Healthcare for People with Disabilities/Special Needs
RI Medicaid provides health care services and supports for people with disabilities and special needs. Services may include comprehensive heath care, premium assistance and/or long-term services and supports, depending on a person's needs.
The RI Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) is the agency responsible for services for adults with developmental disabilities and serious chronic and/or disabling behavioral health conditions beginning at age 22.
Health Coverage for Children
Comprehensive Medicaid health coverage is available for a children with a disability or chronic condition.
Is my child eligible for Medicaid coverage?
A child with a disability and special needs 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 UnitedHealthcare Community Plan. 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.
See Medicaid services and programs for Children with Special Health Care Needs.
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 Medicaid’s Rhody Health Partners . 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 may qualify for.
- Beginning on January 1, 2014, adults between the ages of 19 to 64 without dependent children who have income at or below 133% of the federal poverty line may be eligible for Medicaid coverage. 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. For more information, see 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, see the Medicaid Application. To schedule an appointment, please call your local DHS Office.
Call The POINT at (401) 462-4444 or (401) 462-0740 TTY for information and referrals