Rhode Island Medicaid (Medical Assistance) Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. This article focuses on Rhode Island Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, Long Term Services and Supports (LTSS) or Medicaid for Elders and Adults with Disabilities (EAD). This is different than regular Medicaid, which is for financially limited people of all ages.

Last Updated: Jan 23, 2024

Rhode Island Medicaid Long Term Care Programs Nursing Home Care Care at Home via LTSS Care at Home via EAD Medicaid Eligibility Criteria Nursing Homes LTSS EAD Medicaid How Medicaid Treats the Home Applying Choosing a Nursing Home

Rhode Island Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Rhode Island Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited Rhode Island seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
Skilled nursing care
Physician’s visits
Prescription medication
Medication management
Mental health counseling
Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Rhode Island Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $75/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Rhode Island Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

A Nursing Home Alternative – Rhode Island Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through Rhode Island’s Money Follows the Person program (MFP). This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents. In Rhode Island, MFP is also called Rhode to Home.

Long Term Services and Supports (LTSS)

Rhode Island’s Long Term Services and Supports (LTSS) program will pay for long-term care services and supports that help Rhode Island Medicaid recipients who require a Nursing Facility Level of Care remain living in the community instead of residing in a nursing home. LTSS recipients can live in their 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. While LTSS may cover long-term care benefits in those settings, it will not pay for room and board costs such as mortgage payments, rent, facility fees, utility bills or food expenses.

LTSS operates under the Comprehensive Demonstration Waiver, and it is similar to Home and Community Based Services (HCBS) Waivers in other states.

Available LTSS benefits include in-home skilled nursing, adult day care, home modifications, housekeeping and chore services, medication management and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These and other program benefits will be made available depending on the needs and circumstances of each individual.

The state can assign a licensed caregiver to provide LTSS program benefits, or Rhode Island Medicaid beneficiaries can self-direct their care by hiring caregivers of their choice to provide housekeeping and personal care services. Some family members, like adult children, can be hired as LTSS caregivers, but spouses and legal guardians cannot.

Many LTSS benefits are not an entitlement. Instead, there are a limited number of enrollment spots and funds allocated to this program, and once those spots and funds are gone, additional applicants will be placed on a waitlist. Applicants with the greatest medical need are given priority when it comes to Rhode Island’s LTSS waitlist.

LTSS beneficiaries who require a significant level of care but wish to remain living in the community can also receive help through Rite @ Home.

RIte @ Home
Rhode Island’s RIte @ Home program, which is also known as the Caregiver Homes Program or Shared Living Program, provides a caregiver to elderly and disabled adults to help them continue living at home instead of moving to a nursing home. To be medically eligible for the program, applicants must need a Nursing Facility Level of Care and need help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, laundry and scheduling). The Rhode Island Department of Human Services will administer a functional assessment to determine if the RIte @ Home applicant does require that kind of help.

In most cases, the RIte @ Home program beneficiary will go to live in the home of the caregiver, but the program also allows for the caregiver to move in with the RIte @ Home beneficiary. While the state can help program participants find a licensed caregiver, the program participant can also self-direct their care by hiring a caregiver of their choice, including family members. Spouses and legal guardians, however, are not allowed to be hired.

In addition to paying for a caregiver, RIte @ Home will cover other long-term care benefits like adult day care, skilled nursing services, home modifications and durable medical equipment that can also delay nursing home placement.

Like LTSS, RIte @ Home is not an entitlement. Instead, there a limited number of enrollment spots, and once those spots are full, additional eligible applicants will be placed on a waitlist.

Medicaid for Elders and Adults with Disabilities

Rhode Island’s Medicaid for Elders and Adults with Disabilities (EAD) provides healthcare coverage and long-term care benefits to financially limited Rhode Island seniors who are aged (65 and over), blind or disabled and live in the community. EAD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. EAD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via EAD Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives. It is similar to Aged, Blind, and Disabled Medicaid in other states.

Rhode Island EAD beneficiaries who show a functional need for long-term care services and supports can receive some of those benefits through the Medicaid Preventive Services program or the Program of All-Inclusive Care for the Elderly (PACE).

1. Medicaid Preventive Services
Rhode Island EAD Medicaid beneficiaries who are at risk of nursing home placement (but don’t require a full Nursing Facility Level of Care), can receive long-term care services and supports through Rhode Island’s Medicaid Preventive Services program. The state will conduct an assessment of program applicants to determine if they are at risk of nursing home placement. Their ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, laundry and scheduling) are taken into consideration during the assessment.

Medicaid Preventive Services program participants can live in their own home or the home of a loved one. They can not live in adult foster care, an assisted living residence or any other institution.

Individuals in the Medicaid Preventive Services program can receive up to 6 hours/week of personal care assistance with the Activities of Daily Living and the Instrumental Activities of Daily Living. Couples can receive up to 10 hours/week of these services.

Like Rhode Island’s EAD Medicaid, the Medicaid Preventive Services program is an entitlement. This means that all eligible applicants are guaranteed by law to receive benefits.

2. Program of All-Inclusive Care for the Elderly (PACE)
Rhode Island residents who are age 55 or older and have EAD Medicaid can cover their medical, social service and long-term care personal needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. Rhode Island’s PACE programs can be used by people who are “dual eligible” for Medicaid and Medicare, and they will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. The Rhode Island PACE program is located in Riverside. To learn more about PACE, click here.

Eligibility Criteria For Rhode Island Medicaid Long Term Care Programs

To be eligible for Rhode Island Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Long Term Services and Supports (LTSS) or Medicaid for Elders and Adults with Disabilities (EAD).

Just For You: The easiest way to find the most current Rhode Island Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

Rhode Island Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Rhode Island residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Rhode Island Medicaid. For a single applicant in 2024, the asset limit is $4,000, which means they must have $4,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Rhode Island Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Rhode Island Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $75/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through Rhode Island Medicaid is a combined $8,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $4,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for Rhode Island Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Rhode Island has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through Rhode Island Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. The Rhode Island Department of Human Services will administer a functional assessment of Nursing Home Medicaid applicants to determine if that level of care is required. The assessment will take into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, and laundry).

Rhode Island Long Term Services and Supports (LTSS) Eligibility Criteria

Financial Requirements
Rhode Island residents have to meet an asset limit and an income limit in order to be financially eligible for Long Term Services and Supports (LTSS). For a single applicant in 2024, the asset limit for LTSS in Rhode Island is $4,000, which means they must have $4,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Counts the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for LTSS in Rhode Island for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for LTSS in Rhode Island is a combined $8,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $4,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for Rhode Island LTSS applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Rhode Island has a Look-Back Period of five years. This means the state will look back into the previous five years of the LTSS applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Rhode Island Medicaid’s Long Term Services and Supports (LTSS) is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. The Rhode Island Department of Human Services will administer a functional assessment of LTSS applicants to determine if that level of care is required and what kind of long-term care benefits they need and the state will provide. The assessment will take into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, and laundry).

Rhode Island Medicaid for Elders and Adults with Disabilities Eligibility Criteria

Financial Requirements
Rhode Island residents have to meet an asset limit and an income limit in order to be financially eligible for Medicaid for Elders and Adults with Disabilities (EAD). For a single applicant, the asset limit is $4,000 (as of 2023), which means they must have $4,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Counts the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for EAD for a single applicant is $1,255/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants in 2024, the asset limit for EAD is a combined $6,000, and the income limit is a combined $1,703/month. This applies to married couples with both spouses applying or with just one spouse applying.

Plan Ahead: There are alternative pathways to eligibility for Rhode Island EAD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Rhode Island has a Look-Back Period of five years for Nursing Home Medicaid and Long Term Services and Supports (LTSS) applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to EAD applicants. However, EAD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid or LTSS, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirement to receive basic healthcare coverage through Medicaid for Elders and Adults with Disabilities (EAD) is being aged (65 and over) or disabled. For EAD applicants and beneficiaries who require long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management) to determine the kind of long-term care benefits the state will cover.

How Rhode Island Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – EAD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Rhode Island Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Rhode Island and how you can protect your home from it, click here.

Applying For Rhode Island Medicaid Long Term Care Programs

The first step in applying for Rhode Island Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Long Term Services and Supports (LTSS) or Medicaid for Elders and Adults with Disabilities (EAD).

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that program. Applying for Rhode Island Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Rhode Island Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Rhode Island residents can apply for Medicaid online at Healthy Source RI. They can apply over the phone by calling the Rhode Island Department of Human Services (DHS) at 855-697-4347. Or they download and complete a paper application, and mail it to their local DHS office.

Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

Choosing a Rhode Island Medicaid Nursing Home

After being approved for nursing home coverage through Rhode Island Medicaid, you or your loved one has to decide which Medicaid-accepting nursing home best meets your needs. Even though Rhode Island Medicaid nursing home coverage is an entitlement, not all nursing homes accept Medicaid, and those that do may not have available spaces. Finding the right nursing home can be a challenge, especially if you’re looking in a specific location.

Rhode Island has about 75 nursing homes that accept Medicaid. There are roughly 30 facilities in the Providence area, including Pawtucket. Otherwise, Rhode Island nursing homes are spread throughout the state. There are nearly 10 in Warwick, six in Woonsocket and six on Aquidneck Island (three in Newport and three in Middletown).

Rhode Island residents often cross state lines for personal and business reasons, including healthcare. Medicaid coverage, however, does not cross state lines. So, someone with Rhode Island Medicaid would not be covered for nursing homes in Massachusetts or Connecticut, even if facilities in those states might be convenient or well-suited for Rhode Island residents.

TOOLS: Rhode Island residents can find and compare nursing homes in the state using Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country.

When you’ve found nursing homes that meet your needs and accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. You can also use this Nursing Home Summary Report from the Rhode Island Department of Health. The healthcare professionals who work with you are another great source of information. The Rhode Island Office of Healthy Aging can also help you find information on nursing homes in the state.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: How does the facility handle dental and vision care? Does it offer social activities? What is the food like? Who are the staff doctors? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

CMS data collected from 2019-2022 shows that just 2.5% of residents in Rhode Island nursing homes had depressive symptoms, which was much better than the national average of residents in nursing homes with depressive symptoms, which was 8.1%. The data also showed that Rhode Island nursing homes only averaged 1.5 fire safety violations per facility per year, which was dramatically better than the national average of 13.5.