The Integrated Care Initiative is a model program designed to improve care for Rhode Islanders eligible for both Medicaid and Medicare (dual eligibles). Rhode Island’s Integrated Care Initiative is a joint effort between the State of Rhode Island, the Centers for Medicare and Medicaid Services (CMS), and Neighborhood Health Plan of Rhode Island. Rhode Island is one of thirteen states testing models for integrated care in Financial Alignment Initiative demonstrations.
Phase 1 of the Integrated Care Initiative, sometimes called Rhody Health Options, launched in November of 2013 with a plan called Neighborhood UNITY. UNITY is designed to manage just the Medicaid covered benefits for dual eligibles. It doesn’t change a person’s Medicare, Medicare Advantage or Medicare Part D Prescription Drug Plan. Unlike Phase 2, UNITY is available to individuals with just Medicaid (not Medicare) who are receiving long-term services and supports in a nursing facility or the community. UNITY is still available following the roll out of Phase 2.
Phase 2 of the Integrated Care Initiative, sometimes called the Medicare-Medicaid Plan (MMP), launched in July of 2016 with a plan called Neighborhood INTEGRITY. Eligible individuals who enroll will receive all their covered benefits in Medicare and Medicaid plus additional services through a single integrated plan.
This article describes who is eligible for Neighborhood INTEGRITY and how they should proceed if they would like to enroll.
In order to be eligible to enroll in Neighborhood INTEGRITY, individuals must:
Individuals must meet all four criteria to be eligible. Possible reasons for ineligibility include:
The RI Executive Office of Health and Human Services (EOHHS) estimates that there are approximately 30,000 dual eligibles in Rhode Island who qualify for Neighborhood INTEGRITY.
There are two types of enrollment, Opt-In and Passive enrollment. Both types of enrollment are completely voluntary, as those scheduled for passive enrollment are free to cancel before being enrolled.
Individuals who are identified for the Opt-In enrollment group will be mailed an enrollment packet that includes an enrollment letter (blue), an application, and information on the plan. Individuals can either apply over the phone or send in a paper application. Once they have submitted an application, the State will verify their eligibility and mail a notice either verifying or denying their enrollment. No one in the Opt-In enrollment group will be automatically enrolled in INTEGRITY, they must affirmatively apply to be enrolled.
Individuals who are identified for the Passive enrollment group will be mailed two enrollment letters (yellow), one 60 days prior to their start date and a reminder letter 30 days prior to their start date. People in the Passive enrollment group need to call the Enrollment Line to stop the automatic enrollment if they do not want to be enrolled in Neighborhood INTEGRITY.
Individuals are eligible for Passive enrollment if they meet all of the following criteria:
Initial enrollment for Neighborhood INTEGRITY was scheduled in waves, with different populations receiving enrollment notices over the course of nine months. Enrollment began on July 1, 2016 for Opt-In enrollees and October 1, 2016 for Passive enrollees.
SPMI – severe and persistent mental illness
I/DD – intellectual and developmental disabilities
Those who are passively enrolled don’t need to take any action to enroll.
Those in opt-in enrollment categories have to either complete and submit the paper application they receive in the mail, or call the Medicare-Medicaid Enrollment Line to enroll. The timing of an application is important. If an application is submitted by the tenth of the month, the individual is enrolled on the first day of the following month. If an application is submitted after the tenth of the month, the individual is enrolled the first day of the next month.
If Jane applies on April 5 and her application is processed and approved, her effective date is May 1. If Jane waits until April 15 to apply and her application is processed and approved, her effective date is June 1.
Those who opt in and apply for coverage may have their applications denied. Individuals are most commonly denied coverage under Neighborhood INTEGRITY because they:
Unsuccessful applicants will receive a notice explaining the reasons for the decision, accompanied by instructions on how to request a hearing to appeal the denial. Those seeking additional information on their decision should call the Enrollment Line. Those who are unable to resolve their disputes and plan to file appeals may contact the RIPIN Healthcare Advocate, designated by EOHHS as the Integrated Care Initiative Ombudsman.
Those in opt-in enrollment categories will not be enrolled without affirmatively applying for coverage.
Those scheduled for passive enrollment may opt out or cancel their enrollment up until the last day of the month prior to their enrollment start date (listed on their enrollment letter). Call the Enrollment Line to opt out. You should then receive a notice confirming your decision to opt out.
Individuals may become involuntarily disenrolled if they no longer meet the eligibility criteria (e.g. a covered individual loses Medicare Part A or Part B coverage, loses Medicaid coverage, or moves out of Rhode Island). Individuals will also be disenrolled if they enroll in a Medicare Part D plan or a Medicare Advantage Plan.
EOHHS Integrated Care Initiative Regulations – Link
Three Way Contract Between CMS, EOHHS, and Neighborhood – Link
EOHHS Integrated Care Initiative Page – Link
EOHHS Integrated Care Initiative Resources Page (includes all notices) – Link
EOHHS Integrated Care Initiative Training Manual – Link
EOHHS Integrated Care Initiative Fact Sheet – Link