Rhode Island Medicaid Personal Choice Program

Page Reviewed / Updated - Feb. 2016

The benefits of the Personal Choice Waiver Program are still available to Rhode Island residents, however, the Waiver as a standalone program no longer exists. It has been consolidated into the new Global Consumer Choice Compact Waiver.  Please review that page instead.  This page is maintained for historical purposes.

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 and can 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 2016, unmarried or widowed applicants are limited to $4,000 in countable assets. Countable assets do not include the home, vehicle, and life insurance policies with a benefit of less than $4000.

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 2016, state residents with income below 100% of the Federal Poverty Level ($11,880 / 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.'

A Medicaid planner or a specialist with knowledge of the Rhode Island rules can be of great assistance when one's assets or income are over the limits to appropriately convert them to compliant forms. Applying in this way 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 (to one's or vehicle to improve safety and access)
  • 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. The complete rules and regulations are available for download, make note that these can be confusing. To apply, one can call 401-725-1966 or 401-349-5760 or visit their local Department of Human Services office.