STATE NEWS- RI Medicaid call delays are New England’s highest

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: 39 minutes to wait on hold is pretty bad.



Clipped from:

PROVIDENCE, R.I. (WPRI) — The federal government is raising concerns about how long Medicaid recipients are waiting on the phone to speak with state officials, as Rhode Island wait times rank worst in New England.

The U.S. Centers for Medicare and Medicaid Services sent letters to all 50 states earlier this month, providing them with a series of metrics tied to the ongoing recertification process that requires all Medicaid recipients to re-enroll in the federal health insurance program.

About 350,000 Rhode Islanders — about a third of the state — are enrolled in the program. Recertification was put on pause during the coronavirus pandemic but resumed in April and is expected to take a year to complete.

A Target 12 review of the letters revealed Rhode Island had the worst wait times in New England, averaging 39 minutes per call in May. The delays were far shorter in neighboring states, averaging only one minute in Connecticut and two minutes in Massachusetts.

“CMS has concerns that your average call center wait times and abandonment rate are impeding equitable access to assistance for people who apply for Medicaid,” CMS officials wrote to Rhode Island leaders.

R.I. Human Services Director Kim Merolla-Brito, who oversees the call center, said she wasn’t surprised about the critical letter from the feds as lengthy wait times has been a challenge for a long time in Rhode Island. But she defended the state’s effort in trying to chip away at the issue.

“It is not acceptable,” she told Target 12. “It has been something that DHS has been working on for quite some time.”

BACKGROUND: Wait times a problem heading into RI Medicaid recertification

Merolla-Brito said her department has been working to shorten the time people have to wait on the phone, including call-back services and closing the call lines on Wednesdays so employees can catch up on processing paperwork.

She acknowledged the idea of closing the call center for an entire day could sound counterintuitive, but she argued that by catching up on paperwork, people would receive services more efficiently and that could reduce the number of reasons someone would need need to call.

“The more time that goes by and utilization of our technology resources that are in place will also drive down some of the volume that’s coming into the call center,” she said.

Staffing is another challenge the department is facing.

Merolla-Brito said she needs about 20 more people across her entire system of service providers. And while she said her call center is nearly staffed up, the director plans on asking the General Assembly for an additional 20 full-time positions to help alleviate some of the high-demand the department is experiencing across the board.

“The data that we have I believe will support us asking for it,” she said. “It changes the model in the call center and brings a higher ratio of staff.”

When asked why Rhode Island wait times were so much worse than neighboring states, Merolla-Brito said some other states have more sophisticated technology. Others have call centers completely dedicated to Medicaid calls-for-service, which differs from Rhode Island where workers are also fielding calls from SNAP recipients. The federal food and income program vies with Medicaid for being the largest benefits program in Rhode Island.

Merolla-Brito said there aren’t currently any plans on splitting up the state’s call center to have a group of workers dedicated to fielding Medicaid calls, but she said she’s open to the idea.

“It’s not off the table for us to consider,” she said.

In addition to the long wait times, CMS also raised concerns with the state’s high rate of so-called “procedural termination,” which includes people getting kicked off the program for various reasons such as the state not being able to contact them. Federal officials said the state’s high rate of 11% in May “raises concerns that eligible individuals, including children, may be losing coverage.”

TARGET 12: Thousands of Rhode Islanders booted from Medicaid since April

R.I. Medicaid Director Kristin Sousa, who oversees the program at the state level, sent a letter back to CMS acknowledging the concern. But she highlighted that Rhode Island was deferring the renewal process for families with children until January to make sure they worked out all the kinks in the system beforehand.

“This additional time will provide the state an opportunity to maximize efficiency by identifying and addressing procedural, structure, or system issues while processing Medicaid redeterminations,” she wrote in a letter dated Aug. 22.

Sousa also touted the state’s 2% rate of returned mail, saying it was relatively low and attributing it to their effort to get out the word that recertification was once again required.

“We have been very aggressive in communicating the Medicaid renewal process to members and stakeholders,” she wrote.

The state leaders are hopeful the process will only improve as recertification continues through the rest of the year and into next spring. But because the state deferred families with children, the largest strain on the system will likely begin at the end of the year, raising questions about how well the state’s effort will stand up.

Asked whether she expected wait times to go up at the end of the year, Merolla-Brito said, “I don’t.”

Sarah Guernelli ( is the consumer investigative reporter for 12 News. Connect with her on Twitter and on Facebook.

Eli Sherman ( is a Target 12 investigative reporter for 12 News. Connect with him on Twitter and on Facebook.