Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 15 - Disabled Working Adults › Part 1 - Medicaid Code of Administrative Rules, Section 1373 Medicaid for Working People with Disabilities Program › Section 210-RICR-40-15-1.6 - Medicaid Affordable Care Coverage (MACC) MAGI-eligible Adults

Current through June 14, 2024
A. Working adults with disabilities who are
				  eligible through the Medicaid Affordable Care Coverage groups in: the ACA adult
				  expansion pathway for persons ages nineteen (19) through sixty-four (64); the
				  parent/caretaker pathway; or pregnant women pathway may obtain the work-related
				  services and supports they need through their Medicaid managed care plan or, if
				  enrolled in fee-for-service or a RIte Share approved employer-sponsored
				  insurance plan, through certified Medicaid providers. Pre-authorization of
				  services by the plan or Medicaid provider is required unless a disability
				  determination has been made by the EOHHS Medicaid Review Team (MART) or another
				  government entity such as the Federal Social Security Administration
				  (SSA).
B. There are no special
				  disregards for working adults with disabilities available through the MAGI
				  method for determining income eligibility. However, MACC eligible
				  beneficiaries, including those who qualify for Medicaid LTSS, are not liable
				  under Federal law to pay a share of the costs of their care.
C. If earnings from work increase income
				  above the applicable MACC group eligibility limit, applicants and beneficiaries
				  must seek coverage through an alternative Medicaid eligibility pathway that
				  uses the SSI method and requires a formal disability determination by the MART,
				  unless such a determination has already been made by another government
				  authority including the SSA. The IES automatically evaluates persons for these
				  alternative forms of eligibility if they do not qualify for MACC group coverage
				  due to excess income. Depending on a person's income and resources and level of
				  need, the available pathways are as follows:
1. Community Medicaid (Non-LTSS) - The two
				  (2) alternative eligibility pathways for MACC eligible working adults with
				  disabilities who do not require or meet the level of care criteria for the full
				  scope of Medicaid long-term services and supports are: Community Medicaid EAD,
				  including the Medically needy pathway as specified in §05-1.5 of this
				  Chapter and above, and the Sherlock pathway, as set forth in §
											1.8   of this Part. The SSI
				  work-related income disregards indicated in §
											1.4(B)(1)   of
				  this Part are applied and a disability determination by the MART or SSA is
				  required;
2. Medicaid LTSS -
				  MAGI-eligible working adults with disabilities who meet the level of care
				  requirements for Medicaid long-term services must be determined disabled to
				  obtain work-related services and supports. If income exceeds the MACC group
				  limit due to earnings from work, eligibility may continue to be available
				  through the LTSS/SSI-related pathways including LTSS Medically needy (§
											1.7   of this Part), or the
				  Sherlock pathway (§
											1.8   of this Part). The SSI
				  work-related income disregards indicated in §
											1.4(B)(1)   of
				  this Part are applied and a disability determination by the MART or SSA is
				  required.