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 2 - Community Medicaid: Medically Needy Eligibility › Section 210-RICR-40-05-2.2 - General Provisions Eligibility Criteria

Current through June 14, 2024
A. For
				  the IHCC groups in this section, MN coverage is available to elders and persons
				  with disabilities with high medical expenses who have income above the EAD
				  income limit, but otherwise meet all of the general eligibility requirements
				  for Medicaid set forth in §
										1.9   of this Subchapter.
1. Determination process - Applicants who do
				  not meet the income limits for Medicaid in the IHCC groups are automatically
				  evaluated for MN coverage. Members of the MACC groups must contact an agency
				  eligibility specialist if seeking MN coverage. The MN cases are determined for
				  a six (6) month period beginning with the first
				  (1st) day of the month in which the application is
				  received. NOTE: To ensure EOHHS' continuation of eligibility for enhanced
				  Federal funding, during the novel Coronavirus Disease (COVID-19) Federal
				  declaration of emergency, the State will temporarily extend the six (6) month
				  eligibility period. This extension will last at least until the end of the
				  Federal emergency period. This extension only applies to individuals that are
				  not also enrolled in another Minimum Essential Coverage group (MEC), as defined
				  in  42 C.F.R. §
												433.400. This extension supersedes all references to the
				  six (6) month eligibility period for the duration of the COVID-19 Federal
				  declaration of emergency. Effective the last day of the month following the
				  month in which the Federal declaration of the COVID-19 public health emergency
				  is terminated, the six (6) month eligibility period will no longer be
				  automatically extended.
2.
				  Eligibility for Medicaid health coverage as MN is not established, however,
				  until the applicant has presented proof of health expenses incurred and paid or
				  that remain outstanding for the eligibility period. Any health expenses for
				  which a beneficiary continues to be liable dating back to the retroactive
				  period are also considered.
3.
				  Continuing eligibility - The date of eligibility is the actual day of the month
				  the applicant incurs a health expense - not the billing date - which reduces
				  income to the MNIL. Eligibility may be renewed on a continuing basis if the
				  beneficiary is liable for health care expenses that exceed current income.
				  Otherwise, a re-evaluation of eligibility, based on the cost of health costs
				  currently being incurred is required.
4. Agency responsibilities - The EOHHS must
				  inform applicants who have income above the applicable limit for the
				  appropriate IHCC group that MN coverage is an option and provide information
				  about allowable health expenses for spenddown purposes and the scope and limits
				  of obtaining coverage through this eligibility pathway. In addition, applicants
				  must be informed of the impact of obtaining MN Medicaid health coverage for
				  other programs, including the Supplemental Nutrition Assistance Program (SNAP)
				  and the MPPP.
5.
				  Applicant/beneficiary responsibilities - Eligibility and renewal is contingent
				  upon the applicant/beneficiary providing bills and receipts related to
				  allowable health care expenses that are not paid through a third
				  (3rd) party. Therefore, the chief responsibility of
				  the applicant/beneficiary is to maintain and present this information, unless
				  submitted directly by a provider, to the State agency.