Rhode Island Medicaid Personal Choice Program
What are Medicaid Waivers?
Medicaid pays for long term care services in nursing homes. For nursing home qualified persons that choose to live at home or in a residential community, Medicaid will pay for those services if they can be obtained at a lower cost. These are called Home and Community Based Services, Waiver Funded Services, Medicaid Waivers or simply Waivers.
The Personal Choice Program provides for consumer directed care; also known as the cash and counseling model. Instead of care, nursing home qualified participants receive cash and are able to retain their own personal care providers. Individuals must have a need for nursing home level care but choose to live at home or in the community.
Given the flexibility to choose their own personal care providers and the very personal nature of personal care, many program participants prefer to receive care from persons with whom they are comfortable and familiar. The Personal Choice Program excels in this capacity as certain family members are eligible to be hired as paid caregivers. In this situation, the care recipient is considered an employer and must manage their caregiver or employee. The caregiver receive payments and must pay taxes on the wages they receive.
The Personal Choice program takes into consideration both the financial status and the functional ability of applicants when determining eligibility.Functional Ability
- applicants, at a minimum, must require the level of care provided in nursing homes. An assessment by qualified medical professionals is the norm in determining this qualification.Financial Status
- applicants must be financially qualified for Rhode Island Medicaid, also referred to as the Medical Assistance Program. Both income and assets are taken into consideration. In 2013, unmarried or widowed applicants are limited to $4,000 in countable assets. Countable assets do not include the home or vehicle.
There are two levels of income qualification, applicants can be Medically Needy or Categorically Needy. Categorically Needy applicants have income sufficiently low that they are eligible regardless of their medical expenses. In 2013, state residents with income below 100% of the Federal Poverty Level ($11,490 / yr) are Categorically Needy. Medically Needy individuals may have income in excess of this amount but their medical expenses are factored into the calculation. If they cannot afford their recurring care costs with their income, they become eligible as Medically Needy recipients. This is referred to in RI as the Flex Test.
It is possible to qualify for Medicaid a third way. This involves re-structuring one's finances to meet the eligibility requirements. Assets and income over the limits can be converted into non-countable forms or transferred to a non-applicant spouse. This is a complicated procedure and requires expertise to perform without error. However, for many families it is their only option to care for a loved one. Find assistance qualifying for Medicaid in Rhode Island
Services / Benefits
Each participant in the Personal Choice program is assessed and found eligible for a different array of services. These might include:
-Home Delivered Meals
-Personal Care Assistants
-Personal Emergency Response System
Availability / How to Apply
This program is available in all Rhode Island counties. A Fact Sheet can be downloaded here
. To apply, one can call 401-725-1966 or 401-349-5760 or visit their local Department of Human Services office.
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Page Reviewed / Updated - Feb. 2013