Health Insurance for Low-Income
The Rhode Island Medical Assistance Program, also known as "Medicaid", is a federal and state funded program, providing medical and health-related services for eligible Rhode Island residents.
The Executive Office of Health and Human Services (EOHHS) administers the Medicaid program to provide health insurance for low-income families with children, pregnant women, senior citizens, people with disabilities or special needs, and other residents struggling to access affordable health care.
With the introduction of Obamacare, the Affordable Care Act, Rhode Island opted to expand their Medicaid programs. If you’re are an adult between the ages of 19 and 64 with no disabilities and an income of up to $1,321 a month, you could be eligible for Medicaid’s affordable care coverage through Rhody Health Partners Plan, even if you were denied coverage in the past.
General Program Requirements
To qualify for Medicaid, you must be a low-income resident of the state of Rhode Island in need of health care/insurance assistance. You must also belong to one of the following groups:
- Pregnant women
- Parents/ Guardians of at least one dependent under the age of 19
- Blind or disabled
- Living in a household with a disabled family member
- Age 65 or older
Rhode Island Medicaid Plan Options
Medicaid is available to children who meet the requirements for RIte Care/RIte Share or Katie Beckett coverage, qualify for Supplemental Security Income (SSI), are in substitute care (including foster care), or are part of the adoption subsidy program through the RI Department of Children, Youth, and Families (DCYF).
Long-Term Services and Support
Long-term services and support are available to adults with disabilities that need both medical care and non-medical living support to assist with normal daily tasks.
Medicaid LTSS for adults with disabilities covers care provided at home and in community settings as well as in health facilities like hospitals and nursing homes.
Developmental Disabilities Program
Developmental Disabilities Program provides Medicaid and other publicly funded home and community-based services to people between ages 22 and 64 who are at risk of admission to an institutional setting.
Adult Day Services
Adult Day Services provide care and companionship during daytime hours.
Assisted Living
Assisted living is an option for those who want company, have failing health, or need 24-hour support. The Assisted Living Residence must participate in the Medicaid program.
Rite at Home
RIte at Home Shared living supports adults who cannot live alone and require a considerable amount of help with daily activities. A RIte at Home agency can help you find an appropriate, trained host home or caregiver. The caregiver may be someone you know, like a relative, neighbor or friend, but NOT a spouse.
Program of All-Inclusive Care for the Elderly (PACE)
The Program of All-inclusive Care for the Elderly (PACE) is a care model for acute and long-term care individuals age 55 and older that meet state specific criteria for nursing home care placement. The goal of PACE is to maximize the participant’s autonomy and ability to reside in their community, while receiving quality care at lower cost relative to the Medicare, Medicaid, and traditional private pay programs.
Personal Choices
If you qualify for RI Medicaid LTSS, you may be able to hire and manage your own caretaker to help you with bathing, dressing, and other home activities through the Personal Choice Program.
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
Early and Periodic Screening, Diagnosis and Treatment provides preventative medical care up to the age of 21, including vaccinations and developmental check-ups. In cases, where special health care needs are identified, additional services may be available.
Katie Beckett Medicaid Program
The Katie Beckett Medicaid Program waives family income limits and provides Medicaid for children under the age of 19 who meet federal disability criteria, and for whom at-home care is more cost effective than residential care in a hospital, skilled nursing facility or intermediate care facility
Early Intervention Program
Rhode Island's Early Intervention Program provides a comprehensive developmental evaluation to determine eligibility for services. The program is designed to promote the growth and development of children under 3 years that have a developmental disability or delay in one or more areas, allowing them to develop to their fullest potential. Children do not have to be eligible for RI Medicaid to receive services.
Women’s Cancer Screening Programing
Women’s Cancer Screening Programing covers uninsured or underinsured women at specific income levels who need screenings for breast or cervical cancer. The program also provides diagnostic services and follow-up when an abnormality is found.
Medicare Costing Savings programs
The purpose of Medicare Costing Savings programs is to assist individuals in paying their Medicare premiums and by making payments to medical providers for coinsurance and deductibles for Medicare services.
The Qualified Medicare Beneficiary (QMB) program pays for Medicare Part B premiums, coinsurance, and deductibles for those eligible and enrolled in Medicare Part A.
The Specified Low Medicare Beneficiary (SLMB) program provides payment of Medicare Part B premiums only for individuals who would be eligible for the QMB program except for excess income.
The Qualified Individual (QI-1) program provides payment of Medicare Part B premiums only for individuals who would be eligible for the SLMB program except for excess income.
The Qualified Disabled Working Individual (QDWI) program provides payment of Medicare Part A premiums only for individuals meeting income limits.
Medicaid FAQs
- What is Medicaid?
Medicaid is a state funded insurance that that provides coverage to low-income families, pregnant women, newborns, and children that may not be able to afford to purchase their own care.
- Who is eligible for Medicaid?
Applicants who qualify for Rhode Island Medicaid include:
- Adults with a household income below 133% of the Federal Poverty Line (FPL);
- Pregnant women with a household income below 253% of the FPL;
- Children living in a household with an income below 261% of the FPL;
- Anyone who is blind, disabled, or over 65.
- How do I find out if I am eligible for Medicaid?
To find out if you are eligible for Medicaid, you must fill out an application for Medicaid or CHIP. You may fill out an application at any time of the year. See more on Medicaid.
- Will Medicaid cover my children?
Your household income level will determine if your child or children can be covered by Medicaid.
- What is CHIP?
CHIP is a program that supports children in families that cannot afford private health insurance, but whose household income is too high to qualify for Medicaid.
- Does Medicaid satisfy the health insurance requirement?
Yes, Medicaid will satisfy the Affordable Care Act (Obamacare) health insurance requirement for the covered individuals.
- What information and documents should I have when I'm signing up for Medicaid?
Depending on the Medicaid program being applied for, you will need the following: Identity, Social Security, proof you live in Rhode Island, proof of income, proof of medical costs, and bank account information.
- How does Obamacare work with Medicaid?
Because of Rhode Island's Medicaid eligibility requirements, Obamacare does not impact people who qualify for Medicaid and vice versa. As such, tax credits are only available for people who are not eligible for other plans.
- What is Rhody Health?
Rhody Health is the Medicaid option available to
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