Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 05 - Community Medicaid › Part 1 - Medicaid for Elders and Adults with Disabilities: Community Medicaid › Section 210-RICR-40-05-1.11 - Financial Eligibility Determination

Current through June 14, 2024
1.11.1
Scope and Purpose
To determine a person's eligibility using the SSI
					 methodology, a comparison is made between the countable income and resources of
					 the applicant's FRU and the income limits applicable to the Medicaid
					 eligibility IHCC group. Once these groups have been established, financial
					 eligibility is determined in accordance with the provisions for the SSI
					 treatment of income and resources set forth in §§00-3.1 through
					 00-3.5 of this Chapter, and/or the
					 special eligibility requirements in §
											1.7   of this Part. This
					 section focuses on the financial eligibility determination process for the
					 Community Medicaid pathways in which the State is responsible for initial and
					 continuing eligibility.
1.11.2
The Medicaid Eligibility
				  Group
A. The Medicaid eligibility group
				  for Community Medicaid when determined by the State is as follows:
1. Single Adults - A single adult requesting
				  Community Medicaid, including Medicaid LTSS, is treated as an "individual" -
				  that is - Medicaid eligibility group of one (1).
2. Groups for Adults with Spouses - When two
				  (2) spouses are living together, both the person requesting Medicaid and the
				  applicant's spouse are considered members of applicant's Medicaid eligibility
				  group - a "couple" or group of two (2) - unless one (1) of the exceptions
				  specified below applies. This is true whether or not the spouse is also
				  requesting Medicaid.
a. Living together. A
				  couple is also considered living together in any of the following
				  circumstances:
(1) Until the first (1st) day
				  of the month following the calendar month of death or marriage separation, that
				  is, when one (1) spouse dies or the couple separates;
(2) When the number of days one (1) spouse is
				  expected to receive LTSS in an institution or home and community-based setting
				  is fewer than thirty (30) days; and
(3) When the resources of the couple are
				  reassessed and allocated at the point in which the need for continuous LTSS is
				  determined and an application for Medicaid coverage of LTSS is made as
				  indicated in Part 50-00-6 of this Title, Medicaid Long-Term Services and
				  Supports: Financial Eligibility.
b. Exceptions. Adult applicants with spouses
				  are treated as an "individual" for eligibility purposes in the following
				  circumstances:
(1) When one (1) spouse in a
				  couple is receiving long-term care and applying for Medicaid LTSS, the
				  applicant for Community Medicaid is treated as an "individual" - group of one
				  (1) - for the determination of initial and ongoing income eligibility and
				  resource reviews. The couple, whether or not still married, is treated as no
				  longer living together as of the first (1st) day of the calendar month that the
				  spouse receiving LTSS became eligible for Medicaid. This remains true even if
				  the other spouse receiving Community Medicaid begins receiving Medicaid LTSS in
				  a subsequent month.
(2) When both
				  spouses receive Community Medicaid and are residing in a residential care
				  setting serving four (4) persons or more, each spouse is treated as an
				  individual without regard to whether they live together. This applies to
				  Community Medicaid beneficiaries who do not qualify for LTSS while residing in
				  licensed assisted living residences, behavioral health community residences,
				  adult supportive care homes, and supportive living arrangements for adults with
				  developmental disabilities.
c. Dependent child in the household. The
				  Medicaid eligibility group increases in size for any dependent child under age
				  nineteen (19) who is not receiving SSI.
3. Child (Applicable for MN Eligibility Only)
				  - The Medicaid eligibility group for a dependent child up to age nineteen (19)
				  applying for MN coverage using the SSI methodology is a group of one (1). Once
				  reaching age nineteen (19), the Rules related to a single adult
				  apply.
4. Parent-Child - When a
				  parent and dependent child living together are both seeking Medicaid in IHCC
				  groups in which the SSI methodology applies, they are treated as two (2)
				  Medicaid groups of one (1), if the parent is not living with a spouse. If the
				  parent is living with a spouse, the parents are treated as a Medicaid group of
				  two (2) and the child as a Medicaid group of one (1). When a parent/caretaker
				  is seeking MN eligibility, any MAGI-eligible members of the household are
				  excluded from the eligibility group.