Helping Rhode Island Medicaid Members During the Coronavirus (COVID-19) Pandemic

We cover in-person PCR (polymerase chain reaction), antigen and antibody laboratory testing consistent with federal and state guidance at no cost to our members. These tests must be medically necessary, as determined by a health care provider, in accordance with current CDC and state public health department guidelines.

COVID-19 PCR tests that are laboratory processed and either conducted in person or at home must be ordered or referred by a provider to be covered benefits. We will not cover or reimburse you for these tests when you order them yourself, including when you order using an online self-completed questionnaire. Testing is not covered solely for general workplace health and safety, public health surveillance or for other purposes not primarily intended for a member’s individual COVID-19 diagnosis or treatment. Diagnostic coronavirus testing required as a condition of travel inside or outside of the United States is not covered.

Diagnostic testing required by your provider for surgical or other medical procedures is medically necessary and covered, including if you are pregnant or an expectant parent and testing is required prior to admittance to a delivery facility. As always, coverage is only available to health plan members.

Updates to our current COVID-19 testing policies will be published to this site as they become available.

For our Tufts Health RITogether (Medicaid) members, we have changed our coverage rules. These changes will help you get testing and treatment more easily. Until further notice:

• As new treatments are approved for emergency use authorization, they will be subject to the same guidelines as our other COVID-19 treatments.
• As vaccines for COVID-19 are approved and available, the vaccines will be covered in full. There will be no cost to members. 
• Members are fully covered to get telehealth from network providers. Telehealth is when you receive health care services by phone, video or another technology from a primary care provider or a specialist. Contact your provider to see if telehealth is available.

Call member services at 866-738-4116 (TTY: 711) if you have questions about your coverage.

The FDA has authorized the following two oral antiviral medications under emergency use authorization (EUA) for the treatment of certain cases of COVID-19. When prescribed and dispensed under the requirements of the EUA, one course of therapy can be provided at no charge to the member. Prescriber and pharmacy access is currently extremely limited; speak to your health care provider if you test positive for COVID-19 and believe you qualify for treatment.

• Pfizer’s PAXLOVID™ (nirmatrelvir/ritonavir)
• Merck’s molnupiravir

Prior authorization (PA) requirements that were lifted because of the COVID-19 public health emergency will be reinstated. PA is a request from your provider for approval from us to provide you with certain medically necessary services.

• PA requirements for medical services go back into effective Oct. 1, 2021.
• PA requirements for behavioral health service (such as appointments with a psychiatrist, therapist or other behavioral health provider) go back into effect January 1, 2022.

If you have any questions about this change or if it will affect the health care services you receive, please contact your health care provider(s) directly. Or call our member services team at 866-738-4116 (TTY: 711), Monday through Friday, from 8:00 a.m. to 6 p.m.

Members should continue to see providers in their network whenever possible. Prior authorization may be required for an out-of-network service that is not related to COVID-19. Members do not need a referral from their primary care provider to see in-network specialists.

During the COVID-19 outbreak, it’s still important for children to get their immunizations. They protect your kids from preventable diseases. Measles, mumps and whooping cough are just some of the illnesses we can prevent through vaccines. Providers’ offices are taking steps to see kids in a safe and controlled way when they need an in-office visit.

Call your child’s primary care provider. Make a plan to keep your child on schedule for their immunizations safely. Preventive visits and immunizations are covered at no cost to members.

The following pharmacy policies are in effect until August 7, 2021:

We allow members an early refill of their prescriptions before the expiration date as long as there are refills on the medication. We want to make sure that members have a supply of their medications if they need them.

Members can refill up to a 90-day supply if permitted for that type of medication. Early refills will not be allowed for controlled substance drugs.

If you have multiple maintenance medications, each drug can be refilled early just once.

Members are fully covered to get telehealth from network providers. Telehealth is when you receive health care services by phone, video or another technology from a primary care provider or a specialist. Contact your provider to see if telehealth is available.

If you have questions about COVID-19 or any health issue, call our free NurseLine at 800-285-3580. You can speak to a registered nurse anytime, 24 hours a day, seven days a week.

• Centers for Disease Control and Prevention
• Rhode Island Department of Health