Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 00 - Long-Term Services › Part 1 - Medicaid Long-Term Services and Supports Overview and Eligibility Pathways › Section 210-RICR-50-00-1.9 - Eligibility Pathways

Current through June 14, 2024
A. The eligibility
				  pathways available to persons seeking Medicaid LTSS have different requirements
				  all of which are automatically taken into account when application information
				  is processed. As indicated below, the process for determining eligibility and
				  the sequence may vary for members of a particular population depending on the
				  pathways available.
1. SSI and SSI-related
				  Groups - SSI recipients and members of certain SSI- related groups are
				  automatically eligibility for Medicaid based on a determination by SSA as
				  indicated in Part
				  40-00-3 of this Title. Federal
				  Regulations at  42 C.F.R. §
												435.603(j) specifically exclude Medicaid determinations of eligibility for members of this
				  group, including for LTSS, using the MAGI standard except in instances in which
				  an SSI recipient no longer meets disability criteria and loses cash assistance
				  on this basis. Special provisions also apply to Medicaid LTSS beneficiaries who
				  are receiving SSI and are expected to need LTSS coverage for ninety (90) days
				  or less. Accordingly, access to LTSS proceeds as follows:
a. Eligibility Criteria. Medicaid
				  beneficiaries who are SSI-eligible and need LTSS are subject to the
				  clinical/functional eligibility factors required for an institutional level of
				  care set forth in Subchapter 05 Part 1 of this Chapter as well as the financial
				  eligibility requirements related to the transfer of assets. The resource limit
				  is set at two thousand dollars ($2,000.00).
b. Special Conditions. Re-evaluation of
				  income and resources is not required unless current eligibility is based on
				  different Medicaid group size (couple v. individual) or there is a change in
				  income or resources resulting from need for or use of LTSS. In addition:
(1) SSI recipients who have §1619(b)
				  status, as indicated in §40-05-1.5.4 of this Title, remain
				  eligible for two (2) months of continuing SSI cash assistance if admitted to an
				  LTH, such as Eleanor Slater Hospital or an equivalent HCBS setting;
				  and
(2) SSI recipients who obtain
				  Medicaid LTSS for a period not expected to exceed ninety (90) days may continue
				  to receive SSI cash assistance during this time to maintain a community
				  residence. Such income is excluded in the financial eligibility determination
				  sequence, including the post-eligibility treatment of income.
c. Determination Process. SSI
				  recipients are not subject to a MAGI determination and a re-evaluation of
				  income/resource eligibility using the SSI method is not required when applying
				  for LTSS. Although a review of functional/clinical eligibility is conducted, a
				  full assessment of level of care needs may be waived for certain populations
				  based on their type of disability as indicated in Part 5 of this Subchapter.
				  All other steps in the eligibility determination process apply to the extent
				  that the special Rules applicable to the treatment of SSI income allow, as
				  indicated in Part
				  40-00-3 of this Title.
d. Retroactive Coverage. Retroactive coverage
				  is available for any allowable non-Medicaid covered LTSS expenses in the ninety
				  (90) day period prior to the eligibility date in circumstances in which the
				  applicant for LTSS was not enrolled in Medicaid at that time.