Healthcare

Doctors in a hospital.

Change is here! Better access to affordable healthcare in Rhode Island is happening now. This important part of federal healthcare reform took effect on January 1, 2014. Rhode Island is proud that Medicaid and HealthSource RI are already helping hundreds of consumers of all ages and backgrounds find affordable coverage.

The Executive Office of Health and Human Services (EOHHS) administers the publicly-funded Medicaid program.  Medicaid is an important source of coverage for low-income families with children, pregnant women, elders and persons with disabilities and special needs who otherwise might not be able to pay for or get access to affordable health care. Rhode Island took the option under the federal Affordable Care Act of 2010 to expand Medicaid to adults between the ages of 19 and 64.  The State also chose to establish its own health insurance exchange to make sure other forms of affordable coverage are readily available to Rhode Islanders who need it. 

How is Medicaid Healthcare Changing?

Expansion of Medicaid Eligibility. For the first time, adults between the ages of 19 and 64 who do not have disabilities are eligible for Medicaid in Rhode Island. If you are an adult in this age group and your monthly income for just you is about $1,321 a month, you may be eligible for Medicaid affordable care coverage through Rhody Health Partner’s Plan under this new healthcare reform expansion.

New Way to Apply. Medicaid and HealthSource RI work together using Rhode Island’s new, state-of-the-art eligibility system created for health reform. This web-based system determines eligibility for Medicaid and other forms of affordable coverage using a single, streamlined application.

• You can apply on-line at HealthyRhode.ri.gov. You will be guided step-by-step through the application process. You can still apply using a paper application, in-person or by mail, phone or fax if that works better for you.

• Families with children, adults up to age 64, and pregnant women must use our new application process for Medicaid coverage.

• Nothing is changing right now for elders and people with disabilities and special needs who are looking for Medicaid coverage or long-term services. Click on the healthcare pages for people in these groups listed at right for more information.

• Eventually, consumers will be able to apply for most of the State’s publicly-funded health and human services programs through this same system.

New Income Standard. There is an easier and fairer way of counting income – called modified adjusted gross income or MAGI – when determining Medicaid eligibility for families, children, pregnant women, and adults in the Medicaid expansion group. We can use electronic matches to verify your income in most cases, so you won’t have to provide extra documentation.

Types of Coverage

The types of health services and supports Medicaid covers varies depending on age, family structure and a person's needs.  For families, children and pregnant women, RIte Care and RIte Share offer full health insurance coverage through a managed care organization. Adults ages 19-64 in the new expansion group are covered through a Rhody Health Partners (RHP) plan. For people with disabilities and special needs, there are options in both fee for services (Connect Care Choice) and managed care (Rhody Health Partners) to cover your primary care needs. 

If you need long term care, our programs cover home and community based services (your own home, assisted living or shared living arrangement, and group homes) and institutional settings like nursing homes and certain hospitals, again depending on your needs. We have a new Medicaid Integrated Care option that provides people with long-term care needs with full coverage of all services they need in a single managed care plan. Please see our Integrated Care Initiative for more information.

Eligibility

You must be a resident of Rhode Island to apply and be able to prove that you are a citizen or a legally present non-citizen who is in a status that qualifies you for publicly funded health coverage.  Whether you are eligible for one of our programs depends on a variety of factors including: income, age, type of health care needs and, for certain programs, the amount of your resources or assets.

To check whether you are eligible and how to apply, select a group from the left-hand column that best describes the person(s) needing coverage, or explore our programs by name. Learn more about our new eligibility system here.

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