Overview of RIte @ Home
Rhode Island’s RIte @ Home, also known as LTSS (Long-Term Services and Supports) Shared Living, is a Medicaid LTSS benefit available to seniors and adults with disabilities who cannot live alone due to the need for assistance with their daily living activities. Similar to adult foster care, program participants reside with a caregiver, enabling them to continue to live in a home setting rather than require institutionalization (nursing home care). While the care recipient commonly moves into the caregiver’s home, sometimes the caregiver moves into the care recipient’s home. Supervision, personal care assistance, transportation, and homemaker services are provided by the caregiver. Furthermore, respite care is available to give caregivers a break from caregiving duties.
RIte @ Home is a participant-directed benefit. This allows program participants to select the live-in caregiver of their choosing who is then paid for providing care. While friends and relatives can be hired given they are 18+ years of age, spouses and legal guardians are prohibited from this role. A Community Agency / RIte @ Home Agency contracted by the state provides participants with assistance in finding a caregiver, provides caregiver training, and issues caregiver payments. They also provide nursing services as needed. Two agencies currently serve in this role: Caregiver Homes of Rhode Island and Seven Hills Rhode Island.
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. RIte @ Home, which may also be called the Caregiver Homes Program or the Shared Living Program, is an available HCBS benefit. It is not an entitlement; 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.
Benefits of the RIte @ Home Program
The following benefits may be provided.
– Chore Services
– Homemaker services – i.e., light housecleaning, laundry, meal preparation, shopping
– Medication Reminders
– Nursing Services – provided as needed by a registered nurse employed by the RIte @ Home agency
– On-Call 24/7
– Personal Care Assistance – assistance with Activities of Daily Living (i.e., bathing, grooming, dressing, toileting, mobility, transitioning, eating)
– Respite Care – to give the primary caregiver a break from caregiving duties
– Socialization
– Supervision
– Transportation
In addition to RIte @ Home benefits, program participants may also receive other Medicaid-funded supports, such as durable medical equipment, minor home modifications, and adult day care. Note that if a program participant attends adult day care, their caregiver’s pay will be reduced for the days they attend adult day care.
Rhode Island Medicaid does not cover the cost of room and board in Shared Living. Instead, program participants generally pay this fee from their SSI or Social Security Check. Based on one’s income, a program participant may also be required to pay a “cost share”.
Eligibility Requirements for Rhode Island’s RIte @ Home
RIte @ Home is for seniors (65+ years of age) and adults with disabilities (18 – 64 years old) who are Rhode Island residents and eligible for Medicaid Long-Term Services and Supports. Additional eligibility criteria follows.
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 $2,555 / month (eff. July 2024 – June 2025). 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 $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.
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) is necessary, and deficits in completing Instrumental Activities of Daily Living (i.e., housekeeping, laundry, preparing meals, shopping for essentials) are 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.
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 RIte @ Home. 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. Medicaid Asset Protection Trusts, which must be implemented well in advance of the need for long-term care, is another 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 Rhode Island’s RIte @ Home Program
Before You Apply
Prior to applying for RI’s RIte @ Home (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 RIte @ Home is not an entitlement, there may be a waiting list to receive these benefits. Waiting lists are agency specific, which means one agency might have a waiting list while the other does not.
Application Process
Persons can begin the process of applying for RIte @Home by applying 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. Completed forms should be mailed to Rhode Island Department of Human Services, P.O. Box 8709, Cranston, RI 02920-8787.
Alternatively, persons can receive application assistance by contacting one of the RIte @ Home agencies. To contact Caregiver Homes of Rhode Island, call 401-473-2160 or 866-797-2333. Seven Hills Rhode Island can be reached at 401-229-9700. RI residents can apply via either agency.
More information about RIte @ Home can be found here. Persons can also contact the RI Executive Office of Health and Human Services’ Office of Community Programs at 401-462-6393 or one of the abovementioned RIte @ Home agencies. The Executive Office of Health and Human Services (EOHHS) administers the RIte @ Home Program.
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.
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.