Section 210-RICR-30-05-2.6 - Excluded Medicaid Coverage GroupsA. There are MACC group beneficiaries who receive coverage on a fee-for-service basis rather than through a RIte Care plan, as follows:1. Members of these coverage groups who are covered by employer-sponsored or other third (3rd) party health insurance, may receive Medicaid on a fee-for-service basis, rather than through enrollment in a RIte Care MCO: a. IV-E foster children and children receiving adoption subsidy (see §00-1.8(F)(3) of this Chapter).b. SSI recipients under age twenty-one (21) (§00-1.6 of this Chapter).c. Children with disability - Katie Beckett Eligible under Part 50-10-3 of this Title. Children under age nineteen (19) who: are living at home; require a hospital, nursing home or ICF-ID level of care; and would qualify for Medicaid if in a licensed health care institution.d. SSI recipients over age twenty-one (21).2. Medically needy populations. Flex-test cases are included in the RIte Care program but receive services in the fee-for-service system. With the exception of Katie Beckett children, long-term care coverage groups (Part 50-00-1 of this Title) do not receive services through a RIte Care MCO.3. Extended family planning group. Beneficiaries eligible through this pathway in this RIte Care waiver group are entitled to a limited scope of services rather than comprehensive benefits. The group consists of women who meet the following conditions: income must be above the Medically Needy income limit; if pregnant, income must not exceed two hundred fifty-three percent (253%) of FPL; the women must be twelve (12) months postpartum or twelve (12) months post-loss of pregnancy and, as a result, subject to discontinuation of Medicaid eligibility. Coverage is available for up to twenty-four (24) months.210 R.I. Code R. 210-RICR-30-05-2.6
Amended effective 10/5/2021
Amended effective 12/12/2023
Amended effective 3/17/2024