Learn About Coverage For Medicaid in Rhode Island

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Wondering what services are covered by Medicaid in Rhode Island or how it will cost? Rhode Island Medicaid coverage, also known as Rite Care, is a statewide-managed care program that ensures eligible children, families and pregnant women get quality and comprehensive health care services.

Depending on the types of Medicaid insurance applicants are eligible for, health care services are available at a low cost or free of charge. Download our informative guide to learn more about Medicaid coverage and costs. For more information about how much Medicaid cost in Rhode Island, read the following topics:

How Much Does Medicaid Cost in Rhode Island?

How much is Medicaid in RI? Rhode Island Medicaid coverage requires enrollees with an income higher than 185 percent of the federal poverty line to pay a copayment for preventive or prenatal health services. However, Rhode Island Medicaid cost estimates vary from individual to individual based on their income eligibility and services required.

Meanwhile, copayments amounts range from zero to a few hundred dollars, the majority of the payments are below $40. Enrollees can pay the RI Medicaid coverage copayment as a monthly premium or at the time they receive services. Non-emergency use of emergency transportation services requires a copayment charge.

Learn About Types of Medicaid Insurance in Rhode Island

There are two types of Medicaid insurance in Rhode Island, the United HealthCare of New England and Neighborhood Health Plan of Rhode Island. Applicants eligible for Rhode Island Medicaid coverage can enroll in one of the participating Health Plans or Health Maintenance Organizations (HMOs) approved by the state. Medicaid cost estimates will be different for each type of Medicaid insurance. By downloading our in-depth guide, you will learn more about the coverage options for Medicaid.

The Health Plans ensure enrollees have a primary care provider and access to all the services covered under the benefit package. RI Medicaid coverage is available even if you have insurance from other third parties. In such a case, Medicaid benefits will still apply as long as the petitioner has not exhausted the limits and receive covered health care procedures or items. Keep reading to find out what services are covered by Medicaid and which are not.

What Services are Covered by Medicaid in Rhode Island?

RI Medicaid coverage takes care of the following services:

  • Substance abuse help. Medicaid services in behavioral health include methadone maintenance, hospitalization, day programs and family/individual counseling.
  • Pregnant women and children. For expectant mothers, Rhode Island Medicaid covers services that keep them and their babies healthy during and after pregnancy. Medicaid assigns enrollees personal care managers that help them find a doctor, provide support after birth and educate them about caring for the baby.
  • Wellness programs. RI Medicaid covers various wellness programs including well-care, nutritional classes, pregnancy care and parenting classes as well as smoking cessation classes.
  • Disease and care management. RI Medicaid enrollees with chronic health conditions such as diabetes or asthma qualify for programs that help them manage the conditions. The programs are voluntary and provide members with information about their health condition, treatments, medication and important follow-ups with their care providers.
  • Dental care. Dental services covered by Medicaid include crowns, fillings, X-rays, fluoride treatments, cleanings and exams. The services come with various limitations. Talk with your Health Plan to know the extent of services you qualify for.
  • Mental health programs. Rhode Island Medicaid enrollees with persistent mental illnesses are eligible for individual/group/family therapy, crisis intervention, mobile treatment team, multidisciplinary psychiatric treatment planning, community psychiatric supportive treatment, day treatment, emergency room visits for psychiatric emergencies and acute psychiatric inpatient hospitalization.
  • Prescription drugs. Various prescription drugs from hundreds of pharmacies are covered by Medicaid. You can confirm whether specific drugs are assessable by checking the Preferred Drugs List at RI Medicaid website. Generally, only generic prescription drugs are available.
  • Over-the-Counter (OTC) medicines. RI Medicaid coverage also includes OTC drugs prescribed by physicians. Supply of the drugs is limited to 30 days. The medicines covered include contraceptives, cold medicine, first-aid cream, cough medicine and pain relievers.
  • Injectable medicines. These are medicines that are given as a shot. Your primary care provider (PCP) can have the injectable medication delivered to your home or the physician’s office. Sometimes, the physician can write prescription for an injectable medication (e.g. insulin) that you can get at a pharmacy.

What services are covered by Medicaid in RI but require a copayment? These services include laboratory services, gynecological services, referrals to free clinics for other medical services, prescription and non-prescription family planning methods, outpatient hospital services, surgery and related service.

Medicaid coverage programs also cater for other medical services and items, but with some limitations. Some of the services covered with restrictions include tooth sealants (once every five years), space maintainers (once in a lifetime) and non-emergency medical transportation.

What Does Medicaid Not Cover in Rhode Island?

You can know what is covered by Medicaid by considering whether the service is available in a hospital, clinic or physician’s office. If the answer is yes, Rhode Island Medicaid will cover the hospital, clinic or physician’s services.

What does RI Medicaid not cover? If a service is outside of a hospital, clinic or physician’s office, it is likely not covered. Confirm with you Medicaid services health provider to confirm the coverage for the services you need. RI Medicaid coverage excludes the following services:

  • AA or self-help groups
  • Abortion, except when the life of the mother is in danger
  • Emergency room trips to get a drug prescription and discharge
  • Elective cosmetic surgery and experimental drugs or procedures
  • Exercise gyms (even when ordered by a physician)
  • Examination to determine eligibility for Social Security
  • Transport to fair hearing
  • Transporting Home Health Care (HHC) workers to a member’s home
  • Court hearing fees in a drug or family court
  • Hospital inpatient transportation and discharge