Rhode Island Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

Rhode Island provides long-term care resources to seniors through the Department of Elderly Affairs. Some of the programs the Department offers Adult Day Services, as well as additional information on how to obtain Medicaid or use Medicare resources for long-term care management.

Rhode Island operates its entire Medicaid program under a single Section 1115 Demonstration. This waiver allows states to streamline home and community-based services under a single program. TheExecutive Office of Health and Human Services oversees the Long-Term Services and Supports Programs available to seniors through multiple programs, including: Adult Day Services, Assisted Living, Rite at Home, PACE, and Personal Choice (Self-Directed Care).

Medicaid Waiver Program for Assisted Living and In Home Care

Medicaid Long-Term Services and Supports (LTSS) Community Based Service Options (Section 1115 Demonstration Medicaid Waiver)

Rite at Home (RIte @ Home) Program

Introduction

RIte @ Home is a shared living optionavailable for adults who cannot live alone and require a considerable amount of help with the activities of daily living, such as eating, dressing, personal hygiene, etc. RIte @ Home provides an alternative to institutional care for those who meet clinical, financial and other program criteria. RIte @ Home is a consumer-directed service designed to maximize the control and choice a person has over the services that are provided. RIte @ Home is provided through the Medicaid Program at the Executive Office of Health and Human Services (EOHHS).

Services

Services include a caregiver that will typically live at home with the program participant and provide: Personal care, including assistance with Activities of Daily Living (ADLs); Homemaker services; Chore services; Meals; Transportation; Being on call 24/7; and Providing socialization and a home-like environment.

Eligibility

  1. Health: Rhode Island has two levels of care that determine eligibility for Medicaid benefits for Long-Term Services and Supports. For the Assisted Living program an applicant can meet either the “High Level of Care” or the “Highest Level of Care Criteria”
  2. Financial: Rhode Island offers multiple pathways for seniors looking for long-term care Medicaid benefits, either qualifying through Medicaid through the SSI standard, or using the special income limit or medically-needy pathways for home and community based care. For the special income limit pathway, an individual will qualify if their income is below $2,205 (300% of the Federal Benefit Rate) for 2017. In addition, the individual must have no more than $4,000 in assets (or $6,000 if married). If an individual does not qualify under the strict income cap under the first method, then the “medically-need” pathway is available either for individuals earning above 300% of the FBR, or $2,205 and up to the cost of care, or using the spend down method. If using the spend down category to qualify for benefits, the income level is $883 or an individual ($927 for a couple), and the resource standards remain the same at $4,000 for an individual ($6,000 for a couple). This spend down option means that you can qualify for the benefit if you are spending the majority of your monthly income on medical expenses and remedial care such that you qualify under the limit.

Practical Considerations

Two agencies have been approved to provide RIte @ Home servicesto eligible elders and adults with disabilities: 1) Caregiver Homes of Rhode Island (Contact: Nelia Botelho, MSW; Branch Manager at (401) 332-8151 or nbotelho@caregiverhomes.com) and 2) Seven Hills RI (Contact: Lisa Provencal, Program Coordinator, (401) 229-9760 or (401) 309-4093 lprovencal@sevenhills.org)

Additionally, program participants must meet the following Appropriateness Criteria: 1) A person is not a danger to themselves or others in the shared home; 2) A person must be able to take action for self-preservation (such as exiting the home in case of fire) with the assistance of no more than one person; 3) Both the caregiver and the recipient must be informed of and willing to assume a certain amount of risk regarding safety inherent in this type of living arrangement; and 4) A person must be free from communicable disease or infectious conditions in order to participate in RIte @ Home.

Assisted Living Program

Introduction

Assisted living is an option if you want company, are in failing health, or need 24-hour support. Some residences take care of people with special dementia

Needs. The Assisted Living Residence must be participating in the Medicaid program. Rooms are doubles. There are a limited number singles in a select group of Assisted Living Residence

Services

The following services are provided through the program: meals, recreational activities, personal care, help with medications, homemaker services, limited skilled nursing, and 24-hour support and supervision

Eligibility:

  1. Health: Rhode Island has two levels of care that determine eligibility for Medicaid benefits for Long-Term Services and Supports. For the Assisted Living program an applicant can meet either the “High Level of Care” or the “Highest Level of Care Criteria”
  2. Financial: Rhode Island offers multiple pathways for seniors looking for long-term care Medicaid benefits, either qualifying through Medicaid through the SSI standard, or using the special income limit or medically-needy pathways for home and community based care. For the special income limit pathway, an individual will qualify if their income is below $2,205 (300% of the Federal Benefit Rate) for 2017. In addition, the individual must have no more than $4,000 in assets (or $6,000 if married). If an individual does not qualify under the strict income cap under the first method, then the “medically-need” pathway is available either for individuals earning above 300% of the FBR, or $2,205 and up to the cost of care, or using the spend down method. If using the spend down category to qualify for benefits, the income level is $883 or an individual ($927 for a couple), and the resource standards remain the same at $4,000 for an individual ($6,000 for a couple). This spend down option means that you can qualify for the benefit if you are spending the majority of your monthly income on medical expenses and remedial care such that you qualify under the limit.

Practical Considerations

For more information you can contact THE POINT at (401) 462-4444 or RI Assisted Living Association at (401) 435-8888, or online here.

Conclusion

Individuals must meet both the financial and functional/clinical “level of care”need to qualify for Medicaid Long Term Care. In addition, a person's resources (cash, savings, etc.) must be less than $4,000. Please note: if a person's monthly income is over a certain amount, he/she may have pay towards the cost of his/her LTSS services. You need to complete the Application for Assistance (DHS-2) and mail or bring them to the Providence DHS office along with the required documents. If you are determined eligible, Medicaid Long Term Services and Supports includes home and community-based services or nursing home care. The type of services you receive depends on your level of care needs. Rhode Island offers multiple financial eligibility pathways and consulting with a medicaid planner may help save you money and become eligible for the benefit faster.