Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 05 - Service Delivery Options › Part 3 - RIte Share Premium Assistance Program › Section 210-RICR-30-05-3.14 - Non-custodial Parents with TPL

Current through June 14, 2024
A. Medicaid is
				  always the payer of last resort. Accordingly, EOHHS considers all other health
				  insurance or coverage provided to a Medicaid-eligible individual as third-party
				  liability (TPL) coverage. EOHHS reserves the right to disenroll Medicaid
				  beneficiaries with TPL from Medicaid managed care and enroll them in RIte
				  Share. This is called RIte Share Zero Premium.
1. TPL coverage through the non-custodial
				  parent - Children who are enrolled in both Medicaid managed care and also have
				  access to coverage through a non-custodial parent (NCP), will be transitioned
				  into RIte Share Zero Premium unless the custodial parent shows good cause for
				  not making the transition. The child will retain access to all applicable
				  Medicaid covered services the entire time that they are in RIte Share Zero
				  Premium. Should the NCP lose their ESI, the RIte Share Unit must be notified at
				  least ten (10) days prior to the child's disenrollment to meet established
				  reporting requirements and assure the child is transitioned back into Medicaid
				  managed care without coverage gaps.
2. Custodial parent non-compliance - If the
				  custodial parent refuses to allow the child to be enrolled in the NCP's
				  coverage, the custodial parent's Medicaid eligibility is terminated until the
				  custodial parent complies with the RIte Share participation requirement. Good
				  cause exemptions to RIte Share are permitted under §
											3.23   of this Part.
3. Notice and enrollment - Medicaid
				  beneficiaries must be provided with notice from EOHHS explaining their rights
				  and responsibilities including:
a. RIte Share
				  participation. The requirement to participate in RIte Share is a condition of
				  continuing Medicaid eligibility for adults in the household. The Medicaid
				  member with TPL must receive the notice fourteen (14) or thirty (30) days, as
				  appropriate (see §
												3.12   of this Part), prior to
				  the required transition from a Medicaid managed care plan.
b. Grace period. Parents/caretakers are given
				  a fourteen (14) day grace period to report any changes in the NCP's coverage
				  and/or report any difficulties with using the NCP's coverage.
c. Failure to respond. If the
				  parent/caretaker does not respond, the Medicaid beneficiaries who are covered
				  under the NCP's policy will be transitioned from Medicaid managed care to RIte
				  Share, and sent appropriate documentation. Those household members who are not
				  covered under the NCP's coverage (such as a custodial mom, children not related
				  to the NCP, etc.) will remain in Medicaid managed care.
d. Cost-sharing. The notification must
				  indicate clearly that EOHHS is not responsible for coinsurance, cost sharing
				  obligations, or wraparound coverage for the NCP or any other
				  Medicaid-ineligible family members