Section 210-RICR-30-05-2.5 - Coverage Groups in RIte CareA. The RIte Care population consists of members of: certain Medicaid affordable care coverage (MACC) groups; coverage groups whose eligibility is NOT based on the MAGI standard (non-MAGI) and several non-Medicaid coverage groups. 1. Medicaid Affordable Care Coverage (MACC) Groups - RIte Care plans provides coverage for individuals and families in the following MACC groups:a. Families with income up to one hundred sixteen percent (116 %) of the FPL and parents and caretaker relatives with income between one hundred sixteen percent (116%) and one hundred forty-one percent (141%) of the FPL who have dependent children up to age eighteen (18) or, if attending school full-time, up to age nineteen (19).b. Pregnant women with family income up to two hundred fifty-three percent (253%) of the FPL, including non-citizen pregnant women.c. Children up to age nineteen (19) with family income up to two hundred sixty-one percent (261%) of the FPL, including qualified non-citizen children.2. Non-MAGI MACC Beneficiaries - Rite Care MCOs also provide health services to: a. Children up to age eighteen (18) or nineteen (19) if completing school who are in foster care and/or receiving adoption subsidy under the applicable provisions of Title IV-E of the Social Security Act (see §00-1.8(F) of this Chapter).b. Children up to age twenty-one (21) who are Medicaid eligible as result of receiving Supplementary Security Income (SSI). Individuals in the SSI eligible group under age twenty-one (21) who are enrolled in RIte Care managed care may continue enrollment in a RIte Care MCO when they turn twenty-one (21) years of age until such time as SSI eligibility is discontinued.c. Young adults aging out of foster care between the ages of eighteen (18) and twenty-six (26) who were born prior to January 1, 2005. Young adults who were in participating in foster care, kinship, and guardianship programs authorized by the Rhode Island Department of Children, Youth and Families (DCYF) on the date they turned eighteen (18) are eligible, without regard to income, for continued Medicaid coverage until the age of twenty-six (26) under the Foster Care Independence Act of 1999, as amended by the Affordable Care Act of 2010. Members of this population are only eligible in Rhode Island if they were residing in the State at the time they aged out of DCYF foster care. EPSDT services continue only up to age twenty-one (21) for members of this non-MAGI coverage group.d. Young adults aging out of foster care between the ages of eighteen (18) and twenty-six (26) who were born on or after January 1, 2005. Young adults who were participating in foster care, kinship, and guardianship programs in any state on the date they aged out of the foster care system of their state or Tribe within a state, including children who were cared for under the unaccompanied refugee minor program, without regard to income, for continued Medicaid coverage until the age of twenty-six (26) under the SUPPORT for Patients and Communities Act, Pub. L. No. 115-271. Members of this population are only eligible in Rhode Island if they were enrolled in Medicaid and under the care of the foster care system of their state or Tribe within a state on the date that they aged out of such foster care system. Medicaid eligibility for youth qualifying for this coverage continues until the age of twenty-six (26) as long as the individual remains a resident of the State. EPSDT services continue only up to age twenty-one (21) for members of this non-MAGI coverage group.210 R.I. Code R. 210-RICR-30-05-2.5
Amended effective 10/5/2021
Amended effective 12/12/2023
Amended effective 3/17/2024