Medicaid Affordable Care Coverage for Adults 19-64

Federal health care reform is making it possible for most people to get health coverage. Beginning on January 1, 2014, adults between the ages of 19 to 64 will have much greater access to affordable health coverage.  If you are in this age group and your income is at or below 133% of the federal poverty level, you may qualify for coverage paid for by Medicaid.  To be eligible for Medicaid funded coverage, you must be:

  • A Rhode Island resident;
  • A citizen of the United States or a legally present non-citizen who has been in the U.S for five years or meets certain exemptions;
  •  Not pregnant;
  • Not otherwise eligible for Medicaid or Medicare part A or B benefits; and
  • Living alone or as part of a household with income at or below 133% of the federal poverty level (FPL).

Under federal health care reform, the income eligibility limits for Medicaid are bumped up to include people with income up to 138% of the federal poverty level. 

How to Apply

We have created a new eligibility system for affordable health coverage to streamline the application process and make it easier for you to review your health plan options and what they cost.

·       APPLY ON-LINE  - There is a new on-line application located at the website healthyrhode.ri.gov that will take you step by step through the application process.  If you have access to the web, applying on line is the best choice.  It is both easy and fast and will tell you all of your affordable health coverage options, both Medicaid and non-Medicaid.

·       APPLY IN PERSON OR BY MAIL - You can apply in person or by mail at one of the Department of Human Services offices or the Contact Center.  A copy of the application you will need to complete is available by clicking here. Call this number (1-855-609-3304) if you need help finding a place to apply or with completing the application.

When to Apply

You can start the application process anytime by setting up an account on-line at healthyrhode.ri.gov or by working with a DHS or Contact Center representative. Once you set up your on-line account at healthyrhode.ri.gov, you have 90 days to complete and submit your application. If you don't submit your application in the 90 days, DO NOT WORRY. You can restart the process and apply at anytime.

What You Need to Apply

Whether applying on line, or using a paper application in person or by mail, you will be asked to answer questions about your age, household/family size, U.S. tax filing status, residency and citizenship.

To help make the process go along as smoothly as possible, you should have the following information at hand when you apply:

  • Social Security Numbers
  • Birth Dates
  • Passport or other immigration numbers
  • Tax return from the previous year – 2012 Tax Return Now Information about any health coverage available to you or your family including any information you have about the health insurance your current employer offers even if you are not covered by your employer’s insurance plan.
  • W-2 forms with salary and wage information if you work for an employer
  • 1099 forms, if you are self-employed

In most cases, you will not need to submit documents containing this information. The on-line application will guide you through a series of questions.

Verifying Information

We will check the information you provide on the application using electronic matches whenever possible.  For example, we use our direct connections with a specially created federal data hub to verify social security numbers.  We can verify your income through State salary and wage data bases and your federal income tax information through our electronic data matches with the U.S. Internal Revenue Service.

We will also accept your word through an “attestation” by having you sign that all information you provide is truthful at the time you made application.  If we need additional information we will let you know immediately if you are applying on-line or by letter if you are applying in-person.

If additional documents are needed, you will have the option of uploading them directly to the website, calling by telephone, faxing, mailing or bringing the information in person. 

After Completing the Application

NO MATTER HOW YOU APPLY, once your application is complete, you will be notified about what types of affordable coverage you can obtain. You will know right away if you apply on-line and within 30 days if you apply using a paper application by mail.


·       Medicaid Funded Coverage

  •  If you do qualify for Medicaid under the new group for low income adults you will be enrolled in Rhody Health Partners, a Medicaid approved plan.
  •  If you do not qualify for Medicaid coverage under this new group you might qualify for Medicaid under some other existing program like RIte Care or Rhody Health Partners.  You will be directed to contact a representative of the Department of Human Services (DHS) or the EOHHS or a navigator or in person assistor to help you apply. Your coverage will go back to the first day of the month you applied if you qualify for Medicaid under any one of these programs.

·       Other Affordable Coverage Options

  • If you do not qualify for Medicaid at all, and your income is at or below 400% of the FPL, you may be eligible for a health insurance plan paid in part by federal tax credits or other subsidies. You will be provided with a list of your health plan options and the costs of coverage, including any tax credits or subsidies that will help with affordability.

Applying on line at healthyrhode.ri.gov is the fastest way to get this information.

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