WHEREAS, The approximately 40,0 Rhode Islanders with coverage through both Medicare and Medicaid, known as “dual-eligible enrollees” or “duals,” are some of the most medically fragile Rhode Islanders; and
WHEREAS, Medicare and Medicaid are poorly coordinated programs, coverage options for duals are complex, and transitions in forms of coverage can have serious adverse impacts on duals if significant outside assistance is not available to ensure needed medical services continue; and
WHEREAS, The Executive Office of Health and Human Services (“EOHHS”) had established, in conjunction with the Centers for Medicare and Medicaid Services (“CMS”) a dual- specific Medicare-Medicaid Plan (“MMP”) which integrated Medicare and Medicaid benefits within a single plan, operated by Neighborhood Health Plan of Rhode Island (“NHPRI”) as Neighborhood Integrity, since July 1, 2016; and
WHEREAS, CMS withdrew support for the MMP effective December 31, 2025, requiring EOHHS and NHPRI to end the Neighborhood Integrity plan and transition its enrollees into a new form of coverage known as a “Fully-Integrated Duel Eligible Special Needs Plan” or “FIDE-SNP”; and
WHEREAS, In late 2023, EOHHS issued a procurement for Medicaid Managed Care services whereby awarded vendors would operate plans for duals that integrated Medicare and Medicaid benefits within a single plan, but EOHHS subsequently canceled that procurement, leaving the future of the managed care delivery system for duals in Rhode Island in a state of confusion and flux; and
WHEREAS, CMS has recently promulgated proposed rules which allow for more aggressive advertising of Medicare plans to enrollees including duals, while reducing enforcement of fraudulent or misleading behavior by Medicare plan brokers, and reducing the availability of trusted resources such as the Senior Health Insurance Assistance Programs (“SHIPs”), which are expected to lead to significant confusion for duals navigating an evolving and complicated menu of plans with fewer trusted resources to turn to when issues arise; and
WHEREAS, Approximately 11,300 duals are currently enrolled in the NHPRI FIDE- SNP, and a further approximately 13,000 duals are enrolled in other dual-specific Medicare plans (called “dual special needs plans” or “D-SNPs”); and
WHEREAS, RIPIN has operated, since 2016, Rhode Island’s Medicare-Medicaid Dual Ombudsman Program (the “RIPIN Dual Ombudsman”), which helps duals navigate complicated Medicare and Medicaid enrollment rules, Medicaid redeterminations, obstacles to health plan enrollment, claim and prior authorization denials, access to care challenges, provider disputes, and applications for other federally funded benefit programs; and
WHEREAS, The RIPIN Dual Ombudsman is funded through Medicaid administrative matching with half federal Medicaid funding and half state funding, at the amount of $236,844 all-funds ($118,422 general revenue) per year, serving 467 clients in 2025, with 4,705 individual client interactions, and with a 90% client satisfaction rate; and
WHEREAS, The RIPIN Dual Ombudsman has helped its clients save more than $2.1 million in health care costs since January 1, 2018; and
WHEREAS, The Governor’s proposed fiscal year 2026-2027 budget proposes to terminate funding for the RIPIN Dual Ombudsman; and
WHEREAS, An appropriation of $118,422 in general revenue would leverage an additional $118,422 in federal revenue and would allow the RIPIN Dual Ombudsman program to operate at current capacity for the 2027 fiscal year; and
WHEREAS, Without the RIPIN Dual Ombudsman, there will be no dedicated resource to assist duals, and the sunset of that program would coincide with the largest system transition in the history of Rhode Island’s managed care duals delivery system; and
WHEREAS, Continued funding for the RIPIN Dual Ombudsman is in keeping with the EOHHS Mission Statement “to foster and strengthen a community-driven, equitable, comprehensive, responsive, and high-quality health and human services system in Rhode Island”; now, therefore be it
RESOLVED, That there is hereby appropriated, out of any money in the treasury not otherwise appropriated for the fiscal year 2026-2027, the total sum of one hundred eighteen thousand four hundred twenty-two dollars ($118,422) to RIPIN to continue the operation of the RIPIN Dual Ombudsman, with the expectation that such funds will be matched by federal Medicaid funds and administered by the office of the health insurance commissioner; and the state controller is hereby authorized and directed to draw their orders upon the general treasurer for payment of said sum, or so much thereof as may be from time to time required, upon receipt of properly authenticated vouchers. EXPLANATION BY THE LEGISLATIVE COUNCIL OF JOINTRESOLUTION MAKING AN APPROPRIATION OF $118,4 TO THE RHODE ISLAND PARENT INFORMATION NETWORK (RIPIN) *** This resolution would appropriate the sum of $118,422 to the Rhode Island Parent Information Network (RIPIN).
