Long Term Services and Supports
The EOHHS provides publicly funded long term services and supports (LTSS) tailored to meet the needs of people with chronic illnesses or disabilities who are unable to care for themselves for long periods of time. People of all ages.
People of all ages may need long term care. If you or a loved one or friend is an adult with a disability or an elder, you will find most of the information to make a decision about the State’s LTSS services and supports right here.
Developmental Disabilities Program provides Medicaid and other publicly-funded home and community-based services to people between 22 and 64 years old who are at risk for residing in an institutional setting. For information on programs and services for adults with developmental disabilities.
Am I Eligible? You must meet both the financial and functional/clinical “level of care” need to qualify for eligible Medicaid LTSS. Additionally, your resources (cash, savings, etc) must be at or under $4,000. Note: if your monthly income is over $878, you may have pay towards the cost of your LTSS services.
How do I apply?You need to complete the Medicaid LTSS application and forms and bring them into one of our offices along with the required documents. Find the office that serves your town/city.
- Providence LTSS – Home and Community-Based Services (401) 415-8455
- Providence LTSS – Nursing Homes (401) 415-8455
- East Providence LTSS (401) 415-8455
- Cranston LTSS (401) 462-5182
- Newport LTSS (401) 851-2100
- Woonsocket LTSS (401) 415-8455
What services will I get? Medicaid Long Term Services and Supports include Home and Community-Based Services, Preventive Services, and Nursing Home Care. The type of services you receive depends on your level of care needs.
Highest Level of Care
People who have services needs that meet the criteria for the Highest Level of Care have the option of (1) nursing facility care or (2) home and community-based care.
High Level of Care
People who have LTSS services needs for the High Level of Care are eligible for home and community-based services, but NOT for nursing home care. Covered Home and community based care includes:
- Homemaker/ CNA services
- Environmental modifications
- Special medical equipment
- Meals on Wheels
- Personal Emergency Response Systems
- Case Management
- Senior Companion
- Assisted Living
- Personal care services
- Self-directed care
- Minor home modifications
For additional information about the scope of certain covered services, see the following fact sheets:
Community Transition Services
Community Transition Services are non-recurring set-up expenses for individuals transitioning form an institutional or another provider-operated living arrangement in a private residence where the individual directly responsible for his or her own living expenses. Allowed expenses are those necessary to enable an individual to establish a basic household and may include: security deposits that are required to obtain a lease on an apartment or home, essential household furnishings and moving expenses. Community Transition Services are furnished only to the extent that the services are reasonable and necessary as determined through the service plan development process, the services are clearly identified in the service plan, and the individual is unable to meet such expense or the services cannot be obtained from other sources. Transition services are for individuals who are eligible for Core Services and do not include ongoing shelter expenses, food, regular utility charges, household appliances or items intended for recreational purposes,
Please contact Heather Kinsey, (401} 462-1342 or email at Heather.Kinsey@ohhs.ri.gov for additional information.
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.
LTSS Co-Pay Program
What if I am not eligible for Medicaid LTSS? 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 Long Term Services and Supports. See DEA Co-pay program for more information.
Choosing the Right Setting: LTSS Options
LTSS in Nursing Home
When a nursing home is the best option, it is important that you visit facilities you are interested in, take a tour and meet with the staff. You can visit state and federal websites to help you find nursing homes in your area. It is important to remember that you must have the highest level of need to qualify for Medicaid LTSS coverage in a nursing home.
See “Choosing a Nursing Home” on the RI Department of Health website
Go to www.medicare.gov and select “Resource Locator” and then “Nursing Homes.” This will take you to the Nursing Home Compare page so you can search by area. Data gathered by RI state inspectors are fed into this national system.
LTSS in Home and Community Based Settings
Many elders and people with disabilities who want to stay in their own homes cannot do so without help. The programs that can help you or someone you care for live comfortably and safely at home are called “Home and Community Based Services.”
Some programs can help you fill prescriptions or get meals or rides. Other programs will help you out at home with activities like personal grooming or getting in and out of bed. The programs you use will be based on your needs.
Medicaid LTSS provides medical care and covers most of the services and supports people need to stay in their homes or a community-setting. People who have the highest or high level of need may get Medicaid LTSS in the home or community setting.
Information about levels of care and core and preventive services for people eligible for Medicaid LTSS.
Need Help With Your LTSS Choices?
RIte Resources is a new web site that is designed for hospital discharge planners, patients, and their families. The goal of RIte Resources is to provide better information on the availability of services provided by nursing homes, assisted living facilities, home care agencies, and adult day care agencies.
Would you like to talk to someone about your LTSS options? Contact: the POINT 401-462-4444