Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 1 - Overview of Medicaid Integrated Care Coverage (210-RICR-40-00-1) › Section 210-RICR-40-00-1.5 - IHCC Groups Subject to the SSI Methodology

Current through June 14, 2024
A. On
				  and after the effective date of this rule, the provisions of this chapter
				  govern the following eligibility pathways that use the SSI methodology in whole
				  or in part to determine eligibility for Medicaid benefits:
1. Elders and Adults with Disabilities (EAD)
				  - Low-income elders who are sixty-five (65) and older and people living with
				  disabilities who have income at or below one hundred percent (100%) of the
				  Federal Poverty Limit (FPL) and resources at or under $4,000 for an individual
				  or $6,000 for a couple.
2.
				  Medically Needy (MN) - Elders, persons with disabilities, children, parents and
				  caretakers of Medicaid-eligible children, and pregnant women who do not qualify
				  for eligibility on the basis of income but have high health expenses and must
				  spend or contribute income and/or resources above the applicable income
				  eligibility standards to obtain or retain Medicaid eligibility. Subchapter 5
				  Part 1 of this Chapter pertains to the MN eligibility pathway for Community
				  Medicaid.
3. Supplemental Security
				  Income (SSI) Recipients - All persons receiving SSI cash assistance based on
				  age or as an adult with a disability, as determined by the federal Social
				  Security Administration (SSA). SSI recipients are automatically eligible for
				  Medicaid on this basis and are not required to apply for Medicaid health
				  coverage through the State. Program-specific provisions for SSI recipients
				  twenty-one (21) and older are included in this chapter. The relevant provisions
				  for Medicaid beneficiaries under 21 are located in the sections pertaining to
				  coverage for children and families in Medicaid Code of Administrative Rules,
				  Medicaid Coverage for Children and Families.
4. State Supplement Payment (SSP) - Persons
				  who qualify to receive the optional state- funded supplemental payment are
				  automatically eligible for Medicaid health coverage under the Medicaid State
				  Plan. This group includes beneficiaries eligible on the basis of SSI and EAD as
				  well those with higher income who require Medicaid LTSS who meet the special
				  living arrangement requirements for SSP set by the State.
5. SSI Protected Status Beneficiaries - This
				  group - sometimes referred to "SSI- lookalikes" - includes persons who meet the
				  age or disability criteria for SSI, but are -- or become -- ineligible for full
				  SSI cash benefits or qualify for special treatment. To protect Medicaid health
				  coverage for members of these coverage groups, federal law requires the
				  application of special rules that confer or preserve Medicaid eligibility.
6. Medicaid Premium Payment
				  Program (MPPP) for Medicare beneficiaries with income at or below 135% of the
				  FPL. The MPPP provides financial help through Medicaid to assist in paying
				  Medicare costs including premiums, deductibles, and coinsurance in amounts that
				  vary depending on income and resources.
7. Sherlock Plan for Working Adults with
				  Disabilities - The State's program for working adults with disabilities. The
				  Sherlock Plan provides Medicaid health coverage and/or services and supports to
				  persons with disabilities who are working, and who otherwise meet the SSI
				  disability criteria for Community Medicaid or, based on a functional and health
				  status review, have the level of need required for Medicaid LTSS. As is set
				  forth in greater detail in Medicaid Code of Administrative Rules, Sherlock
				  Program Regulations, beneficiaries in this group may have countable income at
				  or below two-hundred and fifty percent (250%) of the FPL and resources less
				  than or equal to $10,000 individual and $20,000 for a couple.
8. IHCC Medicaid LTSS -- Consists of new
				  applicants seeking Medicaid-funded LTSS and current IHCC group beneficiaries
				  who develop a continuous need for the level of care typically provided in an
				  institution (hospital, nursing facility, intermediate care facility for person
				  with intellectual disabilities). Beneficiaries eligible in the MACC groups (see
				  Medicaid Code of Administrative Rules, Overview of the Affordable Care Coverage
				  Groups) who require LTSS are not subject to the SSI methodology; LTSS
				  eligibility based on the SSI methodology and more generally is located in
				  Medicaid Code of Administrative Rules, Evaluation of Resources and Resource
				  Transfers.