Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 00 - Long-Term Services › Part 6 - Medicaid Long-Term Services and Supports: Financial Eligibility › Section 210-RICR-50-00-6.4 - LTSS Determination of Income

Current through June 14, 2024
A. In accordance
				  with Medicaid institutional rules (Subchapter 05 Part 1 of this Chapter,
				  Medicaid Long-Term Services and Supports: Institutionally Based LTSS), an
				  applicant for Medicaid LTSS is both a financial responsibility unit (FRU) and a
				  Medicaid eligibility unit of one (1) for the family size involved when
				  determining financial eligibility once the joint resources of a couple have
				  been allocated in the community spouse allocation of resources process in
				  accordance with §
										6.5   of this Part. There is
				  also no spouse to spouse deeming of the income in the LTSS financial
				  eligibility determination process.
B. The financial eligibility for current
				  non-LTSS Medicaid beneficiaries is reevaluated using the LTSS Rules with
				  information previously provided to the State by the beneficiary. As additional
				  information from the beneficiary may be required, financial eligibility
				  determination is not automatic unless the basis for coverage is receipt of
				  SSI.
C. Medicaid LTSS is available
				  to applicants and beneficiaries who have countable income that does not exceed
				  the limits established for one (1) or more of the following eligibility
				  pathways:
1. ACA expansion adults - Adults
				  between the ages of nineteen (19) and sixty-four (64) with income up to one
				  hundred thirty-eight percent (138%) of the FPL, including the five percent (5%)
				  disregard, using the MAGI method as set forth in Part 30-00-5 of this Title,
				  Medicaid MAGI Financial Eligibility Determinations and Verification. The LTSS
				  applicant is treated as a family of one (1) for LTSS eligibility purposes,
				  irrespective of whether he or she resides with a non-LTSS spouse and receives
				  services at home, in a health institution or a community-based service
				  setting.
2. Elders and adults with
				  disabilities (EAD), including:
a.
				  SSI-eligible Medicaid beneficiaries;
b. Adults between the ages of nineteen (19)
				  and sixty-four (64). Medicare eligible or enrolled with countable income up to
				  three hundred percent (300%) of the SSI rate using the method set forth in
				  §40-00-3.2 of this Title; and
c. Elders sixty-five (65) and older.
				  Countable income up to three hundred percent (300%) of the SSI rate based on
				  the SSI method in §40-00-3.2 of this Title.
3. LTSS medically needy adults - Adults with
				  countable income above three hundred percent (300%) of the SSI rate up to the
				  average private pay rate for the applicable institutional level of care may be
				  eligible as medically needy if they meet the requirements set forth in Part 2
				  of this Subchapter, Medicaid Long-Term Services and Supports: Medically Needy
				  Eligibility Pathway. For these purposes, the average monthly private pay rate
				  for the institutional level of care is as set forth in §
											2.6   of this Subchapter and is
				  included in summary of resources limits in §40-00-3.1 .7(A)(7)(d) of this
				  Title. Except as provided herein, countable income is determined based on the
				  SSI method in §40-00-3.2 of this Title.