Long Term Services and Supports

Publicly-funded long-term services and supports (LTSS) are available for eligible individuals with chronic illnesses or disabilities who need a certain level of care and meet the eligibility criteria. 

Medicaid Long Term Services and Supports

Eligibility
Individuals must meet both the financial and functional/clinical “level of care” need to qualify for Medicaid Long Term Care. In addition, a person's resources (cash, savings, etc.) must be less than $4,000. Please note: if a person's monthly income is over a certain amount, he/she may have pay towards the cost of his/her LTSS services.

How to  Apply
You need to complete the Application for Assistance (DHS-2) and  mail or bring them to the Providence DHS office along with the required documents. If you are determined eligible, Medicaid Long Term Services and Supports includes home and community-based services or nursing home care. The type of services you receive depends on your level of care needs.

Highest Level of Care- People who have 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 needs that meet the criteria for the 'High' Level of Care are eligible for  home and community-based services, but NOT for nursing home care. Home and community-based care include:

  • 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
  • Respite
  • Minor assistive devices

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.

What are my LTSS service delivery options?

If you meet the clinical and financial criteria for Medicaid long-term services and supports, you have the option of a getting your services through a health plan, through fee-for-services (or traditional Medicaid), or "self direction" which gives a person more control over choosing caregivers and managing them. 

  • Self-direction. is when you and/or your family can purchase home and community-based services on your own. Under this self-direction 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.

DEA 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 Program. See the 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.

 

For More Information

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