Healthcare for Elders
Medicaid for elders – people 65 and older – offered by EOHHS takes many forms including:
- Comprehensive health coverage for services like doctors visits, prescriptions, and hospital stays
- Help paying Medicare premiums
- Long term services and supports (LTSS) in a nursing home, assisted living or shared living residence or at home.
We also offer many other health services and supports to elders who do not qualify for Medicaid.
Eligible Elders without Medicare: Comprehensive Medicaid health coverage for low income elders who DO NOT have Medicare or other health insurance coverage is available through one of the following service delivery options:
- Rhody Health Partners provides comprehensive health insurance coverage to eligible elders through a managed care plan.
- Connect Care Choice offers eligible elders full health coverage through a physician-based coordinated care management program.
Eligible Elders with Medicare: Medicaid health coverage is available for elders who DO HAVE Medicare and are eligible for Medicaid through the EOHHS Integrated Care Initiative (ICI). Enrollment is voluntary and includes all the Medicaid covered services you need. Your Medicare coverage, Medicare Part D prescription drug coverage and, if you have one, Medicare Advantage Plan WILL NOT change if you enroll. Eligible elders have a choice of enrolling through one of the following service delivery options:
- Rhody Health Options is the new integrated care health plan option that provides managed long-term services and supports and coordinates all of your other health care. Your Medicare coverage, Medicare Part D prescription drug coverage and, if you have one, Medicare Advantage Plan WILL NOT change if you enroll in this option
- Connect Care Choice (CCC) Community Partners is the new primary care case management program, modeled on Connect Care Choice, that coordinates managed long-term services and supports and other covered services through CareLink, the State’s new coordinated care partner. CCC Community Partners is a fee-for-services delivery option, so you can continue to go to your primary care doctors and partners while CareLink provides help with care transitions, getting social support services in the community and with overall care management.
- Program for All Inclusive Care for the Elderly or Pace is a long-standing, integrated care option for elders who have a high or the highest level of need for long-term services and supports.
Am I Eligible?
There are three eligibility pathways to Medicaid for low income, uninsured elders. Your income, resources and health needs will determine if you are eligible and what type Medicaid benefits you are eligible to receive. Once you have been determined eligible for Medicaid for elders, you will receive a letter offering you choice of enrolling in a Rhody Health Care Plan or a Connect Care Choice primary care practice. Elders also receive dental care.
Medicare Premium Assistance is available for low income elder who DO HAVE Medicare coverage through the Medicare Premium Payment Program (MPPP).
The MPPP helps elders 65 and older (and adults with disabilities) pay all or some of the costs of Medicare Part A and Part B premiums, deductibles and co-payments. Medicare Part A is hospital insurance coverage and Medicare Part B is for physician services, durable medical equipment and outpatient services.
Am I Eligible for the MPPP?
A person’s income and resource determine eligibility and which type of Medicare premium assistance is available.
Medicaid LTSS Preventive Services are for elders enrolled in Medicaid who do not meet the criteria for full Medicaid long term services and supports. You may qualify for a limited range of “Preventive LTSS" if they meet certain clinic requirements.
Long Term Services and Supports (LTSS)
Long term care services and supports are for people with chronic illnesses and/or disabilities who can not care for themselves all of the time. Publicly funded LTSS covers both medical care and non-medical living supports that assist with normal daily tasks like eating, dressing and using the bathroom. LTSS for elders is available in their own homes and community settings like assisted living as well as in health facilities like nursing homes.
Am I eligible for Medicaid LTSS?
Medicaid LTSS is for elders that meet: (1) financial requirements related to income, resources (like cash) and assets (home ownership) and (2) clinical requirements related to health care needs. We determine the functional/clinical “level of care” need for eligibility. In addition, your resources (cash, savings, etc.) must be under $4,000. If your monthly income is over $878, you may pay a share of the cost for your long term care. See Long Term Services and supports for more information about the types of Medicaid LTSS available and the settings in which they are covered.
What are my LTSS service delivery options?
If you meet the clinical and financial criteria for Medicaid-funded long-term services and supports, you have the choice of having your care delivered through one of the following options:
- Managed long-term services and supports. You have the option to enroll in “Rhody Health Options”; PACE or “Connect Care Choice Community Partners” integrated care service delivery options.
- Fee-for-service. You can get your LTSS through a fee-for-service system. Under this system, you choose agency or provider who delivers the service(s).
- Self-direction. You and/or your family can purchase home and community-based services on your own through a self-direction service delivery system. Under this option, you will work with EOHHS staff to develop a budget for the services in your authorized plan of care. We will then connect you to an agency – a “fiscal intermediary --that will help you pay for needed services.
Am I eligible for LTSS Co-Pay Program?
Elders who do not qualify for Medicaid LTSS may be eligible for the Home and Community Care Co-Pay Program, administered by the Division of Elderly Affairs within the Department of Human Services. The Co-pay program pays a portion of the cost of personal care and adult day services. An individual must be unable to leave home without considerable assistance and must need help with personal care. The income limit is approximately $21,600 annually for an individual. There is no asset limit like there is in Medicaid LTSS program. See DEA Co-pay program for more information.
Prescription Drug Assistance
You may be able to get help paying for part of the cost of some prescription drugs. There are several programs that can help:
- Medicare Part D Prescription Coverage – 1-800-Medicare (1-800-633-4227) or The POINT at (401) 462-4444
- Partnership for Prescription Assistance – 1-888-477-2669
- Veterans Administration – Helps veterans pay for prescriptions. Providence VA Medical Center at (401) 273-7100.
- Best RX
The Division of Elderly Affairs (DEA), within the Department of Human Services, maintains a clearinghouse of information on programs that assist elders in staying healthy, safe and independent. The DEA 2014 Pocket Manual provides a full list of these important resources
Call The POINT at (401) 462-4444 or (401) 462-0740 TTY for information and referrals.