Rhode Island Medicaid Long-Term Services and Supports (LTSS) Under the Comprehensive Demonstration Waiver

Last updated: March 08, 2024

 

Overview of RI Medicaid Long-Term Services and Supports

Rhode Island’s Medicaid Long-Term Services and Supports, or Medicaid LTSS, provides long-term care for state residents who are elderly or disabled. While nursing home care is an available benefit, the state also offers a variety of home and community based services (HCBS) to prevent and delay the need for such care. Examples include in-home personal care assistance, homemaker services, adult day care, personal emergency response systems, and respite care. Transitional services, to assist persons who currently live in a nursing home facility and wish to transition to a private residence, are also available.

Program participants can live at home, the home of a loved one, an assisted living residence, a shared living home (adult foster care home), or a community residence for people with developmental disabilities or chronic conditions.

The services offered under Medicaid LTSS may be provided by licensed care workers or program participants have the option to self-direct their personal care, homemaker services, and chore services. This can be done via two participant-directed options: The Independent Provider Program (IP Program) and the Personal Choice Program. Both programs allow participants to hire, train, supervise, and even fire, their own caregiver. This includes hiring a friend or relative, such as an adult child. Spouses are prohibited from being hired.

Via the Personal Choice Program, persons manage their own budget and decide their caregiver’s rate of pay. However, a service advisement agency contracted by the state provides them with assistance in developing their care plan and monthly budget. Furthermore, a fiscal advisement agency handles the financial aspects of employment responsibilities such as background checks, tax withholding, and caregiver payments. Via the Independent Provider Program, program participants have less responsibility, as they do not manage their own budget.

Benefits offered under this program are not necessarily entitlements; meeting the eligibility criteria does not mean one will immediately receive program benefits. Instead, the number of participant slots may be limited, and when these slots are full, a waiting list forms.

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Wait List Alternatives: Are you interested in connecting with a Medicaid Planning Professional to discuss alternatives to RI Medicaid LTSS? Wait-lists can last from months to years, but there are other Medicaid programs that offer immediate care outside of nursing homes.
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Benefits of RI Medicaid Long-Term Services and Supports

In addition to nursing facility care, a variety of home and community based services are available. The exact benefits a program participant receives is based on an individualized service plan, but may include the following.

– Adult Companion Services / Senior Companion – supervision, socialization, non-medical care
– Adult Day Care
– Assisted Living Services
– Assistive Technology
– Case Management
– Chore Services – to assist in keeping one’s home safe, clean, and sanitary
– Community Transition Services – to assist persons in moving from an institution to a private home (i.e., security deposit, essential household furnishings, utility deposits)
– Consumer Directed Supports – information, training, counseling, assistance with self-directed care
– Home Delivered Meals
– Home Modifications – for safety and accessibility (i.e., grab bars, handheld shower, raised toilet seat, vertical platform lift)
– Homemaker Services – i.e., light housecleaning, laundry, meal preparation
– Medication Administration / Management
– Non-Medical Transportation
– Personal Care Services – assistance with daily living activities (i.e., bathing, dressing, toileting, eating), housekeeping, preparing meals, transportation
– Individual Directed Goods / Services – to promote independence / safety. Bought from a self-directed budget and must be approved in individual service plan (i.e., microwave when a stove cannot safely be used)
– Personal Emergency Response Systems
– Physical Therapy Evaluation / Services
– Private Duty Nursing / Skilled Nursing
– Respite Care – in-home and out-of-home care to relieve a primary caregiver
– Residential Habilitation
Shared Living / Rlte at Home (adult foster care) – program participant lives with a caregiver that provides personal care assistance, homemaker services, meals, and transportation
– Specialized Medical Equipment / Supplies (i.e., rolling shower chair, automatic door opener, tub slider system)
– Supported Employment
– Training / Counseling for Unpaid Caregivers

While services and supports can be provided in assisted living residences, shared living homes / adult foster care homes, and community residences for people with developmental disabilities or chronic conditions, the cost of room and board is not covered by Medicaid Long Term Services and Supports.

 

Eligibility Requirements for RI Medicaid Long-Term Services and Supports

Medicaid LTSS is for seniors (65+ years of age) and adults with disabilities (18+ years old) who are Rhode Island residents. Additional eligibility criteria follows and is relevant for those seeking home and community based services.

 The American Council on Aging provides a Rhode Island Medicaid Eligibility Test for seniors that require long term care. Start Here

 

Financial Criteria: Income, Assets & Home Ownership

Income
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR). This figure increases each January, and in 2024, is $2,829 / month. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,829 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Only the applicant spouse’s income is considered, which is limited to $2,829 / month. Furthermore, the non-applicant spouse may be entitled to a Spousal Income Allowance, called a Monthly Maintenance Needs Allowance, from their applicant spouse.

Rhode Island has set a minimum Spousal Income Allowance of $2,465 / month (eff. July 2023 – June 2024). This allows an applicant spouse to supplement their non-applicant spouse’s monthly income, bringing their income up to this amount. The state also sets a maximum income allowance, which in 2024, is of $3,853.50 / month. While this potentially allows a non-applicant spouse a higher income allowance, any additional amount above the minimum income allowance is dependent on one’s shelter and utility costs.

Assets
In 2024, the asset limit is $4,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $8,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are still limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse can retain up to $4,000, while the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA) to prevent spousal impoverishment. The CSRA allows the non-applicant spouse to keep 50% of the couple’s assets, up to $154,140. If 50% of the couple’s assets falls under $30,828, the non-applicant spouse can keep all of the couple’s assets, up to this amount.

Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Medicaid has a Look-Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our Medicaid Spend Down Calculator.

 

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. For eligibility purposes, Rhode Island considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has Intent to Return, and in 2024, their home equity interest is no greater than $713,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse living in the home.
– The applicant has a minor child living in the home.
– The applicant has a permanently disabled or blind adult child living in the home.

While the home is likely exempt while one is receiving Medicaid benefits, it may not be safe from Medicaid’s Estate Recovery Program. Learn more about the potential of Medicaid taking the home here.

 

Medical Criteria: Functional Need

An applicant must require a high or highest Nursing Facility Level of Care (NFLOC). A level of care assessment is completed to determine if an applicant meets the criteria. A need for assistance with Activities of Daily Living (i.e., transferring from the bed to a chair, moving from one location to another within one’s living space, eating, toileting, bathing, personal hygiene, dressing) and Instrumental Activities of Daily Living (i.e., housekeeping, laundry, preparing meals, shopping for essentials) is considered. Cognitive deficits, and specific behaviors, such as wandering, which are common in persons with Alzheimer’s Disease or a related dementia, are also taken into account. A diagnosis of dementia, in and of itself, does not mean one will meet the level of care need.

 Learn more about long-term care Medicaid in Rhode Island.

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for RI Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.

Persons who have income over the limit, but have high medical bills, can become income-eligible via Rhode Island’s Spend-Down Program. This program permits applicants to spend their “excess” income on medical expenses in order to meet the Medically Needy Income Limit. The amount that must be paid each month can be thought of as a deductible. Once one’s “deductible” has been met for the month, Medicaid LTSS will pay for services and supports.

When persons have assets over the limits, one option is to “spend down” assets. Examples include paying off debt, making home modifications, and purchasing pre-paid funeral and burial expense trusts called Irrevocable Funeral Trusts. Annuities, which turn a lump sum of cash into a monthly income stream, is also an option. There are many other strategies when the applicant has assets exceeding the limit.

Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Rhode Island to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, there are additional Medicaid planning strategies that not only help one meet Medicaid’s financial criteria but can also protect assets from Medicaid’s Estate Recovery Program. These strategies often violate Medicaid’s 60-month Look-Back Rule, and therefore, should be implemented well in advance of the need for long-term care. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.

 

How to Apply for RI Medicaid Long-Term Services and Supports

Before You Apply

Prior to applying for RI’s Medicaid LTSS, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid Eligibility Test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.

Since home and community based services are not an entitlement, there may be a waiting list to receive these benefits. In the case of a waiting list, applicants with a higher level of care need are given priority. This means persons who submitted an application at a later date than other applicants may be awarded a participant slot first if their needs are greater.

 

Application Process

Persons can apply for Medicaid Long-Term Services and Supports online or by completing and submitting an Application for Assistance Cover Sheet and Application for Assistance. The forms can be found here. Once completed, they should be mailed to Rhode Island Department of Human Services, P.O. Box 8709, Cranston, RI 02920-8787.

For application assistance, persons can call the DHS Call Center at 855-697-4347 or RI’s Aging and Disability Resource Center (The Point) at 401-462-4444.

More information about Medicaid Long-Term Services and Supports can be found here.

The Rhode Island Department of Human Services (DHS) administers RI’s Medicaid Long-Term Services and Supports and determines financial eligibility. Functional eligibility is determined by the Executive Office of Health and Human Services’ (EOHHS) Office of Medical Review (OMR).

 

Approval Process & Timing

The Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as a waiting list may exist, approved applicants may spend many months waiting to receive benefits.

 Technical Details
Rhode Island’s entire Medicaid program operates under an 1115 Demonstration Waiver called the Rhode Island Comprehensive Demonstration, previously called the Rhode Island Global Consumer Choice Compact Waiver. Medicaid Long-Term Services and Supports, such as nursing facility care and home and community based services (HCBS), is one component.

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