MENUMENU
Rhode Island Medicaid is a state-run program to provide healthcare to low-income individuals and households. It covers a wide range of medical procedures and medications at low or no cost to members.
Residents who meet The Ocean State’s eligibility requirements to join Medicaid can benefit from the program. RIte Care and HealthSource RI work with the state to provide these comprehensive benefits programs. As of 2023, 369,652 Rhode Islanders are covered by Medicaid.
This guide covers the major aspects of Rhode Island’s state-run Medicaid program and marketplace (HealthSource RI), including the application process, eligibility, and cover.
Rhode Island’s Medicaid might not have everything you need to stay healthy, though. Use the guide below to make a more informed decision about your healthcare needs. Then, if you suspect that the Rhode Island Medicaid plan will fall short, consider third-party insurance to extend your coverage. Many Rhode Islanders extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
Medicaid is a state-run health insurance program that offers cheap or free coverage to low-income Rhode Island residents and their families. The goal of Rhode Island’s Medicaid is to provide great coverage to all people, especially those who lack an employer-sponsored healthcare plan and cannot afford private marketplace insurance.
It’s free to enroll in Rhode Island’s Medicaid program. The copayments range from negligible to a few hundred dollars. However, most services in Rhode Island will require Medicaid members to pay nothing at all.
Rhode Island’s Medicaid is jointly funded by the state and federal government at a match rate of 40% to 60% state-to-federal government. In 2019, Rhode Island spent over $1 billion state dollars and $1.6 billion federal dollars on state Medicaid programs, a sizable portion for the population size.
When you apply for Rhode Island’s Medicaid plan, you get two cards. The first is a specific member ID card for your chosen health plan with your name and plan details, including copayments, office visits, and pharmacy costs. The second card you receive is a separate state “anchor” Medicaid ID card with a unique card ID number.
Local Medicaid recipients must show both of these Rhode Island Medicaid cards when they receive healthcare services. Once approved for Medicaid, you should receive your ID cards within 10 days. Each eligible member of your family will receive a separate Medicaid card.
What is HealthSource RI coverage, and do you need to know how to apply for HealthSource RI’s healthcare options? A better question would be what this particular service does for those looking at Medicaid in Rhode Island.
As a state-designated marketplace, HealthSource RI connects you with coverage through HealthSource RI channels. The state will automatically determine your eligibility for Medicaid when you apply through this site. Alternatively, they’ll let you know whether using a Managed Care Program or a trusted partner of HealthSource RI might be more helpful to you.However, if you want more information on how to apply to Rhode Island’s Medicaid program, you can just as easily visit the Department of Human Services’s website. Call their offices and speak with a staff member to answer any specific questions you have about the application process. You can also apply for Medicaid online or mail them a completed physical application if you can’t apply in person at your regional DHS office.
All marketplace plans and Medicaid plans offer the same set of essential health benefits but other features might vary. Once you apply for Medicaid, they will notify you of your approval and let you choose a suitable health plan. Each plan has its own network of doctors and hospitals, so choose carefully from the available healthcare plans for Rhode Island Medicaid, such as:
If you don’t choose one, the DHS will choose it on your behalf. However, it’s worth taking some time to do your homework when picking a plan.
In 2010, Rhode Island expanded Medicaid to all adults between 19 and 64 who fall below the income eligibility requirements. The eligibility requirements for Medicaid recipients include income limits according to household size, with each additional household member adding to a base figure. If you aren’t certain whether or not you qualify for RI Medicaid, referring to a handy tool such as this simple online test can help you determine eligibility.
Income that counts towards resource limits includes wages, alimony payments, social security payments, pension payments, IRA withdrawals, stock dividends, and veterans benefits. Additionally, to be eligible for Medicaid Long-Term Services and Supports, you must:
To be exempt from resource limits, the Medicaid recipient must live in the house in question and cannot own more than Medicaid’s equity limit for that year. Exemptions to resource limits may include personal belongings, such as:
Note that while your primary residence is generally exempt from Medicaid limits, it is not immune to Medicaid Estate Recovery efforts. When a long-term Medicaid patient dies, the state can reimburse care costs from the deceased’s estate, including their home.
Plus, if at any time you receive a notice informing you of your Medicaid ineligibility, you must enroll in HealthSource RI within 60 days during the Special Enrollment Period. If you are not eligible for coverage through Medicaid or the marketplace, there are other options, such as The Rhode Island Free Clinic.
Once you select HealthSource RI’s programs and enroll with a specific Medicaid provider, you will wait around two weeks to receive a card in the mail. If you have not received your card after fourteen days, call your specific plan provider at their customer service number to check the details.
Is your Medicaid card lost or stolen? Call your provider to report it because using another person’s Medicaid card to receive Medicaid benefits constitutes a crime. The state needs to quickly determine whether someone is using your Medicaid card for fraud.
Once you call and confirm your card has been stolen, you will receive another Medicaid card in the mail with a new ID number. However, you must also renew your Rhode Island Medicaid eligibility each year to determine if you still qualify for coverage. Thankfully, it’s easy to update your financial information at your HealthyRhode account, via phone, or in person at a DHS office.
Once you submit a renewal request, you can monitor your application status. Renewal timelines depend on when you renew, so check back frequently to see if the state has made a decision yet. You will also receive a yellow or green notice in the mail notifying you of your renewal status.
If you’re wondering what HealthSource RI covers or whether it’s necessary to go this route at all, you’re not alone. Check below for what Rhode Island’s Medicaid plan would and would not pay for so that you can make a decision about whether this coverage would be enough to cover your medical needs. Since the information changes from year to year, it’s also a good idea to check back for updates periodically.
Rhode Island’s Medicaid provides dental services for children and adults over the age of 21. The state’s Medicaid recipients get coverage through Medicaid Dental Services or, if they live in a nursing home, through the Nursing Home Mobile Dental Program. If you are eligible for Medicare and Medicaid, you can get dental benefits through Medicaid Advantage with a Dual Eligible Special Needs Plan.
Covered adults can receive up to two exams and oral cleanings per calendar year and all medically necessary diagnostic procedures. Children receive a dental exam and cleanings every six months.
Rhode Island’s Medicaid will pay for emergency dental services for both children and adults.
For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Rhode Island is advisable.
Rhode Island Medicaid includes coverage for medically necessary prescription drugs that are on the Preferred Drug List. However, keep in mind that this list is not exhaustive, and Medicaid may still cover some drugs not on the PDL.
Generally, Medicaid will cover the cost of generic drugs without prior authorization and will require prior authorization for brand-name drugs. Copayments for prescription drugs are small, with the coverage including injectable medications, such as insulin. General prescription limits are one prescription per month per drug per person.
Still, Medicaid in Rhode Island does not cover drugs of the following types:
Rhode Island’s Medicaid requires generic drugs to be used first. Non-generics may feature when the patient demonstrates they have an adverse reaction to generics or a contraindication due to other medications they are currently taking.
After perusing the HealthSource RI selection, it’s clear that Rhode Island Medicaid provides a wide range of extended healthcare services. Examples include services for substance abuse, mental health counseling, and rehabilitative care.
You can check with your local DHS to see if you qualify for any extended healthcare programs under Medicaid. For example, Rhode Island’s program may also cover medication for smoking cessation for eligible individuals, and smoking cessation products do not require prior authorization.
Routine checkups and basic medical treatments will only get you so far. Many patients require additional care, but they go without because of financial concerns, lack of coverage, and restricted access. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.
Rhode Island Medicaid can cover out-of-state coverage as long as the out-of-state provider holds a state license equivalent to the Rhode Island Department of Health’s licensing. They could also be qualified to participate in Medicare or receive prior authorization.
The program will usually cover emergency medical treatment if the patient cannot travel back to Rhode Island due to time pressures or their medical condition. If you are traveling outside of Rhode Island for leisure, invest in proper travelers insurance.
Rhode Island offers Medicaid benefits specifically for seniors through the Rhode Island Executive Office of Health and Human Services. Older adults who do not have Medicare can be eligible for Medicaid through Rhody Health. However, seniors eligible for both Medicare and Medicaid can enroll through the Neighborhood Integrity Plan or the Program for All-Inclusive Care for the Elderly.
Rhode Island does not have any special coverage options for students. All students in Rhode Island can apply for Medicaid if they meet the state’s household income limits and other requirements.
Rhode Island Medicaid offers additional support for subgroups such as military service members or veterans and Native Americans.
Military veterans who are eligible for Medicaid can receive additional benefits for medical transportation and substance abuse counseling and treatment in Rhode Island.
American Indians and Native Alaskans are eligible for additional Medicaid benefits through tribal clinics and other qualified healthcare providers in Rhode Island. Federal Medicaid and CHIP protections exempt Native Americans from Medical premiums or enrollment fees and out-of-pocket costs like copayments and deductibles. Also, certain Native American resources are exempt from Medicaid eligibility income limits.
Rhode Island Medicaid will not cover the following types of procedures and treatments:
If you are not sure about what Medicaid in Rhode Island does or does not cover, you can always contact your local DHS office for inquiries.
Specific medical procedures covered under Rhode Island’s Medicaid can shed some light on what this program could offer you if you’re thinking of joining it. Let's go over some common medical procedures in more detail to see if Rhode Island’s Medicaid does or does not cover them.
| Dental | |
|---|---|
| Rhode Island’s program covers most types of routine and emergency dental procedures for children and adults. Children have higher service limits than adults. | |
| X-rays and exams | Rhode Island Medicaid covers x-rays and cleanings for adults and children. It may also cover all medically necessary extractions and restoration procedures, such as crowns, implants, and veneers. |
| Wisdom teeth | Is wisdom teeth extraction necessary for your overall oral health? Medicaid or a managed care program from HealthSource RI should cover it, as well as other medically necessary teeth extractions. |
| Orthodontic services | Medicaid in Rhode Island will cover specific orthodontic services if they are medically necessary for proper functioning. For example, Medicaid would cover corrective orthodontic work for a malocclusion that prevents proper eating or causes discomfort while speaking. |
| Vision | Rhode Island offers basic vision coverage for in-state providers. |
|---|---|
| Eye exams | Adults over the age of 20 can receive one eye exam every two calendar years. Medicaid will not cover penalties for any canceled or missed appointments. |
| Glasses | Rhode Island’s Medicaid covers one pair of eyeglasses and contact lenses every two years. It will not pay for spare or stolen lenses or contacts but will cover UV tints if this is medically necessary. Children under the age of 21 do not have any limitations if they are under the Early and Periodic Screening, Diagnosis, and Treatment program. |
| Laser Eye Surgery | Rhode Island’s Medicaid does not generally cover LASIK. |
| Surgery | Medicaid will generally cover any surgical procedures that are medically necessary, as well as pre- and post-surgery care and treatment. However, Medicaid does not cover cosmetic procedures. |
|---|---|
| Rhinoplasty | Medicaid will cover rhinoplasty and nasal surgery if it is medically necessary to correct breathing. Specifically covered issues include septal deviations, nasal deformities, sinusitis, and nasal reconstruction after an injury. |
| Breast Reduction | Medicaid will cover breast reduction for medical reasons, such as relieving spinal, shoulder, and neck pain. Rhode Island’s Medicaid also covers breast reduction and reconstruction after mastectomy due to cancer. |
| Hospital | All direct hospital inpatient and outpatient costs receive coverage in Rhode Island, including hospital stays, medical equipment, and hospitality care. However, Medicaid will not cover additional hospital amenities, such as additional food and entertainment equipment rentals. |
|---|---|
| Hospital stays | Hospital stays do not require a copayment, and Medicaid will cover bed and board, hospital drugs, appliance use, diagnostic tests, and other medical services necessary for care. A hospital stay must be at least 24 hours to count as inpatient, but Medicaid covers outpatient procedures, testing, and lab services, too. |
| Ambulance transportation | Medicaid covers emergency ground transportation but does not cover wheelchair or air transportation in Rhode Island. |
| Giving birth | Rhode Island Medicaid covers giving birth and postnatal care. Rhode Island expanded Medicaid in 2021 to provide healthcare for all patients for 12 months after they give birth. Coverage extends for 12 months from the end of the postpartum period. |
| Sexual Health | |
|---|---|
| Gynecologist | Is gynecologist care generally covered under Rhode Island Medicaid or a managed care program via HealthSource RI? Yes. Your benefits should include visitations, exams, pap smears, and other OBGYN care from in-network providers. |
| Erectile Dysfunction | Rhode Island’s Medicaid does not cover medication prescribed for erectile dysfunction. However, it may cover certain drugs that can treat erectile dysfunction if they are prescribed to treat another condition. |
| Birth Control | Rhode Island RIte Care provides additional coverage for women, including oral patch contraceptives, IUDs, and cervical caps. It also covers condoms, spermicidal jellies, and sponges. |
| Fertility Treatment | Rhode Island’s Medicaid covers fertility treatment if infertility is the result of some other medical condition. It will not cover fertility treatment just to increase the chances of conceiving. |
| Specialist Services | |
|---|---|
| Dermatology | Medicaid will cover medically necessary dermatological appointments and treatments, including examinations and prescribed medications. It will not cover purely cosmetic dermatological treatments. |
| Physiotherapy | Medicaid in Rhode Island will cover all necessary physiotherapy, including physical and occupational therapy. It also includes coverage for medical equipment for physical therapy and rehabilitation, such as braces, crutches, and mobility assistance devices. |
| Massage Therapy | It depends on your specific Medicaid plan, but some Medicaid providers offer additional coverage for massage therapy in Rhode Island. Even acupuncture may receive coverage, depending on the provider and the reason for the appointment. |
| Podiatry and Foot Care | Medicaid does cover podiatrists and routine footcare, such as ingrown toenail treatment and nail debridement. It also covers office visits and emergency podiatric services, flat foot correction for children under 21, and orthopedic shoes. |
| Allergist and Allergy Testing | Medicaid in Rhode Island covers allergy testing for diagnosis and medically necessary purposes. |
| Sleep Physician Services and CPAP Machines | Medicaid will cover specific types of durable medical equipment, including activity chairs, breast pumps, sleep apnea machines, car seats, compression garments, and emergency response systems. |
Rhode Island Medicaid is fairly comprehensive, but it may not cover every inch of your medical care and related costs. In that case, a private health insurance plan can extend your coverage beyond what Rhode Island’s Medicaid offers. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.
Below are some reasons to consider expanding Medicaid coverage with a private option:
Would you like to supplement your coverage under Rhode Island Medicaid or a Managed Care Program that HealthSource RI has paired you with? Insurdinary makes it easy to find private insurance using a quick lookup tool to compare the top health insurance quotes from the best providers.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
