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Understanding Medicaid Coverage 2006
What Is Medicaid?
Medicaid is a federal program that provides medical assistance to certain individuals and families with low incomes and limited resources. The Rhode
Island Medical Assistance Program is also known as Medicaid, and its provisions can be found in Title 27-Insurance of Rhode Island General Law.
In Rhode Island there are two categories of eligibility for medical assistance. They are:
Categorically Needy: includes individuals who are eligible or receiving cash assistance from the Supplemental Social Security Income Program (SSI),
or the Family Independence Program (FIP).
Medically Needy: includes individuals who are under the income and resource limit or if they have large medical expenses.
To be eligible in Rhode Island you must:
Be a Rhode Island resident;
Have an income less than approximately $795 each month;
Have resources (savings) of less than $4,000 for an individual or $6,000 for a couple.
It is important to note that the house you live in and term life insurance policies (below a certain face value) are not counted as resources when
determining eligibility.
Characteristics of Medicaid Coverage
Retired or disabled individuals who have low incomes and are enrolled in Medicare may also qualify for medical assistance from Medicaid.
If your income is too high to qualify for Medicaid coverage and you are having trouble affording Medicare coverage, there are five programs offered
by Medicaid that will provide you medical assistance:
The Qualified Medicare Beneficiary Program (QMB) will pay your Medicare monthly premium and your Medicare deductibles and coinsurance if your
household income is less than $798 for an individual, $1,070 for a couple.
The Specified Low-Income Medicare Beneficiary Program (SLMB) will pay for your monthly Medicare premiums if an individual has an income under
$957. Married couples' combined income must be under $1,283 per month to qualify.
The Qualifying Individuals-1 Program (QI-1) will pay your Medicare Part B premium if an individual has an income under $1,077 per month. Married
couples' combined income must be under $1,444 per month to qualify.
The Qualified Disabled and Working Individuals Program (QDWI) may pay for your Medicare Part A premium if your income is below $1,695 a month
with resources under $4000 and you are currently working. For a couple, the income must be below $2245 a month with resources below $6000.
RIteCare and RIteShare
RIteCare is Rhode Island's Medicaid managed care program that provides families on the Family Independence Program (FIP) and eligible
uninsured pregnant women, parents, and children up to age 19 with comprehensive health insurance coverage. Families receive most of their health
care through three participating health plans: Neighborhood Health Plan of Rhode Island, United Healthcare of New England, and Blue Chip. (To find
out more about these health plans please refer to the Rhode Island Cancer Council's Certified Health Plans binder.)
RIteShare is a premium assistance program that helps families get health insurance coverage through their employer or spouse's employer.
If a family qualifies, RIte Share will pay for all or part of the employee's share of the health plan insurance premium.
The qualifying agents necessary for participation in the RIteCare and RIteShare programs are:
Families with children and/or;
Children up to age 19 and/or;
Pregnant women
The costs of RIte Care and RIte Share are:
Families with incomes up to 150% of the federal poverty level receive either program at no cost.
Families with incomes between 150% and 250% of the federal poverty level pay a monthly premium of $61, $77 or $92, depending on the family's
income.
For information or an application, contact the RIteCare/RIteShare hotline:
(401) 462-5300
Medicaid Covered Benefits
The following is a list of covered benefits for both categorically and medically needy individuals. However the benefits that are followed by an
asterisk sign (*) are not covered benefits for the medically needy group.
Inpatient services
Outpatient hospital services including clinical and emergency room care (*), laboratory and x-rays, and pharmacy services.
Physician services
Pharmacy services
Dental services
Clinical laboratory services
Durable medical equipment, surgical appliances, and prosthetic devices
Certified home health agency services
Podiatry services
Ambulance services
Nursing facility services
Hospice care services
Community Mental Health Center services
Substance abuse services
Nursing facility services
Optometric services
Intermediate care facility and day treatment services
Treatment services for the mentally retarded
Organ transplant services
To find out if you or other members of your family qualify for Medicaid, you can contact the:
Rhode Island Department of Human Services
Call (401) 462-5300, to obtain the locations and telephone numbers of the office nearest to you.
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