Qualifications for Medicaid in Rhode Island

Rhode Island Medicaid benefits eligibility for the Rhode Island Medical Assistance Program (Medicaid) depends on residency requirements, income restrictions and a variety of other factors. Rhode Island Medicaid eligibility requirements include having a disability, being a pregnant woman or being elderly. To determine who is eligible for Medicaid in Rhode Island, the Rhode Island Department of Human Services now uses an online HealthSource RI system. The online system helps applicants to determine eligibility for public assistance programs such as Rhode Island Medicaid.

To find out what are the Medicaid application guidelines in Rhode Island, read the topics below:

  • Who is eligible for Medicaid in Rhode Island?

  • What are the requirements for Medicaid in Rhode Island?

  • What are the income requirements for Medicaid in Rhode Island?

  • What are the Medicaid application guidelines in Rhode Island?

  • Other Rhode Island Medicaid public assistance programs

Who is Eligible for Medicaid in Rhode Island?

RI Medicaid eligibility requirements vary between each program, as the state divides health care coverage into group options. RI Medicaid benefits eligibility groups are low-income adults, parents or caretakers and disabled applicants are all eligible to receive Medicaid health insurance benefits. To find out how to qualify for Medicaid in RI, applicants must first determine in which covered group they belong.

Beneficiaries who meet RI Medicaid eligibility requirements will be eligible to receive coverage for doctor’s office visits, prescription drugs, laboratory tests, hospital care, emergency care, drug or alcohol consoling and mental health services. Additionally, Medicaid eligibility requirements qualify a beneficiary to receive transportation services, dental care, smoking cessation programs, parenting classes, interpreter services, nutrition services, home health care and skilled nursing care. An applicant’s Modified Adjusted Gross Income (MAGI) as well as tax-based income and family size in accordance with Federal Poverty Level guidelines determine who is eligible for Medicaid.

What Are the Requirements for Medicaid in Rhode Island?

RI Medicaid eligibility requirements are different for each coverage group. RI Medicaid benefits eligibility is available to pregnant women with income of up to 253 percent of the Federal Poverty Level. Additionally, children up to 19 years of age with family incomes of up to 261 percent of the Federal Poverty Level are also eligible. RI Medicaid benefits eligibility also applies to parents and caretakers with children or dependents under 18 years of age with household income of up to 133 percent of the Federal Poverty Level. Newly eligible low-income adults cannot have an income more than 133 percent of the Federal Poverty Level.

Medicaid applicants must reside in the state of Rhode Island. Medicaid petitioners must also be a U.S. national, citizen, permanent resident or be a legal alien. Additionally, Medicaid benefits eligibility requires applicants to have a need for health care assistance. Medicaid benefits eligibility groups that qualify as having a need for health care assistance includes being pregnant, blind, elderly, having a disability or living with a family member who has a disability. RI Medicaid benefits eligibility also applies to parents or relative caretakers living with dependent child under 19 years of age. Income restrictions also apply.

Note: Medicaid applicants denied benefits but feel they meet RI Medicaid benefits eligibility may file an appeal. Petitioners have 35 days to file an appeal after the denial.

What Are the Income Requirements for Medicaid in Rhode Island?

Medicaid petitioners who want to know what are the income requirements for Medicaid in RI must be aware of how the state calculates thresholds. Generally, Medicaid eligibility requirements apply to household size and maximum annual income levels.

  • Households of one may not exceed $15,800 per year

  • Households of two may not exceed $21,307 per year

  • Households of three may not exceed $26,813 per year

  • Households of four may not exceed $32,319 per year

  • Households of five may not exceed $37,825 per year

  • Households of six may not exceed $43,331 per year

  • Households of seven may not exceed $48,851 per year

  • Households of eight may not exceed $54,384 per year

Households with more than eight people must add an extra $5,533 per additional household member.

What Are the Medicaid Application Guidelines in Rhode Island?

Applicants who meet Medicaid eligibility requirements in Rhode Island may apply for Medicaid coverage in-person or online through HealthSourceRI. Candidates meeting Medicaid benefits eligibility and who wish to apply in-person may visit a local Department of Human Services office. Completed applications are also available for submission by mail.

Candidates who meet Medicaid benefits eligibility and who wish to apply online must use the Medicaid application available to Rhode Island residents, the Application for Assistance. Applying online using this application form will show applicants how to qualify for Medicaid in Rhode Island. However, applicants must create an online account before beginning the application process.

When creating an online account RI Medicaid benefits eligibility requires applicants to enter the applicant’s birth date, Social Security Number, current health insurance information, immigration or citizenship information as well as income and tax information. Additional supporting documents to furnishing when submitting a Medicaid application include proof of income, proof of pregnancy for pregnant applicants, proof of immigration status and proof of identity and citizenship status. To find out how to qualify for Medicaid in Rhode Island, applicants will also need to create a username and password.

Other Rhode Island Medicaid Public Assistance Programs

When a Medicaid candidate determines his or her Medicaid benefits eligibility through HealthSource RI, other available human service programs available are available for review by using an online estimation tool. Other public assistance programs include the Rhode Island Works Cash Assistance Program, Child Care Assistance, General Public Assistance, State Supplemental Payments, Nutrition Assistance Program and Child Support services. Medicaid benefits eligibility may also determine whether an applicant is eligible to receive Medicaid for Children with Special Healthcare Needs, WIC, family planning or birth control services and immunizations.

Applicants may use the website to estimate Medicaid benefits eligibility and suitability for other public assistance programs. However, the information will not be saved in the estimation system and an actual Medicaid application must be filled out to apply for coverage.



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