CRANSTON, R.I. (WPRI) – Rhode Island health and human services officials are bracing for an April 1 deadline when they have to begin a Medicaid recertification process that will affect about a third of the state’s population and could kick at least 25,000 people off the program.

At the start of the pandemic, Medicaid stopped requiring recipients to submit annual paperwork showing they remained qualified for the taxpayer-funded program, which provides insurance for poor and disabled Americans. That pause is coming to an end, after the Medicaid rolls have swelled to its largest level in history.

In Rhode Island, more than 350,000 people are currently covered by Medicaid – roughly a third of the state’s 1.1 million population – and they all must go through the recertification process beginning next month.

State officials estimate 25,000 to 30,000 enrollees will lose coverage as a result of having become unqualified, although it won’t happen all at once because the state will spread the process out over a 12-month period to lessen the administrative burden.

And while state officials insist they are ready and have the resources needed both inside and outside government to meet the impending demand, the process is expected to cause widespread confusion among thousands of Rhode Islanders who will be interacting with a Medicaid recertification process for the first time in three years.

During a news briefing with reporters Thursday morning, state Medicaid Director Kristin Sousa described the recertification process as “one of the largest things the country will do” since implementation of the Affordable Care Act, also known as Obamacare, which mostly came into effect in 2014 and has since vastly expanded Medicaid coverage across America.  

At a news conference following the briefing, Gov. Dan McKee drew parallels between the recertification process and his effort to get Rhode Islanders vaccinated for COVID-19.

“This whole process is concerning, but not any more concerning than when I said we get 90% of the state vaccinated during the COVID,” McKee said. “There were a lot of people who said, ‘I don’t think he could do that,’ but we are No. 1 in the country in terms of vaccinations.”

(Rhode Island is the No. 1 state for people fully vaccinated, at 88%, according to data compiled by the U.S. Centers for Disease Control. But the agency says Rhode Island trails Vermont, Washington, D.C., Massachusetts, Maine, Minnesota and Washington when it comes to percent of population with updated bivalent booster shots.)

Rhode Island has already begun sending Medicaid recertification notices to recipients in English, Spanish and Portuguese. And state officials said they are pleased only to have received returned mail at a rate of about 7%, suggesting relatively few enrollees lack an up-to-date address on file. But they acknowledged returned mail isn’t a foolproof way to determine people’s whereabouts and there are concerns many might never know the recertification process is happening, causing their coverage to lapse if they fall through the cracks.

“I’m concerned,” said Senate Finance Committee Chairman Louis DiPalma, who has long advocated for a stronger health and human services system in Rhode Island. “This is a critical step in the overall execution of the public health emergency unwinding.”

The director of technology for the R.I. Executive Health and Human Services, Nicole Nelson, said they have a tiered approach to get in touch with people who don’t respond to mail, including reaching out through email, phone and text. The state is also posting information on a dedicated website, staycovered.ri.gov, and people can submit paperwork at R.I. Department of Human Services locations and through community partner nonprofits across the state.

Yet despite the preparation efforts, the April 1 start date is fast approaching, and Rhode Island has a rocky history of handling major changes to its health and human services programs — most famously the notorious UHIP technology system for social services that took years to fix after its botched launch under then-Gov. Gina Raimondo.

There have already been warnings about the potential for administrative errors affecting the recertification process. Last year, a report by an arm of the U.S. Department of Health and Human Services estimated about 45% of Americans who still qualified for Medicaid would lose coverage anyway — falling off the rolls for administrative reasons.

“Administrative churning refers to the loss of Medicaid coverage despite ongoing eligibility, which can occur if enrollees have difficulty navigating the renewal process, states are unable to contact enrolled contact due to change of address or other administrative hurdles,” federal health officials wrote in the report.  

For about half of Medicaid recipients — roughly 150,000 people in Rhode Island – the experience should be relatively easy thanks to a process called “passive renewal.” In those cases, state officials possess accurate information about an individual’s income and financial situation, meaning they won’t need to take any action after receiving notifications, unless something is incorrect about their information.

The other half, however, will need to take some level of action to ensure no lapse in coverage. The state’s health insurance exchange, HealthSourceRI, is expected to step in to serve at least some of the tens of thousands of people who are expected to get kicked off of Medicaid.

HealthSourceRI, also created under Obamacare, offers a variety of insurance plans that are deeply subsidized by federal tax credits, depending on people’s incomes. Some portion of people removed from Medicaid rolls will have an option to transfer into one of those plans, which currently cost less than $20 per month for 30% of their customers, according to HealthSourceRI Director Lindsay Lang.

But Lang said her agency estimates Rhode Island’s uninsured rate could rise from its current level of 2.9% to as high as its pre-pandemic level of about 4%. And many expect much of that will depend on how well Rhode Island handles the inevitable influx of calls, in-person visits and other types of inquiries from people trying to navigate the system.

“Now comes the most important step: flawless execution of the plan,” DiPalma said.

Kimberly Merolla-Brito, acting director of R.I. Department of Human Services, acknowledged that the demand will be too much for any individual state agency to handle on its own. But she was steadfast in her optimism that they would be able to mange thanks to partnerships with community organizations and private health insurance companies.

“The state is prepared for what is going to happen,” she said.

Correction: An earlier version of this story had outdated Medicaid enrollee data. It has been updated.