Examining Substitution: State Strategies to Limit "Crowd Out" in the Era of Children's Health Insurance Expansions. RITECARE (Rhode Island)

12/09/1997

HISTORY:

RIteCare is an 1115 Waiver program that was implemented August 1, 1994. Rhode Island's statewide initiative seeks to increase access to primary and preventive health care services for all Aid to Families with Dependent Children (AFDC) beneficiaries and certain low-income women and children through a fully capitated managed care delivery system. RIteCare expands Medicaid eligibility and provides an enhanced set of primary care and preventive benefits through a fully capitated managed care system. Unlike the traditional Medicaid program, RIteCare requires cost sharing for individuals with family incomes between 185% and 250% of the poverty level.

TARGET POPULATION:

The Rhode Island Department of Human Services estimates that approximately 7,000 previously uninsured persons will find themselves able to access care through RIteCare. RIteCare provides coverage to pregnant women and children up to 8 years of age with family incomes at or below 250 percent of the FPL; in addition, women who would otherwise lose Medicaid eligibility post-partum remain eligible for family planning services. RIteCare currently serves 73,500 people. Seventy thousand of these are AFDC and AFDC-related Medicaid beneficiaries. The remaining 3,500 are children up to age 8 and pregnant women with incomes of 185-250% of the federal poverty level. On May 1, 1997, coverage was made available to all uninsured children up to age 18 in families up to 250% of the poverty level.

BENEFIT PACKAGE:

Each health plan offers medical, dental and mental health benefits, and enhanced outreach services such as provision of bus passes. Participating health plans are required to offer a package of services intended to overcome non-financial barriers to care, such as outreach, home visits, nutrition counseling, childbirth education, and parenting classes.

PROVIDER NETWORK AND REIMBURSEMENT:

Four managed care plans are currently serving RIteCare enrollees: Harvard Pilgrim Health Care, Coordinated Health Partners, Neighborhood Health Plan of Rhode Island, and United HealthCare of New England. Rhode Island has made significant strides in improving access to primary care through RIteCare. Primary care physician participation in Medicaid has increased from 350 to over 800 physicians. The average number of physician visits per enrollee increased from two per year to five per year in RIteCare's first year (1995). Both hospital utilization and emergency room visits fell by more than one third from 1993 to 1995.

FINANCING:

RIteCare is funded through a mix of Medicaid dollars, state funds and individual premiums. Individuals with family incomes between 185% and 250% of the poverty level contribute to the cost of their insurance through monthly premium payments.