Rhode Island - Medicaid

Medicaid is a government health insurance program that helps certain people get health care services at a lower cost. This includes people who are older, blind, or living with a disability. ## What does Rhode Island Medicaid cover? Medicaid pays for medical services such as: - Visits to health care providers (including physicians and nurse practitioners) - Inpatient and outpatient hospital services - Prescription drug coverage (only available in certain cases) - Lab tests - X-rays - Medical transportation - Nursing home care - Home health services - Family planning services Most states also cover optional services such as: - Physical, respiratory, and occupational therapy - Home- and community-based care - Case management - Prescription drugs - Dental and vision care - Hearing services - Podiatry services - Hospice care Since the program serves those with limited income and resources, people with Rhode Island Medicaid pay few to no out-of-pocket costs for their benefits. To get coverage once you are enrolled, you must go to health care providers that take part in the Rhode Island Medicaid program. In Rhode Island, Medicaid applications are handled by the RI Department of Human Services (DHS). Call [1-855-840-4774](tel:1-855-840-4774) to learn more about the coverages provided. ## How do I know if I qualify for Medicaid in Rhode Island? In general, to get Medicaid, you must: - Be a Rhode Island resident - Be a U.S. citizen or a qualified non-citizen - Meet the income and/or asset limit for your coverage group You can get help from the Medicaid program if your income and resources fall below a certain amount. Some resources may not be counted when determining whether you meet the program guidelines. These include your home, car, and certain portions of life insurance and burial accounts. If you are a U.S. citizen and meet the other Medicaid guidelines, you may get help from this program. Some people who are not U.S. citizens may also take part in the program. Contact your local office for more information about Medicaid citizenship rules. ## What are the different Medicaid programs in Rhode Island? You may be able to get health coverage if you fall into one of the following categories. **Nursing Home Medicaid** The Nursing Home Medicaid program in Rhode Island provides health care and support services in a nursing home or other medical facility. In addition to room and board, you may get other benefits such as: - Nursing care - Rehabilitation services - Social services - Medical equipment and supplies - Prescription medications - Personal care items such as hair care and clothing You may be able to get this coverage if you have limited income and resources. You must also have a medical condition that requires the skills of a licensed nurse on a regular basis. **The Sherlock Plan: Medicaid for Working People with Disabilities - RI** If you have a disability and are working, the Sherlock Plan in Rhode Island may provide you with health care benefits. In some situations, working and earning money could prevent you from getting public benefit programs such as Medicaid. This program lets you work, keep money in savings, and still get health care coverage. You may have to pay a monthly premium. **Medicaid LTSS Home and Community Based Services** Rhode Island LTSS Home and Community Based Services provide long-term care services in your home or community rather than in a nursing facility. Services include personal assistance services, in-home or out-of-home respite care (for caregivers), home nursing services, emergency response services (emergency call button), and home-delivered meals. Adult day programs may also be included. **Medically Needy Program (Medicaid Spend-Down)** The Medically Needy Program lets you get Rhode Island Medicaid even if your income is higher than program guidelines. It works by letting you spend down your income so that you meet Medicaid’s income limits. The spend-down amount is the amount of income that is over the Medicaid limit. This amount is different for each person. To get Rhode Island Medicaid benefits, you must submit current paid or unpaid medical bills equal to or greater than your monthly spend-down amount. Once your medical bills reach this amount, you will get Medicaid coverage for the rest of the calendar month. While using Rhode Island Medicaid to pay for your medical expenses, you should use a health care provider who takes part in Medicaid. Some examples of medical expenses you can use to spend down your income include: - Unpaid medical bills (that have not been used to spend down your income before) - Health insurance premiums - Medical bills you paid within the last three months - Medical bills that will not be paid by health insurance (or any other source) - Co-pays for medical bills - Medical services prescribed by your doctor - Transportation by ambulance, bus, or taxi to get health care services ## How do Medicare and Medicaid work together? If you get Medicare, you may also be able to get help from Rhode Island Medicaid. This is called being “dual eligible.” Medicaid pays for some services not covered by Medicare such as eyeglasses, hearing aids, and dental care. If you have Medicare and qualify for full Medicaid coverage, the state will pay your Medicare Part B (Medical Insurance) monthly premiums. Depending on the level of Rhode Island Medicaid you qualify for, the state might also pay for: - Your share of Medicare costs, like deductibles, coinsurance, and copayments - Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage In addition, if you are dual-eligible for Medicare and Medicaid: - You will automatically be signed up for the Low-Income Subsidy (LIS)/[Extra Help](https://benefitscheckup.org/program/rxgov_fd_medicare_lis) program through Medicare Part D (prescription drug coverage). This program helps people with low income pay for their medicines. - You may be able to get your coverage through a Medicare Advantage Special Needs Plan (SNP) instead of having original Medicare with separate Medicaid coverage. This plan can help you manage the health care services you need. SNPs may also offer more benefits than what you already get from original Medicare. In some cases, you may have no monthly premiums and/or you may pay lower co-payments. All SNP plans are different, so check with the plans to see what they cover and if you can enroll. **Note:** SNPs are not available in every community. To find out if there is an SNP in your area, [visit the Medicare website](https://www.medicare.gov/) or call [1-800-633-4227](tel:1-800-633-4227) or [1-877-486-2048](tel:1-877-486-2048) (TTY). ## How do I prepare to apply for Rhode Island Medicaid? When you apply for Rhode Island Medicaid, you’ll be asked for important information to help determine if you qualify for benefits. Before you start, gather some basic information to make your application process easier: - A document that shows your age, such as your birth certificate or driver’s license - Your Social Security card - Pay stubs for anyone in your household who has earned income - Documentation that shows any other form of income, such as letters from Veterans Affairs (VA) or the Social Security Administration (SSA) - Information about your financial assets, such as bank account or investment account statements ## How do I apply for Medicaid in Rhode Island? There are a few different ways you can apply for Medicaid in Rhode Island. Read below to learn more about which option might be right for you. **Apply Online** The quickest and easiest way to apply for Medicaid in Rhode Island is online at [HealthSourceRI.com](https://healthsourceri.com/how-to-enroll/). All your personal information is kept 100% confidential and protected by special security technology. [Apply Online](https://healthsourceri.com/how-to-enroll/) **Apply by Phone or in Person** Call HealthSourceRI at [1-855-840-4774](tel:1-855-840-4774) to apply for Medicaid by phone. Apply for Medicaid in person by [visiting your local DHS office](https://dhs.ri.gov/DHSOffices/index.php) and filling out an application. ## How can I get help with my Rhode Island Medicaid application? There are a few ways to get help filling out your Medicaid application: - Call HealthSourceRI at [1-855-840-4774](tel:1-855-840-4774). - Reach out to a HealthSourceRI Navigator. [Find one near you](https://healthyrhode.ri.gov/HIXWebI3/DisplayNavigatorSearch). - Visit a Benefits Enrollment Center (BEC), if there’s one near you.[ ](https://benefitscheckup.org/article/how-to-find-a-benefits-enrollment-center-near-you)[See if there’s one in your area](https://benefitscheckup.org/article/how-to-find-a-benefits-enrollment-center-near-you). **NCOA also has a HelpLine you can call to get free support. Call [1-800-794-6559](tel:+18007946559) anytime Monday–Friday, from 8 a.m. to 7 p.m. EST.**