RI's Home and Community Care Medicaid Waiver

Page Reviewed / Updated - Mar. 2014

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services.

Waiver Description

Elderly Rhode Island residents can receive a variety of care services and support through the Home and Community Care Program.  This program is intended as an alternative to nursing homes and therefore services are provided to individuals living at home or "in the community".  By the rules of the program, "in the community" includes assisted living residences.  Having said that, most of the benefits of the program are selected to support individuals at home.  For example, assisted living residents would not be able to receive financial assistance for home modifications.

 This program is under the jurisdiction of the Rhode Island Division of Elderly Affairs.  This division also offers another option for Medicaid eligible seniors called the RIte @ Home Program.

 

Eligibility Guidelines

The Home and Community Care Program has multiple layers of eligibility requirements. 

Age - Applicants must be 65 or older.

Residency - Applicants are required to be legal residents of the state of Rhode Island.  However, there is no duration of residency requirement.

Functional Ability - This program is intended as an alternative to nursing home placement.  Therefore, participants must be at risk of nursing home placement.  Practically this means they require assistance to perform the activities of daily living such as bathing, grooming, eating and mobility.  Typically, the inability to leave their home without considerable assistance is indicative of an individual who would qualify from a functional perspective.

Financial Status - RI Medicaid (and therefore the Home and Community Care Program) considers both the applicant's income and countable resources.  In 2014, the monthly income limit for one applicant is set at approximately $1,000.  The countable resources limits, which do not include a home, burial plot and some other personal effects, is set at $4,000.  

Married applicants have a different set of rules, this is especially true if only one spouse is applying for Medicaid.  Couples in this situation and single individuals over these limits should strongly consider consulting with a Medicaid planning expert prior to contacting state Medicaid officials. Read more.

 

Benefits and Services

Follows is a list of possible benefits covered by this program.  Not every participant will be eligible to receive all of these.

  • Home Health Care by Certified Nursing Assistants
  • Adult Day (Health) Care
  • Meal Delivery
  • Companion Care
  • Personal Care
  • Personal Emergency Alert Systems
  • Home Modifications (limited to $20,000 over 5 years)
  • Assistive Technology (limited to $500 per year)
  • Assisted Living

 

How to Apply / Learn More

To apply for this program, state residents should contact their Area Agency on Aging regional office.  The program is available statewide.  However as with many Medicaid Waivers, there may be a waiting list for services.   Limited information is available on the Department of Elder Affairs webpage.