Medicaid in Rhode Island is a joint federal and state program designed to provide health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. The program is tailored to meet the specific health needs of Rhode Island residents, offering a range of benefits, including hospital services, doctor visits, prescription drugs, and long-term care services, among others.

Rhode Island has actively participated in Medicaid expansion under the Affordable Care Act, which has significantly increased the number of residents eligible for Medicaid, thereby reducing the uninsured rate in the state.

The state operates its Medicaid program focusing on comprehensive care. It has implemented innovative models, such as the Integrated Care Initiative, to improve care coordination for individuals with complex health needs.

Additionally, Rhode Island Medicaid emphasizes the importance of preventive care. It has initiatives to improve health outcomes while controlling costs, making it a vital component of the state's healthcare system.

Medicaid in Rhode Island covers a wide range of services to meet the healthcare needs of its beneficiaries. Here's an overview of the covered services, each with a brief description:

1. Doctor Visits: Scheduled appointments with healthcare providers for routine check-ups, illness, or injury treatment.
2. Hospital Services: Includes both inpatient and outpatient services provided by hospitals for emergency care, surgeries, and other medical procedures.
3. Prescription Drugs: Medications prescribed by a healthcare provider, covered under the plan with varying co-payments.
4. Laboratory and X-Ray Services: Diagnostic services, including blood tests, X-rays, and other imaging services to assist in diagnosis and treatment.
5. Long-Term Care Services: Assistance with daily living activities and health services for individuals with chronic illnesses or disabilities, available in both home-based and institutional settings.
6. Mental Health and Substance Abuse Services: Counseling, therapy, and treatment programs for individuals dealing with mental health issues or substance abuse.
7. Dental Services: Preventive, diagnostic, and treatment services for oral health, including cleanings, fillings, and extractions. Coverage may vary for adults and children.
8. Vision Services: Eye exams and, in some cases, coverage for glasses or contact lenses, primarily for children and some adults under specific conditions.
9. Rehabilitative Services: Physical, occupational, and speech therapies to help individuals recover from an injury or illness, improving their functional abilities.
10. Preventive and Wellness Services: Services aimed at disease prevention and health promotion, including vaccinations and routine health screenings.
11. Family Planning Services: Access to contraceptive methods, counseling, family planning, and reproductive health education.
12. Emergency Medical Services: Urgent and emergency care services for conditions that require immediate attention to prevent serious health outcomes.
13. Transportation Services: Non-emergency transportation to and from healthcare appointments for eligible individuals without other means of transportation.

This list is not exhaustive; specific coverage details, including eligibility for certain services, may vary. Rhode Island Medicaid aims to provide comprehensive health coverage to support the well-being of its beneficiaries.

Eligibility for Medicaid in Rhode Island is determined based on income, age, family size, and specific circumstances such as disability or pregnancy. Income eligibility is often expressed as a percentage of the Federal Poverty Level (FPL), which adjusts annually. Here are some specific eligibility levels for different groups as a percentage of the FPL, reflective of the standards before my last update:

1. Adults (without dependent children, under the Medicaid expansion): Eligible if their income is up to 138% of the FPL.
2. Parents/Caretaker Relatives: Eligibility levels for parents and caretaker relatives living with children vary, but often up to 133% of the FPL.
3. Pregnant Women: Pregnant women can qualify for Medicaid if their income is up to 250% of the FPL, offering them access to prenatal, birth, and postpartum care.
4. Children: Under the Children's Health Insurance Program (CHIP), which extends coverage beyond the Medicaid thresholds, children can be eligible with family incomes up to 261% of the FPL.
5. Elderly and Individuals with Disabilities: Eligibility for this group is based on income, resources, and specific disability criteria, with income limits often set at a percentage of the FPL but considering additional factors like medical expenses.

These eligibility levels are subject to change based on state budget decisions, federal policy changes, and annual adjustments to the Federal Poverty Level. When determining eligibility, Rhode Island also considers factors like household size and specific health needs. For the most current eligibility requirements and income thresholds, contacting the Rhode Island Medicaid office or visiting their official website is recommended, as these sources provide the most up-to-date and detailed information.

To apply for Medicaid in Rhode Island, you have several options to choose from, allowing for convenience and accessibility based on your personal preference or situation. Here are the steps and contact information to guide you through the process:

1. Online Application: Visit the Rhode Island Department of Human Services (DHS) website and access the online portal for health coverage. The website for applications is HealthSource RI, Rhode Island's health insurance exchange, where you can fill out and submit your Medicaid application.‍
2. In-Person Application: You can apply in person by visiting a local Department of Human Services office. To find the nearest office, you can visit the DHS website or call the DHS Info Line at 1-855-MY-RIDHS (1-855-697-4347) for locations and hours.‍
3. Mail: If you prefer to apply by mail, you can download and print the application form from the DHS website or HealthSource RI. Complete the application and mail it to the address provided on the form or any DHS office.‍
4. Phone: You can apply over the phone by calling HealthSource RI at 1-855-840-4774. A representative will assist you with the application process and answer any questions you may have.

If you need help completing your application or have questions, navigators and certified application counselors are available through HealthSource RI. They can provide assistance in understanding your options and completing the application process.

Renewing Medicaid coverage in Rhode Island is an annual process to ensure that individuals and families continue to meet the eligibility criteria for receiving health care benefits. Here’s what you need to know about the renewal process, including specific steps and contact information:

Notification

The Rhode Island Department of Human Services (DHS) will send you a renewal notice before your coverage is set to expire. This notice typically arrives in the mail and includes instructions on how to renew your Medicaid coverage.

Review Your Information

The renewal process may require you to review your current information, report any changes in income, household size, address, or other relevant details that could affect your eligibility.

Renewal Methods

1. Online: The easiest way to renew your Medicaid coverage is online through HealthSource RI at https://healthsourceri.com/. Log in to your account to review your information and submit your renewal.
2. By Mail: You can complete the renewal form included with your notification letter and return it to the address provided. If you lost the form, you can download it from the DHS website or request a new one.
3. In Person: Visit a local DHS office to submit your renewal information. Find your nearest office by calling the DHS Info Line at 1-855-MY-RIDHS (1-855-697-4347) or visiting the DHS website.
4. By Phone: Call HealthSource RI at 1-855-840-4774 to renew over the phone. A representative can assist you with the renewal process and answer any questions.

It’s important to submit your renewal by the deadline indicated in your notification to avoid a lapse in your coverage. If you do not renew on time, you might lose your Medicaid benefits and need to reapply.

Once your renewal is processed, you will receive a notice about the status of your Medicaid coverage. If there are any issues or if further information is needed, DHS or HealthSource RI will contact you.