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RI Medicaid: Guide to Rhode Island Medicaid Coverage and Eligibility

The Medicaid program is slightly different in all 50 states. It is both federally and state-regulated; eligibility requirements and benefits are slightly different in each state. About one out of every six adults and three out of every eight children in Rhode Island are covered by Medicaid. Find out if you’re eligible to receive no or low-cost healthcare!

Click below to learn more about RI Medicaid:

Rhode Island Medicaid Benefits and Coverage

Rhode Island Medicaid provides comprehensive coverage at very little or no cost to beneficiaries. People who qualify but have an income above 185% of the Federal Poverty Line may owe copayments for some covered services. RI Medicaid copayments can be as little as $1 or as much as a few hundred dollars, but most services won’t ever cost more than $40.

The Rhode Island Medicaid program covers most medically necessary services. Some of the highlights include:

  • Wellness programs
  • Mental health and substance abuse help
  • Maternity care
  • Disease care and management
  • Dental
  • Medical transportation
  • Prescription drugs (and some over-the-counter medicines)
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RIte Care/CHIP

“RIte Care” is sometimes mistaken for RI CHIP because they both cover children, but they are two different programs. RIte Care is the UnitedHealthcare Rhode Island Medicaid managed care program for eligible pregnant women, children, and parents. CHIP is the Children’s Health Insurance Program and it can cover eligible kids in Rhode Island.

The Children’s Health Insurance Program can cover kids whose parents don’t qualify for Medicaid but can’t afford to pay their children’s healthcare bills. When you apply for Medicaid, someone from the Rhode Island Department of Human Services can let you know that you do not qualify for Medicaid but your kids qualify for CHIP.

RIte Smiles and Dental Coverage

Children and adults are offered two different benefit packages under Rhode Island Medicaid. Adults and kids born before May 1, 2000, will receive services through “Medicaid Dental Services.” Kids born after May 1, 2000, will receive services through “RIte Smiles.”

Benefits include:

  • Two cleanings and oral exams per year
  • Medically necessary x-rays, biopsies, and other diagnostic/radiology services
  • Root canals and other endodontic services
  • Amalgams, resins, and other restorative services
  • Periodontal services (gingival curettage, gingivectomy, etc.)
  • Adjustments, dentures, and limited prosthodontic services
  • Emergency services like extractions, incisions, and abscess drainage
  • Surgeries when medically necessary
  • KIDS ONLY: Orthodontic services
  • KIDS ONLY: General anesthesia

Non-Emergency Medical Transportation

RI Medicaid’s NEMT services are provided by Medical Transportation Management, Inc. Medicaid members seeking a ride to and from a doctor’s appointment should call 1-855-330-9131 (TTY 711) with at least two business days (M-F, 8-5) notice. Same day trips may be available for urgent care, but you should still call 911 in an emergency. Anyone who is above 150% of the Federal Poverty Line will owe a copayment for this service.

Those who do not have Medicaid but are over the age of 60 may still qualify for NEMT through the ETP (Elderly Transportation Program).

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RI Medicaid Eligibility

Use the income chart below to determine whether or not you might be eligible for Rhode Island Medicaid. Even if you don’t qualify based on your income, you may be able to take the “Medically Needy (MN) Pathway.” The pathway is usually called the “Spend-Down Program” in other states and means that you spend enough money on healthcare costs to put you below the eligibility numbers listed below.

RI Medicaid Eligibility

Applying for RI Medicaid with HealthSource RI

You can apply for RI Medicaid online at HealthSourceRI.com. Even if you do not qualify for Medicaid, this application can tell you if you qualify for affordable commercial coverage instead. You can also apply in person at your local Department of Human Services (DHS) office or by phone at 1-855-840-4774. No matter which way you apply, you’ll receive a notice from the DHS letting you know if you were approved, denied, or if more information is needed.

If you have Medicaid but are deemed no longer eligible, you’ll receive a notice telling you that you may be eligible to enroll in another health plan through HealthSource RI. You will have 60 days to complete that process or risk having a gap in your coverage.

What is HealthSource RI?

HealthSource RI is the online marketplace for Rhode Island health insurance. When you apply for Medicaid with HealthSource RI, you apply for all healthcare programs in Rhode Island, making it easy for you to see your options.

How to get Both Medicare and Medicaid in RI?

Now that you know that you qualify for Medicaid, think about whether or not you qualify for Medicare as well. Qualification for both programs will mean that you can enroll in a DSNP, or dual-eligible special needs plan. DSNPs are a form of Medicare Advantage that covers all or most of your out-of-pocket costs and can get you the low-cost but high-quality healthcare you need.

There are three main ways to qualify for Medicare in Rhode Island:

  1. Turn 65
  2. Receive an ALS (Lou Gehrig’s Disease) or ESRD (End-Stage Renal Disease) diagnosis
  3. Receive SSDI (Social Security Disability Income) for at least 25 months.

If you think you may qualify for a DSNP, click here for more information. We can help you select the best DSNP for your individual needs.

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