Rhode Island Medicaid Preventive Services under the Comprehensive Demonstration Waiver

Last updated: March 09, 2024


Overview of Rhode Island Medicaid Preventive Services

Rhode Island’s Medicaid Preventive Services is more formally referred to as Long-Term Services and Supports Preventive Services. The program is intended for state residents who are elderly or disabled who do not fully qualify for RI Medicaid’s Long-Term Services and Supports Program. While these individuals are at risk of institutionalization (nursing home care), they do not yet require a Nursing Facility Level of Care (NFLOC). Through Medicaid Preventive Services, they receive personal care assistance and homemaker services to delay and prevent the need for more extensive care.

Program participants can live at home or the home of a loved one. They cannot live in an assisted living residence or an adult foster care home.

Many Medicaid programs allow program participants the option of self-directing their own care, specifically hiring the caregiver of their choosing. This is not an option through Medicaid Preventive Services.

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. Community Medicaid, which is the state’s Regular Medicaid program, is one component. Through Community Medicaid, Medicaid Preventive Services are available. These services are an entitlement; meeting the eligibility criteria ensures one will receive assistance.

 What are 1115 Medicaid Demonstration Waivers?
Also called 1115 Research and Demonstration Waivers, these Waivers allow states to “waive” (not use) some federally set Medicaid requirements. This allows states flexibility to improve their Medicaid program by allowing them to experiment and test new approaches to better serve the residents of their state. Some ways in which states might use 1115 Waivers are to target specific populations, such as persons with Alzheimer’s disease, to provide services and supports otherwise not provided by Medicaid, and to utilize a managed care delivery system.


Benefits of Rhode Island Medicaid Preventive Services

Program participants can receive personal care assistance and homemaker services. Personal care assistance includes assistance with daily living activities such as bathing, personal hygiene, eating, mobility, toileting, and transitioning. Homemaker services may include light housecleaning, laundry, meal preparation, and shopping for essentials. An individual can receive up to 6 hours per week of personal care assistance / homemaker services, while a couple can receive up to 10 hours per week.

Adult day care and minor environmental modifications, such as grab bars, handheld showers, raised toilet seats, transfer bath benches, and shower chairs, are also available to persons receiving Medicaid Preventive Services. While they are not part of Medicaid Preventive Services, they are available through RI’s Medicaid State Plan.


Eligibility Requirements for Rhode Island Medicaid Preventive Services

Medicaid Preventive Services is for Rhode Island residents who are aged or disabled. Additional eligibility criteria follows.

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


Financial Criteria: Income, Assets & Home Ownership

In 2024, the individual applicant income limit is $1,255 / month. For a married applicant, regardless of if one spouse or both are applicants, the income limit is $1,703 / month.

 Many home and community based services Medicaid programs allow a non-applicant spouse to retain a larger portion of a couple’s income and assets. Rhode Island’s Medicaid Preventive Services does not. However, the state’s Medicaid Long-Term Services and Supports Program allows a non-applicant spouse a Monthly Maintenance Needs Allowance from their applicant spouse and a Community Spouse Resource Allowance.

In 2024, the asset limit is $4,000 for a single applicant. For married couples, with one spouse or both as applicants, the asset limit is $6,000.

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.

While there is a 60-month Look-Back Rule in which Medicaid checks past asset transfers of those applying for Medicaid Long-Term Services and Supports (includes nursing home care), it does not apply to Rhode Island Medicaid’s Preventive Services.

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Rhode Island Medicaid will take it. Applicants for Medicaid Preventive Services need not worry. As long as they live in their home, the home is exempt (non-countable). However, if they live in a relative’s home, they must have Intent to Return home in order for it to remain exempt. It is important to note that other RI Medicaid programs, such as Medicaid Long-Term Services and Supports, have more rules surrounding home exemption. More on when Medicaid can and cannot take the home here.


Medical Criteria: Functional Need

An applicant must have a medical need for Medicaid Preventive Services. Generally this means one requires assistance with their 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). While a person with Alzheimer’s disease or a related dementia could meet the functional criteria, a diagnosis of dementia, in and of itself, does not mean one will automatically qualify.

 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 Preventive Services will pay for services and supports. More about the Medically Needy Pathway to eligibility.

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 Medicaid planning 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, while Medicaid’s 60-month Look-Back Rule does not apply to the RI’s Medicaid Preventive Services, it does apply to RI’s Medicaid Long-Term Services and Supports. As more extensive Medicaid-funded care might be required in the future, it is vital that one not violate the Look Back Rule. Medicaid planning strategies should ideally only be implemented with careful planning and 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 Rhode Island Medicaid Preventive Services

Before You Apply

Prior to applying for RI’s Medicaid Preventive Services, 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, previous bank statements, 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.


Application Process

To apply for Medicaid Preventive Services, one must be enrolled in RI Medicaid. Persons can apply for Medicaid online or by submitting an Application for Assistance (found halfway down the page). Completed applications should be mailed to Rhode Island Department of Human Services, P.O. Box 8709, Cranston, RI 02920-8787. Alternatively, persons can put their completed application in a secure drop box at any of the DHS Regional Centers.

For application assistance or to learn more about Medicaid Preventive Services, 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.

Persons already enrolled in traditional Medicaid can contact the RIPIN call center at 401-270-0101 to inquire about Preventive Services. Those enrolled in Medicaid managed care should contact their Managed Care Organization. A member services number can be found on the back of one’s health plan card.

Rhode Island’s Executive Office of Health and Human Services’ Department of Human Services administers RI’s Medicaid Preventive Services.


Approval Process & Timing

The Rhode Island 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 even further. 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.

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