Rhode Island Medicaid Eligibility and Enrollment

What Is Rhode Island Medicaid?

Medicaid serves as health insurance for many low-income Rhode Island residents. Enrollees can receive medical care for low or no out-of-pocket costs. Covered services depend on the program and the enrollee's needs but may include: 

• Routine medical care
• Necessary treatments for illness and injuries 
• Prescriptions
• Lab tests 
• Mental health services 
• Hospital and emergency care 
• Dental services 
• Home health and skilled nursing care 
• Transportation services 

Medicaid is managed and funded by both state and federal governments. States must comply with federal rules when administering Medicaid benefits. However, each state sets specific eligibility guidelines. The Rhode Island Executive Office of Health and Human Services (EOHHS) manages and administers the Rhode Island Medicaid program. 

Medicaid is also known as Medical Assistance in Rhode Island. It includes the Children's Health Insurance Program (CHIP), RIte Care and RIte Share, which provide low-cost health care coverage to children and families. 

Who Is Eligible for Medicaid in Rhode Island? 

Rhode Island Medicaid is available to state residents. Enrollees must also be U.S. citizens or have been legal residents in the United States for the past five years, although there are some exceptions. 

Medicaid programs are available to focus on the needs of: 

• Families with children 
• Pregnant women 
• Low-income adults
• Older adults
• Adults with special needs 

In 2010, Rhode Island expanded its Medicaid program to include low-income adults between the ages of 19 and 64. That means that, unlike some other states, Rhode Island doesn't require adults to be older or have a disability to qualify for benefits. Any Rhode Islander meeting the program's low-income requirements may be eligible for Medicaid benefits. 

What Is the Income Limit for Medicaid in Rhode Island?

Applicants must qualify as low-income under the state's guidelines to receive Medicaid benefits. Income limits do vary between Medicaid programs. For example, pregnant women will have different income limits than other adults. Income limits also depend on household size, with larger households having higher income limits. 

Income Limits for Adults

Low-income adults who apply for benefits under Medicaid Expansion may qualify if they earn no more than $26,973 per year for a single adult or $36,482 for a couple. 

The Sherlock Plan is a Medicaid Plan for adults with disabilities who are still able to work. An eligible enrollee's income can be no more than 250% of the FPL, and an enrollee in this plan cannot have more than $10,000 in assets. Some accounts, like health savings accounts, may be excluded from assets. Additionally, items that a beneficiary needs to remain employed (such as a wheelchair-accessible vehicle) don't count towards assets. 

Income Limits for Children, Families and Pregnant Women

Rhode Island offers two Medicaid options for children, families and pregnant women: 

• RIte Care is Rhode Island's Medicaid plan that functions like health insurance for these groups.
• RIte Share is a state program that helps individuals in these groups pay for an employer-provided health insurance plan. 

Eligibility for these programs depends on income, family size and structure. Parents with minor children may qualify for one of these Medicaid programs if their income is no more than 133% of the FPL for their family size, as seen on the below table:

Pregnant women may qualify with a household income up to 253% of the FPL ($32,586). Children under the age of 19 may qualify with a household income up to 261% of the FPL ($33,617). 

What Is the Medicaid LTSS Program? 

The Long Term Services and Supports Program is also known as Medicaid LTSS and is part of Rhode Island's Medicaid program. Medicaid LTSS provides services to people with chronic illnesses or disabilities, including older adults, who are unable to care for themselves all of the time. 

Medicaid LTSS covers medical care but also provides coverage for non-medical services to assist people who are unable to complete daily tasks such as cooking or bathing. People living in a private home, assisted living facility or nursing home may receive LTSS benefits. 

For a person to be eligible for Medicaid LTSS, they must meet the following requirements: 

• Have a clinical need for provided services 
• Possess less than $4,000 of resources such as cash and savings accounts
• Have a monthly income of no more than $878

Individuals with income over $878 may still qualify for LTSS benefits with a requirement to pay for some portion of their care. 

How Do I Enroll in Medicaid in Rhode Island? 

To enroll in Medicaid in Rhode Island, you will need to apply through the EOHHS. You may apply in one of the following ways:

• Online
• By telephone at 1-855-840-4774
• By printing and mailing an application
• In-person at a local Department of Human Services Office

Assistance with filling out an application is available online or at a local DHS office. Having information about your income, assets, residency and medical needs ready when you begin the application may expedite the process. 

Contact Information for Rhode Island Medicaid 

For questions about Rhode Island Medicaid health coverage or to apply for Medicaid by phone, call HealthSource RI at 1-855-840-4774. General questions about health and human services programs may be directed to 1-855-697-4347.

To apply for Medicaid by mail, send a completed application to:

Department of Human Services

P.O. Box 8709

Cranston, RI 02920-8787

Applications for Long Term Care should be mailed to:

DHS Long Term Care Unit 

206 Elmwood Ave

Providence, RI 02907

Additional information is available on the EOHHS website, as well as a directory of local DHS offices.