Healthcare for People with Disabilities
and Special Needs
Rhode Island Medicaid provides publicly funded health care services and supports for people with disabilities and special needs who can not afford or otherwise obtain the assistance they need to optimize their health and lead productive lives. These services may be available across the life cycle and, depending on a person’s needs, may include comprehensive heath care, premium assistance and/or long term services and supports.
The EOHHS administers Medicaid programs for children with disabilities and special health care needs.
The RI Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) is the agency responsible for serving adults with developmental disabilities and serious chronic and/or disabaling behavioral health conditions beginning at age 22.
If you do not qualify for Medicaid, the EOHHS and the departments offer many other services and supports to persons with disabilities and special needs and their families and caregivers.
Health Coverage for Children
Comprehensive Medicaid health coverage is available for a child with a disability or chronic condition.
Is my child eligible for Medicaid coverage?
A child with a disability and special needs automatically qualifies for Medicaid coverage, when the child:
- Meet the requirements for RIte Care/RIte Share or Katie Beckett coverage. Katie Beckett is an eligibility category in the RI Medicaid program for children under the age of 19 who have serious disabling conditions, meet certain clinical level of care criteria, and live at home. The income and resources of a child’s parents do not count when determining eligibility.
- Qualify for Supplemental Security Income (SSI); or
- Are in substitute care (like a foster home) or part of the adoption subsidy program through the RI Department of Children, Youth, and Families (DCYF).
Once eligibility has been determined, you have the choice of enrolling your child in one of the RIte Care health plans. Children who are receiving Medicaid funded care and services in an institutional setting like a hospital, residential treatment facility or similar facility are NOT ENROLLED in a RIte Care health plan. If your child is residing in one of these settings, Medicaid coverage will be provided on a fee-for-service basis instead.
- Enrollment in a Health Plan. Participating health plans include: Neighborhood Health Plan of RI and UnitedHealth Community Care of New England. Both health plans offer large networks of providers and covered benefits and services. They also offer a special Care Management Program to assist with care coordination or for help arranging transportation or other services. See FAQs on Enrollment in RIte Care's Health Plans for Children with Special Health Care Needs.
- Medicaid Fee-for-Service
Children who do not qualify for enrollment in a health plan, obtain Medicaid coverage on a fee-for-service basis.
Health Coverage for Adults with Disabilities
Comprehensive Medicaid health coverage is available for adults with disabilities.
Am I eligible?
- For Adults with a disability or chronic condition who DO NOT have Medicare or other health insurance coverage may be eligible to enroll in either Medicaid’s Rhody Health Partners , a managed care plan, or Connect Care Choice , a physician-based coordinated care management program. There are three eligibility pathways to Medicaid for low income persons with disabilities. Your income, resources and health needs will determine if you are eligible and what type of Medicaid benefits you qualify to receive.
- Beginning on January 1, 2014, adults between the ages of 19 to 64 who have income at or below 133% of the federal poverty line may be eligible for Medicaid funded coverage for adults in this age group without dependent children. On October 1, 2013, you can find out if you are eligible for this coverage by applying on-line or in person or by mail. You will not have to meet the disability standards or assets limits in effect for other Medicaid programs for adults with disabilities if you qualify for this coverage option. LONG TERM SERVICES AND SUPPORTS (LTSS) ARE NOT COVERED UNDER THIS OPTION. Apply as directed in the section below if you need LTSS. More details about the new coverage option for adults without children is located at Healthcare for Adults 19-64.
- Premium Assistance for Adults with Medicare. Low income adults with disabilities who DO have Medicare coverage, may be eligible for the Medicare Premium Payment Program (MPPP). The Medicare Premium Payment Program 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. A person’s income and resource determine which type of Medicare premium assistance is available.
- LTSS Preventive Services. Adults with disabilities enrolled in Medicaid who do not meet the criteria for full Medicaid long term services and supports may qualify for a limit range of “Preventive” LTSS services and supports if they meet certain clinic requirements.
Long Term Services and Supports (LTSS) for Adults with Disabilities
Long term services and supports are for adults with disabilities who need both medical care and non-medical living supports to assist with normal daily tasks like eating, dressing and using the bathroom. Medicaid LTSS for adults with disabilities covers care provided at home and in community settings as well as in health facilities like hospitals and nursing homes.
Am I eligible for Medicaid LTSS?
Eligibility for Medicaid LTSS is based on both financial and clinical criteria. You must 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 $820, 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.
Need More Information About How to Apply? To find out what is required to apply,seethe Medicaid Application . To schedule an appointment, please call your local DHS Office
To learn more about the special services and supports available for adults with disabilities, click here
Call The POINT at (401) 462-4444 or (401) 462-0740 TTY for information and referrals