Rhode Island Medicaid Definition
Medicaid in Rhode Island is also called Medical Assistance (MA) and is administered by the State of Rhode Island Department of Human Services (DHS) agency.
Medicaid is a wide-ranging health insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, health coverage is provided for varying groups of Rhode Island residents, including pregnant women, families with children, adults without dependent children, disabled individuals, and seniors. While there are differing eligibility groups, this page is focused strictly on Medicaid eligibility for Rhode Island elders, aged 65 and over, and specifically for Long Term Services and Supports (LTSS), whether that is at home, in shared living, in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Rhode Island seniors may be eligible. These programs have slightly different financial and medical (functional) eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that Rhode Island offers multiple pathways towards Medicaid eligibility.
1) Institutional / Nursing Home Medicaid – this is an entitlement program. This means anyone who meets the eligibility requirements will receive assistance, which is provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – with these programs, there are a limited number of participant enrollment slots. Therefore, wait lists may exist. Benefits are provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Elders and Adults with Disabilities (EAD) – this is an entitlement program, which means as long as eligibility requirements are met, one will receive assistance. Benefits are provided at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from an Rhode Island Medicaid program. Alternatively, it can be helpful to take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible for Medicaid in Rhode Island. More.
|2020 Rhode Island Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,349 / month||$4,000||Nursing Home||$4,698 / month (Each applicant can have up to $2,349)||$8,000 (Each spouse is allowed up to $4,000)||Nursing Home||$2,349 / month for applicant||$4,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,349 / month||$4,000||Nursing Home||$4,698 / month (Each applicant can have up to $2,349)||$8,000 (Each spouse is allowed up to $4,000)||Nursing Home||$2,349 / month for applicant||$4,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Regular Medicaid / Elders and Adults with Disabilities (EAD)||$1,063 / month||$4,000||None||$1,437 / month||$6,000||None||$1,437 / month||$6,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, Veteran’s benefits, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends.
When only one spouse of a married couple is applying for institutional Medicaid or home and community based services via a Medicaid waiver, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. However, in the case where only one spouse of a married couple is applying for regular Medicaid, the income of both the applicant spouse and the non-applicant spouse is counted towards the income limit. Learn more about how Medicaid counts income.
For married couples, with non-applicant spouses’ of nursing home Medicaid applicants or HCBS Medicaid waiver applicants with insufficient income from which to live, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA). The MMMNA is intended to ensure non-applicant spouses do not become impoverished. Basically, if the non-applicant spouse, also called the community spouse or well spouse, has income under $2,113.75 / month (this figure is current as of July 2019 and is set to increase in July 2020), he or she is entitled to a portion of the applicant spouse’s income to bring his or her monthly income to $2,113.75. If the well spouse has income equivalent to $2,113.75 / month or more, the non-applicant spouse may be entitled to a greater portion of his or her applicant spouse’s income, given shelter and utility costs are costly. As of 2020, the maximum monthly maintenance needs allowance is $3,216 / month (this figure will change in January 2021.) This income allowance does not apply to married couples with one spouse applying for regular Medicaid.
What Defines “Assets”
Countable assets (also called resources) include cash, stocks, bonds, investments, promissory notes, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility purposes, there are many assets that are not counted. In other words, they are exempt from the eligibility limit. Exemptions include personal belongings, such as clothing, household furnishings, an automobile, a burial plot, and a burial trust (limited to $1,500). One’s primary home, given the Medicaid applicant or his or her spouse lives in the home and the equity value is under $595,000 (in 2020) is also exempt.
For married couples, as of 2020, the community spouse (the non-applicant spouse of an institutional Medicaid applicant or a HCBS Medicaid applicant) can retain half of the couples’ joint assets (up to a maximum of $128,640), as the chart indicates above. However, if a couple’s joint assets are equal or less than $25,728, the non-applicant spouse can keep 100% of the resources. This is referred to as the Community Spouse Resource Allowance (CSRA) and is intended to prevent the non-applicant spouse from becoming impoverished. To be clear, there is no resource allowance for non-applicant spouses of those applying for regular Medicaid.
It is vital that one does not give away assets or sell them for less than fair market value in an attempt to meet Medicaid’s asset limit. This is because Rhode Island has a Medicaid Look-Back Period, which is a period of 60 months (5 years) that dates back from one’s Medicaid application date. During this time frame, Medicaid checks all past transfers to ensure no assets were sold or given away for less than they are worth. If one is found to be in violation of the look-back period, one will be penalized with a period of Medicaid ineligibility.
Qualifying When Over the Limits
For Rhode Island elderly residents (65 and over) who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy (MN) Pathway – In Rhode Island, the Medically Needy Pathway, also commonly referred to as a Spend-Down Program, allows those who are over the income limit to qualify for Medicaid if they have high medical expenses. In simple terms, one may still qualify for Medicaid services by “spending down” their excess income (the income over the Medicaid income limit) on private health insurance, unpaid medical bills, care assistance, and medical expenses that Medicaid does not cover. (The amount one must “spend down” can be thought of as a deductible.) Once one has spent their income down to the income limit, Medicaid will kick in for the remainder of the “spend down” period, which is six month in Rhode Island.
Make note, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in reducing their excess assets to meet the asset limit. However, one can “spend down” assets by spending excess assets on non-countable ones, such as home modifications (addition of first floor bedrooms, wheelchair ramps, or stair lifts), prepaying funeral and burial expenses, and paying off debt. Remember, Medicaid has a “Look-Back” period of 5 years, and if one is in violation, a period of Medicaid ineligibility will result.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Rhode Island Medicaid Programs
1) Global Consumer Choice Compact Waiver – also called the Rhode Island Comprehensive Demonstration, this program is intended to prevent and delay nursing home placement of seniors. Benefits include personal care assistance, personal emergency response systems, home/vehicle modifications, meal delivery, adult day care, respite care, and more. This waiver also allows for consumer direction, which allows program participants to choose the caregiver of their liking, including their adult children.
2) Shared Living Program – also referred to as the Caregiver Homes Program or RIte @ Home, this program is a benefit under the RI Global Consumer Choice Compact Waiver, which is mentioned above. Also a nursing home diversion program, program participants move in with a caregiver, who may be a relative or friend, and the individual provides personal care assistance for the program participant. Other benefits include transportation, adult day care, and chore services.
How to Apply for Rhode Island Medicaid
To apply for long-term care Medicaid in Rhode Island, elderly residents can apply online at HealthyRhode RI, over the phone by calling the Department of Human Services (DHS) at 855-697-4347, or by completing a paper application and mailing it to their local DHS office. In addition, seniors can apply in person at their local DHS office. For application assistance, persons can call 401-462-4444 to reach the POINT. Seniors might also wish to contact their local Area Agency on Aging for questions regarding Medicaid and for application assistance.
Prior to submitting a Medicaid application for long-term care in Rhode Island, it is imperative that seniors be positive that all eligibility requirements (covered in detail above) are met. Persons over the income and / or asset limit(s) can still qualify for benefits with Medicaid planning. The application process is complicated and documentation is required in addition to the completed application. For general information about the Medicaid application process, click here.