R.I. Medicaid enrollments continue to climb

April 24--PROVIDENCE, R.I. -- The number of Rhode Islanders enrolled in Medicaid keeps going up, confounding forecasts that nearly five years of growth in the public health insurance program would reverse, according to new figures released Monday.

An average of 311,367 Rhode Islanders are expected to be on Medicaid in the year ending June 30, 6,428 more people than Gov. Gina Raimondo assumed in her January budget plan, according to new statistics released by the Executive Office of Health and Human Services Monday.

Those extra beneficiaries are the primary reason Medicaid spending is tracking $18.3 million over budget in the year ending June 30 and cost estimates for the following year have increased by $18.4 million from Raimondo's budget.

Fortunately, the federal government will pick up the bulk of that increase, with the Medicaid budget hit to the state pegged at $1.9 million this year and $2.8 million next year.

But instead of pulling back, Raimondo Monday asked lawmakers to add another $15.7 million in Medicaid spending next year, bowing to pressure from hospitals to restore a series of payments that compensate them for charity care.

If the General Assembly agrees to restore the "Disproportionate Share Hospital" payments, it would put Raimondo's projected Medicaid budget for next year $18.5 million in the red including just state dollars and $34.1 million including federal spending.

State Medicaid Program Director Patrick Tigue Monday said the administration wanted to restore the hospital payments after Congress reauthorized them in February even though just last month Raimondo pointed to Super Bowl ads and executive salaries of hospital group Lifespan as evidence hospitals could afford to tighten their belts.

The Hospital Association of Rhode Island, which is led by former Senate President Teresa Paiva Weed, called the restoration of $15.7 million "an important first step" in the state budget process, according to an email from spokeswoman Kayla Mudge.

The request to restore hospital payments came after the state budget picture for next year brightened somewhat last week on news that revenue collections through March are running $46.5 million ahead of forecasts.

Over the last two years, the Raimondo administration has blamed problems with the troubled public assistance computer system known as UHIP for failing to find and purge ineligible people from the Medicaid rolls. When the system begins working properly, they predicted, enrollment would shrink.

UHIP still isn't working properly, but for the first time since it went live in the fall of 2016, Executive Office of Health and Human Services officials on Monday said they believe computer bugs are no longer inflating enrollment figures.

Tigue Monday could not point to any specific factor why the state has underestimated Medicaid enrollment in recent years. A report to the panel of fiscal analysts setting budget estimates for the year ahead noted HealthSource RI, the state's Obamacare exchange, saw a 5 percent jump in enrollment for this year.

At Monday's revenue estimating conference, fiscal advisers for the House and Senate questioned Raimondo's decision to try to add $15.7 million in new state spending in a footnote at the bottom of the Medicaid report and how projected enrollment declines had suddenly vanished.

"It does look like we are way exceeding our estimates for how many people are eligible," said House Fiscal Adviser Sharon Reynolds Ferland. "I am just wondering how much of this is perhaps the verification systems are not catching what they should catch."

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