Dual Eligible Strategy Documents

Model Options for Dual Eligibles - Key Learnings, 2019 Stakeholder Discussions

Consumer Notices- ICI Phase 2

 List of Notices and why they are sent

Notice 32Application  FAQ : Opt-In Enrollment Letter, Application

Notice 32 Spanish, Notice 32 Portuguese- Opt-In Enrollment Letter

Notice 31 and FAQ: Passive Enrollment Letter #1

Notice 31 Spanish, Notice 31 Portuguese -Passive Enrollment Letter #1

Notice 5: Passive Enrollment Letter #2

Notice 5 Spanish, Notice 5 Portuguese- Passive Enrollment Letter #2

Notice 4: Receipt of Completed Enrollment Request and Confirm Enrollment

Notice 6: Notice for Requesting Information

Notice 8: Member Has Employer or Union Retiree Drug Subsidy

Notice 9: Denial of Enrollment

Notice 11: Acknowledgement of Request to Cancel Enrollment

Notice 16: Notice to Confirm Voluntary Disenrollment

Notice 17: Denial of Disenrollment

Notice 19: Disenrollment Due to Out of Area Status

Notice 21: Disenrollment Due to Loss of Medicaid Status

Notice 23: Disenrollment Due to Death

Notice 24: Disenrollment Due to Part A or B Ending

Notice 25: Disenrollment Due to Incarceration

Notice 27: Acknowledgement of Reinstatement

Notice 28: Acknowledgement of Request to Opt-Out of MMP

Translation insert (included with all notices)

Appeals Instructions and Form (Eng)

Appeals Instructions and Form (Span)

Appeals Instructions and Form (Port)


Cancelling vs. Disenrollment Fact Sheet, 2/4/2020


PACE-RI is a health plan for adults 55 and older who have chronic health needs and want to live at home.  PACE provides health care, insurance, and support services including primary care, access to specialists, prescription drugs, durable medical equipment, dental care, 24-hour emergency services, home care, transportation to all medical appointments, day center services, meals, and physical, speech, occupational and respiratory therapies.  PACE-RI serves the entire state (except Block Island and Prudence Island).  For more information, call 401-654-4176, 877-781-7223 (toll-free) or visit Website:
PACE Brochure


Background Documents