Rhode Island Medicaid Eligibility for Long Term Care: Income & Asset Limits

Last updated: February 03, 2022

 

Rhode Island Medicaid Definition

Medicaid in Rhode Island is called Medical Assistance (MA). It is administered by the State of Rhode Island Department of Human Services (DHS) agency.

Medicaid is a health insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, coverage is provided for varying groups of Rhode Island residents. This includes pregnant women, families with children, adults without dependent children, disabled individuals, and seniors. This page, however, is focused strictly on Medicaid eligibility for Rhode Island elders, aged 65 and over. Specifically, Long Term Services and Supports (LTSS) is covered. In addition to care services in nursing homes, assisted living facilities, and shared living, RI Medicaid pays for non-medical services and supports to help frail seniors remain living at home.

  The American Council on Aging now offers a free, quick and easy Medicaid eligibility test for seniors.

 

Income & Asset Limits for Eligibility

There are several Medicaid long-term care programs for which Rhode Island seniors may be eligible. These programs have varying financial and medical (functional) eligibility requirements, as well as 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; Anyone who meets the eligibility requirements will receive assistance. Benefits are provided only in nursing home facilities.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – These are not entitlement programs; There are a limited number of participant slots and wait lists may exist. Intended to delay the need for nursing home admissions, services and supports are provided at home, adult day care, shared living, or in assisted living. More on Waivers.

3) Regular Medicaid / Elders and Adults with Disabilities (EAD) – This is an entitlement program; As long as eligibility requirements are met, one will receive assistance. Various long-term care services, such as personal care assistance or adult day care, may be available.

The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a Rhode Island Medicaid program. Alternatively, it can be helpful to take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Rhode Island. More.

2022 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 $2,523 / month* $4,000 Nursing Home $5,046 / month ($2,523 / month per spouse)* $8,000 ($4,000 per spouse) Nursing Home $2,523 / month for applicant* $4,000 for applicant & $137,400 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $2,523 / month† $4,000 Nursing Home $5,046 / month ($2,523 / month per spouse)† $8,000 ($4,000 per spouse) Nursing Home $2,523 / month for applicant† $4,000 for applicant & $137,400 for non-applicant Nursing Home
Regular Medicaid / Elders and Adults with Disabilities (EAD) $1,133 / month $4,000 Help with ADLs $1,526 / month $6,000 Help with ADLs $1,526 / month $6,000 Help with ADLs
*All of a beneficiary’s monthly income, with the exception of a personal needs allowance of $50 / month, Medicare premiums, and potentially a monthly income allowance for a non-applicant spouse, must go towards the cost of nursing home care.
†Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.

 

What Defines “Income”

Any income that a Medicaid applicant receives is counted. 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. Covid-19 stimulus checks and Holocaust restitution payments are an exception and do not count as income.

When only one spouse of a married couple applies for Institutional Medicaid or a Medicaid Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact the income eligibility of their applicant spouse. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. The MMMNA is a spousal impoverishment rule and is said to be the minimum amount of monthly income a non-applicant spouse requires to avoid impoverishment. In RI, the MMMNA is $2,288.75 (effective 7/1/22 – 6/30/23). If a non-applicant’s monthly income falls under $2,288.75, income can be transferred from their applicant spouse, bringing their income up to this level.

In Rhode Island, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $686.63 / month (effective 7/1/22 – 6/30/23). In 2022, a spousal income allowance cannot put a non-applicant’s monthly income over $3,435. This is the Maximum Monthly Maintenance Needs Allowance. More on how the spousal income allowance is calculated.

Income is counted differently when only one spouse applies for Regular Medicaid / Elders and Adults with Disabilities; The income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. Learn more about how Medicaid counts income.

 

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. There are also many assets that are not counted; 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 lives in the home or has intent to return, and in 2022, their home equity interest is not greater than $636,000, is also exempt. Equity interest is the amount of the home’s value owned by the applicant. The home is also exempt, regardless of any other circumstances, if the applicant has a spouse residing there.

 While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s estate recovery program. Following a long-term care Medicaid beneficiary’s death, Rhode Island’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, spousal impoverishment rules permit the non-applicant spouse of an Institutional Medicaid or Waiver applicant a Community Spouse Resource Allowance (CSRA). In 2022, in RI, the community spouse (the non-applicant spouse) can retain 50% of the couples’ assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets falls under $27,480, 100% of the assets, up to $27,480 can be retained by the non-applicant.

It is vital that one does not give away assets or sell them for less than fair market value within 60-months of applying for long-term care Medicaid. This is because Rhode Island has a Medicaid Look-Back Period that immediately precedes one’s Medicaid application date. During this 5 year period, Medicaid checks all past transfers. If assets have been gifted or sold under fair market value, the Medicaid agency assumes it was done to meet Medicaid’s asset limit. Violating the look-back period, even unintentionally, triggers a period of Medicaid ineligibility.

 Non-Financial Eligibility Requirements – For Rhode Island long-term care Medicaid eligibility, an applicant must have a functional need for such care. For Institutional Medicaid and Medicaid Waivers, a nursing facility level of care (NFLOC) is required. Furthermore, for some program benefits, additional eligibility criteria may need to be met. For example, for respite care, an inability to be left unsupervised might be necessary. For long-term care services via the Regular Medicaid program, a functional need with the activities of daily living is required, but a NFLOC is not necessarily required.

 

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, there is a Spend-Down Program, which allows seniors 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 income on private health insurance, unpaid medical bills, care assistance, and medical expenses that Medicaid does not cover. In 2022, the medically needy income limits (MNILs) are $1,008 / month for an individual and $1,050 / month for a couple. The “spend down” amount, which can be thought of as a deductible, is the difference between one’s monthly income and the MNIL. In RI, one’s spend down is calculated for a 6-month period. Once it has been met, one will be Medicaid eligible for the remainder of the period. The asset limit is $4,000 for an individual and $6,000 for a couple.

2) Asset Spend Down – Persons who have assets over Medicaid’s limit can still become asset eligible by spending down extra assets. This is done by spending countable 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, assets cannot be gifted or sold under fair market value, as doing so violates Medicaid’s look back rule. It is recommended one keep documentation of how assets were spent as proof the look back rule was not violated.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” or “over-asset” or both, but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid estate recoveryMore on Medicaid Planning or connect with a Medicaid planner.

 

Specific Rhode Island Medicaid Programs

Like all states, Rhode Island Medicaid pays for nursing home care for state residents who are medically and financially eligible for such care. RI Medicaid also offers Medicaid programs for seniors who require nursing home level care or have slightly lesser care requirements and do not wish to reside in a nursing home. These programs provide care at home or “in the community”.

1) Long Term Services and Supports (LTSS) – Formerly called the Global Consumer Choice Compact Waiver and 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) Medicaid Preventive Services – is related to LTSS but is intended for individuals with needs less severe than LTSS.

3) RIte @ Home – Also called the Caregiver Homes Program or Shared Living Program, this program is a benefit under the RI Global Consumer Choice Compact Waiver. 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.

4) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care services, and Medicare are combined into one program. Additional benefits, such as dental and eye care, may be available.

 

How to Apply for Rhode Island Medicaid

Elderly residents in Rhode Island can apply for long-term care Medicaid online at HealthyRhode RI, over the phone by calling the Department of Human Services (DHS) at 855-697-4347 (855-MY-RIDHS), or by completing a paper application and mailing it to their local DHS office. Seniors can also apply in person at their local DHS office. For application assistance, persons can call POINT at 401-462-4444. One’s local Area Agency on Aging office might be helpful in answering Medicaid related questions and offering 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.

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