Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 00 - Affordable Coverage Groups › Part 1 - Medicaid Affordable Care Coverage Groups Overview and Eligibility Pathways › Section 210-RICR-30-00-1.5 - Eligibility Pathways for MACC and Non-MAGI Groups

Current through June 14, 2024
A.
				  Rhode Island's Medicaid MACC groups are comprised of individuals and families
				  who share an eligibility characteristic, such as age or relationship as
				  follows, unless otherwise indicated below. MACC group members do not have
				  access to retroactive coverage under the terms and conditions of the State's
				  Section 1115
				  W aiver.
1. Families
				  and Parents (caretaker relatives). The defining characteristic of this coverage
				  group is a relationship with a child up to the age of eighteen (18), or the age
				  of nineteen (19) if enrolled in school full-time, who is eligible for Medicaid.
				  Parent/caretaker eligibility is a function of how the eligible child is claimed
				  for tax purposes as a dependent when constructing a MAGI household. This
				  coverage group includes:
a. Families with
				  income up to one hundred sixteen percent (116%) of the Federal Poverty Level
				  (FPL) who are eligible under the Medicaid State Plan through the authority
				  provided by §1931.
b. Parents/caretaker relatives with income
				  from one hundred sixteen percent (116%) to one hundred forty-one percent (141%)
				  of the FPL who are eligible under the State's Section
				  1115 waiver.
c. Parents/caretakers with income from one
				  hundred thirty-eight percent (138%) to one hundred seventy-five percent (175%)
				  of the FPL who would have been eligible for Medicaid on December 31, 2013, may
				  qualify for the Rhode Island Affordable Health Care Coverage Assistance
				  Program. Parents/caretakers eligible for this program may obtain a State
				  subsidized "silver" commercial plan through the Rhode Island's health insurance
				  marketplace as specified in Subchapter 10 Part 1 of this Chapter. The State's
				  integrated eligibility system automatically evaluates the parents/caretakers of
				  Medicaid-eligible children for this Program if they do not qualify for coverage
				  under this Part.
d. Pregnant
				  people. Members of this coverage group can be of any age. The pregnant person
				  and each expected child are counted separately when constructing the household
				  and determining family size. Eligibility extends for the duration of the
				  pregnancy and, as of October 1, 2022, twelve (12) months post-partum. The
				  coverage group includes all pregnant people with income up to one hundred
				  fifty-three percent (253%) of the FPL. Pregnant people with income under one
				  hundred ninety percent (190%) of the FPL who meet Medicaid requirements for
				  citizenship/immigration status are eligible for medical coverage through
				  Medicaid. Pregnant people with income above one hundred ninety percent (190%)
				  of the FPL up to two hundred fifty-three percent (253%) of the FPL who meet
				  Medicaid requirements for citizenship/immigration status and pregnant people
				  with income up to two hundred fifty-three percent (253%) of the FPL who meet
				  Medicaid requirements for citizenship/immigration status are eligible for
				  medical coverage through CHIP. CHIP medical coverage for those pregnant people
				  who do not meet Medicaid requirements for citizenship/immigration status is
				  based on the eligibility status of the unborn child.
Retroactive medical coverage is available for up to ninety
					 (90) days prior to the eligibility date for otherwise eligible pregnant
					 people.
(1) As of October 1, 2022,
				  twelve (12) month post-partum coverage shall be extended to people who:
(AA) Are not eligible for Medicaid under
				  another Medicaid eligibility category; or
(BB) Do not have qualified non-citizen status
				  for Medicaid, whose births are financed by Medicaid through coverage of the
				  child and who, before October 1, 2022, were only eligible to receive State-only
				  extended family planning benefits postpartum, as outlined in §05-2.6(A)(3) of
				  this Chapter.
e. Children and Young Adults. Age is the
				  defining characteristic of members of this MACC group. This coverage group
				  includes:
(1) Infants under age one (1) unless
				  a deemed newborn (see §
													1.7(A)   of
				  this Part) up to age nineteen (19) who have family income up to two hundred
				  sixty-one percent (261%) of the FPL; and
(2) All children, including all non-citizen
				  children not legally present, up to the age of nineteen (19), who have income
				  up to two hundred sixty-one percent (261%) of the FPL.
f. ACA Expansion Adults - The group consists
				  of citizens and qualified non-citizens with income up to one hundred
				  thirty-three percent (133%) of the FPL who meet the age characteristic and are
				  not otherwise eligible for, or enrolled in, Medicare or Medicaid under any
				  other State plan or Section
				  1115 waiver coverage
				  group. Adults found eligible awaiting a determination for Supplemental Security
				  Income (SSI) or the receipt of Social Security benefits are also eligible under
				  this coverage group during the two (2) year application pending and benefit
				  waiting periods.