Rhode Island Medicaid Personal Choice Program

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

 Under Personal Choice, family members can receive payment for providing caregiving services to their loved ones.

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 receives payments and must pay taxes on the wages they receive.

 

Eligibility Guidelines

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 2014, 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 2014, state residents with income below 100% of the Federal Poverty Level ($11,670 / 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.   Learn more.

 

Benefits and Services

Each participant in the Personal Choice program is assessed and found eligible for a different array of services. These might include:

  • Environmental Modifications
  • Fiscal Advisement
  • Home Delivered Meals
  • Personal Care Assistants
  • Personal Emergency Response System
  • Service Advisement
  • Specialized Equipment

 

How to Apply / Learn More

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.