Rhode Island
What Is Rhode Island’s Medicaid Program for Long-Term Care?
Rhode Island’s Medicaid program, known as Medical Assistance (MA), helps low-income residents of all ages access health services. For those aged 65 and older, Medicaid can cover not only nursing home care, but also personal support services at home, in assisted living, or in shared living arrangements. Medicaid for seniors in Rhode Island falls into three main categories:
What Is Institutional or Nursing Home Medicaid?
This is a guaranteed benefit for eligible individuals, offering care strictly in nursing home settings.
What Are Medicaid Waivers or Home and Community Based Services (HCBS)?
These programs are not guaranteed; they have enrollment limits and possible waitlists. Services are offered in homes, adult day care, assisted living, or shared living settings to delay institutional care.
What Is Regular Medicaid for Elders and Adults with Disabilities (EAD)?
Also an entitlement, this program provides services such as personal care and adult day programs for those meeting eligibility criteria.
What Are the Income and Asset Requirements for Medicaid in Rhode Island?
Eligibility for Medicaid’s long-term care programs varies depending on the specific program and changes annually. It’s also influenced by one’s marital status. Below is an overview of the simplified eligibility rules for 2025:
What Are the Financial Limits for a Single Applicant in 2025?
To qualify for Nursing Home Medicaid, a single applicant must have:
- Monthly income under $2,901
- Assets not exceeding $4,000
- A need for a nursing home level of care
How Do the Financial Criteria Vary by Marital Status and Program Type?
See the chart below for 2025 eligibility limits for single applicants, couples applying together, and one spouse applying:
Type of Medicaid | Single | Married (both spouses applying) | Married (one spouse applying) |
---|---|---|---|
Institutional / Nursing Home Medicaid | Income: $2,901/mo Assets: $4,000 Level of Care: Nursing Home | Income: $5,802/mo ($2,901 per spouse) Assets: $8,000 ($4,000 per spouse) Level of Care: Nursing Home | Income: $2,901/mo (applicant) Assets: $4,000 (applicant) & $157,920 (non-applicant) Level of Care: Nursing Home |
Medicaid Waivers / HCBS | Income: $2,901/mo Assets: $4,000 Level of Care: Nursing Home | Income: $5,802/mo ($2,901 per spouse) Assets: $8,000 ($4,000 per spouse) Level of Care: Nursing Home | Income: $2,901/mo (applicant) Assets: $4,000 (applicant) & $157,920 (non-applicant) Level of Care: Nursing Home |
Regular Medicaid / EAD | Income: $1,304/mo Assets: $4,000 Level of Care: Help with ADLs | Income: $1,763/mo Assets: $6,000 Level of Care: Help with ADLs | Income: $1,763/mo Assets: $6,000 Level of Care: Help with ADLs |
What Happens to Income That Exceeds the Limits?
For nursing home Medicaid, most of the recipient’s income must go toward the cost of care, minus allowances for personal needs, Medicare premiums, and possibly spousal support.
How Is Income Treated in Rhode Island Medicaid?
What Types of Income Count Towards Medicaid Eligibility?
Most income sources count, including wages, pensions, Social Security, IRA withdrawals, and dividends. Exclusions include Holocaust restitution payments and VA Aid & Attendance benefits.
How Is Income Evaluated for Married Couples?
When only one spouse applies for Medicaid, only the applicant’s income is considered. The non-applicant spouse may receive a Spousal Income Allowance if their own income falls below a certain threshold.
What Is the Monthly Maintenance Needs Allowance in 2025?
In Rhode Island, the non-applicant spouse can retain up to $2,643.75 per month, and potentially up to $3,948 depending on housing and utility costs.
How Is Income Counted for Regular Medicaid Applicants?
When applying for Regular Medicaid, income from both spouses is considered. There is no spousal income allowance under this program.
How Does Medicaid View Assets in Rhode Island?
What Assets Are Counted and Which Are Exempt?
Countable assets include cash, bank accounts, investments, and non-resident real estate. Exempt assets include personal belongings, one vehicle, a primary residence (under certain conditions), and retirement accounts in payout status.
What Happens to Assets When One Spouse Applies?
All marital assets are considered. The non-applicant spouse may retain up to $157,920 (or $31,584 if total assets are below that threshold), under the Community Spouse Resource Allowance.
What Is the Medicaid Look-Back Rule?
Rhode Island enforces a five-year (60-month) look-back period for Nursing Home Medicaid and Waivers. Transfers of assets for less than fair market value during this period may result in a period of ineligibility.
Does the Federal Gift Tax Rule Affect Medicaid Eligibility?
No. Gifting under the $19,000 federal limit may still violate Medicaid’s look-back rule if done within the five-year review window.
How Is a Home Treated Under Rhode Island Medicaid?
Is the Home Always Exempt?
A home may be exempt if the applicant or their spouse lives in it. If not, the applicant must show intent to return. A home equity limit of $730,000 applies (2025). This limit doesn’t apply to Regular Medicaid.
What Is Medicaid Estate Recovery?
After the death of a Medicaid recipient, the state may attempt to recover care costs from the deceased’s estate, including their home.
What Level of Medical Need Must Applicants Demonstrate?
Applicants must require assistance with daily tasks or meet a nursing facility level of care (NFLOC), depending on the program. Additional criteria may apply for specific benefits such as respite care.
Can Seniors Qualify for Medicaid If They Exceed Income or Asset Limits?
What Is the Medically Needy or “Spend Down” Option?
Those with high medical expenses may qualify by spending excess income on medical bills. For 2025, income limits are $1,167/month (individual) and $1,208/month (couple), with six-month evaluation periods.
What Is Asset Spend Down?
Seniors may reduce countable assets by spending on exempt items such as home modifications, funeral plans, or debts. These transactions must not violate the look-back rule.
What Is Medicaid Planning?
For those over income or asset limits, Medicaid planning can help preserve assets and meet eligibility criteria. Professionals can also help protect homes from estate recovery.
What Programs Are Available for Seniors Through Rhode Island Medicaid?
Long Term Services and Supports (LTSS)
This program includes services such as personal care, home modifications, meal delivery, adult day care, and allows participants to hire family caregivers, including adult children.
RIte @ Home Program
This shared living program places seniors with caregivers—possibly relatives or friends—who provide daily support. It includes homemaking, transportation, and respite care services.
Medicaid Preventive Services
Designed for those with mild needs, these services help delay the need for full LTSS or institutional care.
Program of All-Inclusive Care for the Elderly (PACE)
PACE combines Medicaid and Medicare benefits, offering comprehensive care, including dental and vision, under one plan.
Money Follows the Person
Known locally as “The Rhode to Home,” this program helps institutionalized individuals transition back into the community with support.
How Can Someone Apply for Medicaid Long-Term Care in Rhode Island?
Applications can be submitted online through HealthyRhode RI, by phone at 855-697-4347, in person at DHS offices, or by mailing in a paper application. Seniors should call The POINT at 401-462-4444 for help. Ensuring eligibility prior to applying is essential, and Medicaid planning may assist those over the financial limits.