the emergency room results in higher private insurance premiums for insured Rhode Islanders because hospitals must recoup these costs in what they charge privately insured patients.
The funds for RIte Care/RIte Share come from both the State and Federal government. For every dollar spent on RIte Care/RIte Share, approximately 52% is paid for by the Federal government with the remaining 48% paid for by Rhode Island. Because of this “Medicaid match” provided by the Federal government, insuring children through RIte Care is a relatively cheap means of doing so. This also means that Rhode Island only saves 52 cents on the dollar if it chooses to cut the RIte Care/RIte Share budget. In other words, it is very cost-effective to insure children and pregnant women through RIte Care and not very cost-effective for the State to save money by cutting it.
RIte Care only accounts for about one-fifth of all Medicaid costs. Other parts of the Medicaid budget cost far more than RIte Care. The vast majority of the Medicaid budget goes to the elderly and disabled who are not on RIte Care. RIte Care is very cost effective; it costs an average of just $200 per member per month.2
Rigorous evaluation has shown that the Rhode Island plans provide excellent insurance coverage to the RIte Care population. In fact, U.S. News and World Report and the National Committee for Quality Assurance ranked Neighborhood Health Plan of Rhode Island as the best Medicaid health plan in the nation for 2006. Blue Cross Blue Shield of Rhode Island and United Healthcare of New England were second and fourth in the nation, respectively. This type of national recognition shows that there is general agreement that RIte Care is a national model that other states should attempt to emulate.
RIte Care/RIte Share has been recognized nationally as enormously effective in improving the health of low-income Rhode Island children and families:
- “For example, one study found that the portion of pregnant Medicaid beneficiaries receiving adequate prenatal care increased from 56 percent in 1993 [just before RIte Care began] to 73 percent in 2000. . . . Researchers have [also] found that from 1993 to 1995, the incidence of low-birth-weight babies declined by half, from 10 percent to 5 percent.” –The Commonwealth Fund
- “Rhode Island has been a national leader in efforts at screening for lead poisoning, following up with treatment, and other lead-abatement strategies.” –National Health Policy Forum at The George Washington University
The lesson is clear: RIte Care/RIte Share works for low-income children and families and works for Rhode Island tax payers. It deserves to be protected.
We know that the Governor has identified at least $50 million in unspecified cuts to social programs that could very well include cuts to RIte Care. That’s why it’s important to recognize now that RIte Care is an effective, efficient program and commit to protecting both eligibility levels and benefits. Even in difficult fiscal times, Rhode Island’s most vulnerable citizens deserve our continued support.
1. A History of RIte Care, First Focus: Children’s Budget Summit, Presented by Elizabeth Burke Bryant, Rhode Island KIDS COUNT, July 20, 2007
2. Rhode Island Annual Medicaid Report, Executive Office of Health and Human Services, Jane A. Hayward, Secretary, December 1, 2006