Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 3 - Medicaid and Children's Health Insurance Program (CHIP) Non-Financial General Eligibility Requirements › Section 210-RICR-10-00-3.10 - Cooperation Requirements

Current through June 14, 2024
A. As a condition
				  of eligibility, all Medicaid applicants and beneficiaries must meet certain
				  cooperation requirements which enable to State to meet Federal laws, Rules and
				  Regulations related to obtaining and retaining Federal matching funds for the
				  program.
1. General cooperation requirements -
				  Applicants and beneficiaries must:
a.
				  Application information. Provide any information requested by the State that is
				  necessary to determine eligibility for Medicaid;
b. Assignment of rights. Medical support or
				  other third-party payments for health care services must be assigned to the
				  State. An applicant must also assign to the EOHHS any third-party payments for
				  any other household members eligible under the Medicaid and CHIP State Plan
				  and/or Section 1115 demonstration waiver for whom he or she has the legal
				  authority under State law to make such an assignment. This assignment
				  obligation takes effect under State law upon an applicant's filing for
				  Medicaid;
c. Child support.
				  Cooperate in establishing paternity and obtaining support, except when an
				  exemption exists, with the State's Office of Child Care Enforcement. Exemptions
				  exist for pregnant women with no other children until the birth of the child,
				  parent/caretakers in child-only application cases, and children in general. The
				  State does not deny initial eligibility to an adult applying for Medicaid
				  pending cooperation with the child support requirement. However, termination of
				  eligibility is initiated if an adult applicant or beneficiary does not
				  cooperate by the time of the first periodic electronic verification;
d. Enrollment in RIte Share. An applicant
				  with access to cost-effective employer-sponsored insurance (ESI) must enroll in
				  the plan as a condition of eligibility. Medicaid-eligible children are not
				  denied eligibility or subject to the loss of coverage, if their
				  parent/caretakers with access to coverage do not cooperate and enroll in the
				  approved plan. Specific provisions governing the RIte Share program are located
				  in Part 30-05-3 of this Title;
e. Alternative sources of support and
				  assistance. Take all reasonable actions to make income/resources available to
				  meet needs. A reasonable action is one that will likely result in more
				  financial benefit accruing to a household than the cost of Medicaid coverage.
				  In addition, for eligibility to continue to exist, a beneficiary who claimed
				  that income or resources owned by or owed to him or her are unavailable must
				  show a good faith effort to continue to take reasonable actions unless the
				  State approves a good cause exemption made in writing. Reasonable actions
				  include, but are not limited to:
(1) Filing
				  applications for other benefits to which an applicant/beneficiary may be
				  entitled including, but not limited to, State and federally-funded health care
				  and cash assistance programs and income tax credits and private or public
				  retirement benefits, food assistance, or supplemental insurance;
(2) Making formal requests to other joint
				  owners to sell or otherwise liquidate jointly held property;
(3) Requesting guardians, trustees, and other
				  legally authorized representatives to make resources or income available from
				  estates, trusts, settlements, and other financial instruments;
(4) Retain counsel to petition a court to
				  adjudicate any monetary or property claim which the client may have against any
				  person; and
(5) Report to the State
				  at the time of renewal or more frequently upon request progress being made
				  toward making the resource or income available for use.
f. Quality Assurance. Assist the State by
				  providing full cooperation in any quality assurance and/or program integrity
				  activities.